[Kiren]

My textbook says a pre-dialysis patient with a GFR between 15 and 60 should be restrict daily protein intake to 0.6-0.8 g/kg of body weight. However, it does not say what the protein intake of a patient on dialysis should be. I know it should increase and be high quality proteins with restricted dairy consumption, but how much should the protein intake be?

[neygray]

The amount of protein allowed in the dialysis diet is determined by checking the amount of protein (and protein waste byproducts) in the person’s blood, as well checking the urea clearances before and after dialysis. This is usually monitored on a monthly basis. Laboratory tests may include chem-20, creatinine, albumin, and pre and post dialysis blood urea nitrogen.


I know that doesn't give you an exact amount, but this is usually how it's determined on a pt to pt basis since no two are the same.

[RN1989]

Most RF pts don't get such specific dietary info. They are told to avoid high protein (limit meat intake) and if diabetic, avoid sugar. Getting a dialysis pt to comply with a diet restriction is a miraculous feat.

[neygray]

Originally Posted by RN1989

Getting a dialysis pt to comply with a diet restriction is a miraculous feat.

And that my friends is the most honest answer I've read in a while!

[HeatherB-SST]

While that is most probably true, I respectfully ask, have you ever tried to follow a renal (dialysis)/diabetic diet? My brother did for three years, and let me tell you, it is a logistical nightmare.

He managed to stay within guidelines, his dry weight was always good, and his labs were always WNL. However, it was almost impossible to order in a restaurant or eat at a friend's house. He ate with us about half the week, and we had to plan meals the day before to allow time to leach potatoes, review ingredients, etc. He basically had ONE thing he could order at any restaurant, and even that was special-ordered to the hilt. He made fast friends with restaurants that were willing to tweak the menu for him.

It was not impossible but it was definitely hard. He has since had a kidney/pancreas transplant and is doing well, but is having trouble getting over the food issues he developed during those three years. By issues I mean losing any joy or happpiness related to eating because it had been such a looming issue for so long. He now cannot relate food with celebrations or fun the way most of us do. It is only a tool to stay alive and healthy to him now.

[neygray]

CST wannabe, you are correct about the diet being hard to follow. What I meant in my comment though was not to be meanspirited, but true in many cases. My daughter is a diabetic and I feel like banging my head against the wall with her sometimes. She tries to follow her diet mostly, but you have to help yourself some. The medication and treatments can't completely do it alone. There are some that try to follow a diet as best they can, I know it's difficulty and nobody is perfect. You have to live a little sometimes. But there are many frequent fliers on a renal floor I work frequently that think that because they faithfully go to dialysis, that's all the effort they have to make. Thus, that is why they are frequent fliers. I commend your brother for realizing that the machines can't do it alone and giving it his best effort!

[traumaRUs]

I'm an advanced practice nurse in a nephrology practice. I work with an indigent, poor, homeless, psych population. My issue with the diet is that my patients can't afford the quality protein needed to maintain an albumin of 4.0 which is what KDoqi guidelines now state is the goal.

[neygray]

Originally Posted by traumaRUs

I'm an advanced practice nurse in a nephrology practice. I work with an indigent, poor, homeless, psych population. My issue with the diet is that my patients can't afford the quality protein needed to maintain an albumin of 4.0 which is what KDoqi guidelines now state is the goal.

That's the sad state for patients with many health problems now. It hurts when you know that they are in the health that they are in because they don't have the financial means for the proper food, medicine, tx's to take care of themselves properly. The ones that seem to be falling through the cracks the most are the working poor.