Hemodialysis is the most important treatment for uremia patients, however, in clinical maintenance hemodialysis patients are very easy to cause fluid retention, hyperkalemia, congestive heart failure, even die just due to poor diet controlling. So, in this time diet nursing play a pivotal role in treatment, the reasonable diet guidance can not only prevent or reduce the occurrence of complications, keep good nourishment status, but also improve dialysis effect and anemia, and up to better treatment, thus strengthen the patients’ability to adapt daily life and social activity, improve the life quality of patients.
Although renal replacement therapy is developing, end-stage renal diseases patients still have a high mortality. In many of dead factors, malnutrition is accounted for important place. Let the patients know that the dialysis is just an intermittent treatment for renal failure, the controlling of diet and fluid amount are the continuing therapy. So, reasonable and effective diet guidance is important. Must insist on the following diet principle: fine high protein、high heat、maintain water balance、high vitamin、low sodium、low potassium、high calcium、low phosphorus diet.
1、Take enough protein
Hemodialysis could lost a certain amount protein and amino acid, at the same time have an effect on promoting protein alienation, cause negative nitrogen balance, should offer fine high protein(like egg white、milk、lean、fish such of animal protein), these of fine protein including essential amino acid is higher than vegetable protein, and the availability of synthesize protein is high, less of metabolic wastes. Everyday protein intake is suitable as 1.2-1.4g per kilo body weight.
2、Take enough heat
Enough heat could restrain protein alienation and keep ideal weight. Lack of heat, the protein in the food and body protein will be consumed as heat resource, for maintenance hemodialysis patients, heat is offered by sugar and fat. Everyday heat intake is suitable as 33-35kcal per kilo body weight.
3、Maintain water balance
Majority maintenance hemodialysis have symptom of oliguria or anuria, control the intake of water strictly, maintain water balance are the important link to prevent complications and improve survival rate. Dialysis interphase drunk more water would cause water retention、high blood pressure、congestive heart failure, during the dialysis too much ultrafiltration would cause hypotension、stenocardia、arrhythmia and muscle spasm. In principle, everyday water intake equals to urine plus dialysis ultrafitration water divide dialysis interval numbers plus 500ml.
4、Limit the intake of salt
The patients whether obey the stipulation of liquid limit, in a large content depends on the intake of sodium, for maintenance hemodialysis patients, limit salt is more important than limit water, for example in the food limiting salt appropriately, can avoid thirsty and decrease the water intake, for maintenance hemodialysis patients the intake of salt is usually 3-5g/d, at the same time avoid eating high sodium food.
5、Limit the intake of potassium
Hyperkalemia has toxic effect for cardiac muscle cell, and induce all kinds of arrhythmia; serious patients may have ventricular fibrillation and cardiac arrest. Maintenance hemodialysis patients should pay special attention to potassium in the food, avoid high potassium food(like vegetable、fruit、nut fruits、potatoes、mushroom、cocoa、chocolate、soluble coffee). Decreasing the content of potassium in the food through steep、boil、cryogenic refrigeration, and monitor the concentration of serum potassium timely and adjust the intake of potassium according to urine quantity, in case of serum potassium too high or too low.
6、Limit the intake of phosphorus
Everyday intake of phosphorus should control in 600-1200mg, the patients should eat more high calcium low phosphorus food, yolk、plucks、marrow、nut fruit with much phosphorus should avoid eat more about them.