The Hospital Diet
© 1997 Andrew Lundin, M.D. All rights
reserved. Reproduced with permission.
All your stories about horrible hospital diets imposed
on dialysis patients ring true. I wonder why the NKF Council of Renal
Dieticians has not taken up this issue as an education program
for their colleagues. Have they or is it worth suggesting?
My experience covers the gamut. My first two years on
dialysis were not adequate and I survived by sticking to a very strict
diet. That is one of the purposes of a "renal" diet - to minimize
uremic complications. Other outcome of prescribing a renal diet is an attempt
to slow the progression of the kidney disease. Several of you have
pointed out the dangers of this diet when one goes too long,
namely malnutrition.
If one is started on subadequate dialysis, then a renal
diet will minimize uremic symptoms but also shorten survival. I
was within weeks of death when I started medical school and my dialysis
time was increased to 14 hrs. With good dialysis, the appetite
should increase so much so that the dietary restrictions of dialysis come into play.
Ergo the "dialysis" diet.
I view the dialysis diet as a diet of moderation. All
things can be eaten but in moderation, some more restricted than others.
One has to eat also in relation to the dialysis treatment. This
required an understanding of food content and time of absorption
into the blood for dialysis. Another way to look at it is to look for endpoints.
How much fluid weight have I gained since my last treatment and what did I eat to do it? If I gained too much where should I cut down?
What is my potassium level? What did I eat in the past days since
the last treatment? Can I eat more? Remember that the amount of
salt or sodium (preservatives, baking soda) that you eat will make you
thirsty. K levels can safely rise to 6.5 mEq/L in a dialysis patient.
Higher increases the anxiety scale. Is it checked on the first
dialysis (after 2 days off) or midweek? Midweek K values probably
should be lower.
What is the right BUN to look for as an end point?
There are a number of variables that can effect the BUN
level, but when patients are hungry I do not worry about how much protein
they eat as long as the phosphorous and K are in safe limits. If the BUN
number scares the doctor then increase the dialysis. Clearly too much protein
ingested can cause other problems but few ingest to that level.
I used to have what I call the "anorexia nervosa of dialysis". Fear of
eating lest I suffer the side effects and complications. I observed my patients
eating, enjoying it and not complainting. I now try to do the
same and am gaining weight.
Peter Lundin, M.D.
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