Hemodialysis patients diet care

Constantly updated and significantly improve the technical level of modern blood purification equipment, survival time of patients with chronic renal failure greatly extended. However, long-term dialysis patients due to the accumulation of toxins in water and urine, stomach and intestines slow, not dull is to eat vomiting, resulting in poor nutrient intake, or due to the unreasonable diet, leading to water retention, blood potassium disease, congestive heart failure, and even death. Meanwhile, with the decline of renal function, and protein loss and other reasons cause deterioration of the nutritional status of the patient. Good nutritional status can prevent or reduce the complications and improve dialysis effect, thereby enhancing the patient's ability to adapt to everyday life and social activities [1,2]. Thus, long-term hemodialysis patients diet care has become an important issue.

1 diet care points

1.1 adequate intake of protein

Hemodialysis may lose a certain amount of protein and amino acids, while promoting protein catabolism, causing negative nitrogen balance. Therefore, hemodialysis patients should eat more protein than conservative treatment of patients [35]. Protein intake to 1.2 kg / d more appropriate. Note that high quality protein, 80% high biological value should be given high-quality protein, such as egg white, milk, lean meat, fish and other animal protein, such as high quality protein amino acid content, utilization of synthetic human proteins than vegetable protein essential, produce metabolic wastes (such as urea) less.

1.2 adequate intake of calories

Sufficient heat can inhibit protein alienation and maintain ideal weight; if insufficient heat, food protein will be consumed as heat source. Since protein catabolism accelerated gluconeogenesis increases can produce more metabolic waste. For hemodialysis patients, the recommended calorie intake and nutritional status should be based on the patient's blood lipid levels and labor intensity appropriate changes. Heat is mainly provided by carbohydrates and fat, carbohydrate intake is generally 5 g / (kg · d) ~ 6 g / (kg · d), fat intake is usually 1.3 g / (kg · d) ~ 1.7 g / (kg · d), should be more intake of unsaturated fatty acids, such as vegetable oil, can reduce cholesterol, free fatty acids and triglycerides, so as not to aggravate atherosclerosis.

1.3 to maintain the water balance, limiting salt intake

Most hemodialysis patients little or no urine, strict control of water intake, diet foods try to eat more water. To maintain the water balance is to prevent complications and improve survival important part. Between dialysis water caused by excessive water retention, severe cases can cause circulatory overload and death. Ultrafiltration dialysis too much can cause low blood pressure, angina, arrhythmias and muscle spasms. In principle, the amount of water daily into the urine + dialysis UF = water / number of days between dialysis +500 mL. Determine the moisture limit of the best indicators of changes in body weight, weight gain between two dialysis should be controlled within 1.5 kg is appropriate. Patients should be every day under the same conditions, within a fixed time record weight and blood pressure. Drink hot and cold water to quench their thirst than drink water and add a few drops of lemon juice or mouth with ice cubes are a good way to control the amount of drinking water. Patients can observe liquid restrictions depends largely on sodium intake. Common clinical some new patients often feel thirst, the main reason is because there is no limit salt. Because sodium can retention of water, salt Iddo produce thirst, increased water intake. As appropriate to limit sodium in food, to avoid thirst, often can automatically reduce the amount of water to prevent water retention, high blood pressure, congestive heart failure and dialysis complications. So for hemodialysis patients, salt restriction limit is more important than water. The amount of salt is generally 3 g / d ~ 5 g / d.

1.4 limit potassium, phosphorus intake

Hyperkalemia can cause arrhythmia, heart attack, avoid the use of potassium vegetables, such as spinach, mustard greens, bitter melon, dried mushrooms, leeks, cabbage, bamboo shoots, seaweed, lilies, mushrooms, bean sprouts and so on; avoid eating high potassium fruits, such as bananas, guava, cantaloupe, melons, grapes, oranges, carambola. Pay particular attention to the broth, soup, lettuce and other high potassium content, it should Eat. Wash eating vegetables should be cut, and then the dish burns, pour the soup and cook, and eat only fruits 1 d 2 times, preferably before eating soaking 1 h ~ 2 h and then eat. Others such as Chinese soup very high potassium content should be careful service. Lower potassium content in food can by soaking, boiling, ultra-low temperature refrigeration and other methods to remove potassium foods. Timely monitoring of serum potassium concentration, and adjusted at any time according to the amount of urine potassium intake to avoid too high or too low potassium.

Renal osteodystrophy, also known as renal osteodystrophy, a bone disease due to the calcium, phosphorus and vitamin D metabolism, secondary hyperparathyroidism, acid-base balance disorders caused by other factors. Hyperphosphatemia is caused by renal osteodystrophy and secondary hyperparathyroidism hyperthyroidism important factor, but also the maintenance hemodialysis patients with serious complications, so limiting intake of phosphorus in the diet is extremely important. Low phosphorus diet is dialysis patients avoid hyperphosphatemia first step. Phosphorus is mainly present in dairy products, egg yolks, organ meats (heart, liver), shrimp, peanuts, nuts, soy and other foods, pay attention to proper control; the soup contains dissolved phosphorus, should drink less better.

1.5 increase calcium intake, a water-soluble vitamin supplement

Because active vitamin D deficiency in dialysis patients as well as the body of active vitamin D effects on resistance, and dietary restriction of phosphorus intake, often resulting in low calcium concentration. Should be under close monitoring of serum calcium and phosphorus levels condition, the patient add enough calcium and vitamin D. Dialysis patients inevitably lose water-soluble vitamins, plus restrictions potassium, high phosphorus food and other factors, reducing the intake of water-soluble vitamins, it is timely to supplement, especially folic acid and vitamin B.

In addition, the trace element plays an important role in the treatment of uremic hemodialysis patients. Such as serum zinc reduction will affect uremic hemodialysis patients arteriovenous fistula anastomotic healing, reasonably zinc can promote anastomotic healing, iron supplementation can improve the patient's anemia status. In order to iron supplementation improved hemoglobin, dialysis patients can eat beef, lamb, pork, liver, blood, etc., limiting dietary intake of copper have a role in the prevention of atherosclerosis. By strengthening the patient's diet care and dietary guidance to patients, so that patients can take the initiative with the adjustment of the diet, the body can effectively improve the content of trace elements.

2 diet should pay attention to the problem of nursing

Note 2.1 good psychological care

Anxiety, depression, fear, sadness and other negative emotions, can cause the sympathetic nerve, and inhibit the secretion of digestive motility, leaving patients decreased appetite, eating less, or even anorexia; and a relaxed state of mind will promote appetite, guarantee digestion and absorption of nutrients. Therefore, the maintenance hemodialysis patients diet care must not ignore psychological care, promote patient and cheerful, improve the diet of compliance. Patients who can not strictly control the water, to be patient to talk, to correct poor eating habits and breach of the principles of health behavior, so that patients understand the volume overload adverse effects on the heart and blood pressure and excessive ultrafiltration occur in dialysis complications, the patient can consciously and strictly control the intake of sodium and water, maintain a good nutritional status, in order to facilitate a speedy recovery.

2.2 good health education

Long-term low-salt diet will affect the patient's appetite, attention should be based on the patient's eating habits, and offers a variety of color, smell and taste of food, to increase appetite. Generation of high potassium salt, dialysis patients with life-threatening, not edible. Multi-protein diet rich in potassium, phosphorus, and provide more hydrogen ions. When considering the protein nutrition, on the one hand to maintain nitrogen balance and prevent protein deficiency, and to minimize the accumulation of protein metabolites; on the other hand also to avoid hyperkalemia, hyperphosphatemia and severe metabolic acidosis. Therefore, be sure to patient education, to explain the nutritional requirements, the patient continues to investigate the intake of various nutrients to help patients make reasonable arrangements diet, develop individualized diet program, and according to the changing needs of the individual, continuous observation, timely adjustment. At the same time, but also let the patient's family to understand the nutritional content of various foods, and learn cooking of these foods, in order to correct for the patient to eat.

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