Question

A. How can you manage nutritionally a patient suffered renal failure? The patient is
male, hypertensive, diabetic type-2, obese, and aged 58 years. The patient has been
advised to postpone the renal dialysis (Weight is 110 kg, height is 180 cm).
1. What are the requirements of macronutrients?
2. What are the requirements of water? What about hot weather?
3. What are the required micronutrients?
4. If anemia and osteoporosis how can you manage the complications?
5. If patient has gluten sensitivity, try to recommend restrictive diet.
6. If patient has non-alcoholic fatty liver disease, how can you improve liver function
and remove the accumulation of fat.
7. How can you manage the poor wound healing and bleeding gums?
8. The patient suffered burn, and he needed parenteral feeding, what type of parenteral
feeding require? & how can you manage fluid overload due to kidney failure?
9. Identify timely monitoring criteria for such patient.
10.What type of physical activity could be followed for such patient?

Answer 1

1)Expert panels recommend lower dietary protein intake of 0.8 g/kg of body weight/day, while higher dietary protein intake (>1.2 g/kg of body weight/day) is advised among diabetic end-stage renal disease patients receiving maintenance dialysis to counteract protein catabolism, dialysate amino acid and protein losses, and protein-energy wasting. Carbohydrates from sugars should be limited to less than 10% of energy intake, and it is also suggested that higher polyunsaturated and monounsaturated fat consumption in lieu of saturated fatty acids, trans-fat, and cholesterol are associated with more favorable outcomes.

2) Patients with renal failure are commonly advised by primary care physicians or lay people to maintain a generous fluid intake. Moreover, in daily practice, there even seems to exist a direct correlation between serum creatinine and prescribed daily fluid intake. The higher the serum creatinine, the higher the prescribed fluid intake, the upper limit in our experience being approximately 4 L/d.

High temperatures can result in increased core temperatures, dehydration, and blood hyperosmolality. Heatstroke (both clinical and subclinical whole-body hyperthermia) may have a major role in causing both acute kidney disease, leading to increased risk of acute kidney injury from rhabdomyolysis, or heat-induced inflammatory injury to the kidney.

3.)High intake of several micronutrients including vitamins C, E, D, cobalamin, folate, magnesium, and potassium was associated with a decreased risk, while sodium was associated with an increased risk of incident for kidney failure.While guidelines recommend dietary sodium restriction to less than 1.5–2.3 g/day, excessively low sodium intake may be associated with hyponatremia as well as impaired glucose metabolism and insulin sensitivity.

4)Treating mineral and bone disorder in renal failure patient includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis.