KARACHI, Nov 1: Maximum adequacy of dialysis to reduce the symptoms associated with uremia including fatigue, nausea, pruritus and anorexia is strongly recommended to counter low protein intake and malnutrition-induced morbidity and mortality among patients with End Stage Renal Disease (ESRD).

Rabia Khalid, a nutritionist associated with the Sindh Institute of Urology and Transplantation (SIUT), discussing the significance of nutrition in haemodialysis in a SIUT publication, reminded that virtually every study evaluating the nutritional status of ESRD patients has reported some degree of malnutrition.

The reason for malnutrition in these patients were said to be altered endocrine and metabolic functions which contribute to decrease appetite. The therapeutic low protein diet initiated in the predialysis stage in hope of delaying disease progression, may contribute to malnutrition.

Under the given situation, the nutritionist stressed need for appropriate diet therapy for patients receiving maintenance dialysis. The therapy must be aimed to minimize interdialytic weight gain besides improving the patient’s metabolic status.

The nutritionist, suggesting low cholesterol, low saturated fat diet besides low sodium intake for patients with ESRD, recommended an optimal protein intake of 1.2 to 1.4 gm, per day for haemodialysis patients.

According to her, adequate dialysis can help to correct subtle uremia, enabling patients to have the appetite to ingest large quantities of proteins, resulting in an improved nutritional status and a higher hematocrat level.

Adequately dialysed patients with no metabolic acidosis were said to have no necessary potassium restriction.

The dialysis related reasons for malnutrition were cited as inadequate dose of dialysis, bioincompatibility of haemodialysis membranes which may result in increase losses of aminoacid, increased resting energy expenditure and losses of amino acids or proteins and water soluble vitamins through dialysate. — APP