Nutritional management of residents undergoing dialysis should be a priority in any aged care facility.

Kidney disease affects a large number of Australians, approximately 1.7 million. As kidney disease progresses a number of these people will require dialysis.

Dialysis is needed to remove waste from the blood, restore the balance of electrolytes and remove excess fluid when the kidneys are not functioning properly.

Unfortunately, chronic kidney disease (CKD) and dialysis can have numerous nutritional consequences for residents; Muscle wasting (sarcopenia) and electrolyte and fluid disturbances are two of the main nutritional concerns. Sarcopenia can be a result of nutritional deficiencies, physical inactivity and chronic inflammation and is generally increased in the CKD population.

As CKD advances muscle strength and size reduces. As a result of muscle wasting, residents may experience decreased independence and mobility, increased risk of fractures from falls and decreased quality of life.

Regular Nutritional Assessments

All residents with CKD should have regular nutritional assessments to monitor their risk of muscle wasting. An assessment should consider factors such as changes in weight, dietary intake, gastrointestinal factors (bowel disturbances, vomiting, and appetite) and a physical assessment.

The dietary management of residents with CKD can change depending on their stage of CKD and whether or not they are receiving dialysis. For those residents with early stage CKD ensuring a nutritious diet and weight management are the main priorities.

For those with late stage CKD, having a diet with adequate energy and protein is essential, along with monitoring potassium and fluid intake. If a resident is receiving dialysis, the monitoring potassium, sodium and fluid intake remains imperative along with ensuring adequate protein and energy is consumed.

While these are general guidelines, each resident must be assessed individually to ensure their diet is appropriate for their situation.

Dietary strategies to prevent sarcopenia and maintain good health in those with CKD:

1. Encourage CKD residents to consume a protein food with each meal.  Protein with each meal helps to stimulate muscle synthesis.  High protein foods include, meat, dairy, nuts, legumes, eggs.
2. Encourage 50% of the protein residents consume to be high biological value protein.  This is protein derived from animal sources such as meat and dairy.
3. Encourage higher fibre foods to maintain good bowel habits.
4. Monitor potassium levels in those with CKD and only restrict potassium if required.  Potassium restrictions are more frequently required when residents are having haemodialysis rather than peritoneal dialysis. Fruits and vegetables are some of the main sources of potassium in a person’s diet.
5. Most people receiving dialysis will be on a fluid restriction.  It is important that all liquids be counted, this includes water, tea, coffee, cordial, juice, ice, jelly, yoghurts, soups, gravies, iceblocks etc.
6. Limit sodium intake. Salt will make residents thirsty which can make adhering to fluid restrictions difficult.  Choose reduced salt products and avoid adding salt to foods.
7. Encourage variety in the resident’s diet to ensure a nutritious diet.  Encourage foods from each of the food groups including breads and cereals, meat, dairy, fruits and vegetables.
8. Encourage daily physical activity.  This will help limit muscle breakdown.

In summary, residents with CKD will require regular assessments and their diet needs to be tailored to their individual circumstances.  A dietitian can help guide the resident and facility through this process to ensure the best outcomes for all involved.

References:  Nutritional considerations in the dialysis population: from malnutrition to obesity, Dietitian Connection, Jessica Stevenson, March 2017.