Malnutrition is a term used to describe any abnormal nutritional status leading to either ectomorphism or obesity. Various reasons constitute malnutrition extending from unhealthy or insufficient diet to organ system damage. Kidney disease and liver disease are the major factors that constitute malnutrition when the intake of nutritious food is not a topic of concern. 

Dialysis is a continuous mechanical cleansing unit that artificially purifies blood through an external circuit. This in turn means kidney functions of the patient are insufficient to carry out its duties. Dialysis is recommended for patients who have CKD in its chronic stages, kidney failure, etc. 

How can dialysis affect nutritional status?

  • Dialysis promotes protein catabolism which is the breakdown of protein and removal of excessive amino acids from the blood leading to low protein levels in the body.
  • it is a cause of hypoalbuminemia
  • The process of dialysis causes severe lethargy and energy deficit.
  • a patient on dialysis has dietary restrictions to the maximal levels.
  • All these factors contribute to a low energy diet combined with the effects of artificial mechanics of the dialysis process leading to malnutrition.

Pathophysiology of Malnutrition in dialysis patients.

  1. The kidney is the purification unit of the blood. In CKD the capacity of the kidney to purify blood is not as efficient as for any person without CKD.
  2. foods with high levels of proteins, and potassium cause damage to the kidneys as it puts pressure on them to work on clearing the metabolites.
  3. Most of the patients may hence fall into the category of low potassium, protein energy Malnutrition, and micro and macro nutrients malnutrition as rich potassium and protein foods are red flags for patients on dialysis.

General effects of malnutrition in patients on dialysis.

  • poor build of the body.
  • weight loss.
  • weakness, lethargy, and fatigue
  • electrolyte imbalance
  • giddiness, headache.
  • psychological weakening
  • loss of self confidence and feeling of dependency
  • investigations may show hypoalbuminemia and low potassium levels.

Specific effects of malnutrition in patients on dialysis.

  • anorexia or poor appetite
  • poor eating habits
  • financial instability
  • unavailability of specific foodstuff.
  • body pain.
  • protein energy deficit.
  • recurrent infections
  • poor wound healing
  • development of comorbid conditions.

Complications faced by patients with malnutrition due to dialysis.

  • the patient may face issues with activities of daily living due to weakness in the limbs and trunk. In younger individuals, it may not be very evident but in patients with underlying complications, and co-morbid conditions it is significant. These activities may include bathing, washing, brushing, cooking, dressing, etc.
  • In old age, this dependency may extend up to the inability to sit or stand independently.
  • respiratory complications may find their way in due to low immune response and comparatively high levels of immobility.
  • recurrent hospital stays.
  • employment and occupational issues can arise as well.
  • traveling, heavy physical work, etc has to be stopped. 

What are the significant effects of protein energy Malnutrition (PEM) in dialysis patients?

  • Lower muscle mass
  • Lower muscle strength
  • muscle fasciculation
  • sunken eyes
  • pale skin
  • the trouble with movements and body functions.
  • lack of active participation in the society.
  • quick tiredness.

How to minimize malnutrition in dialysis patients?

  • frequent visits to the dietician for changes in dietary supplements.
  • experimenting with new recipes with acceptable ingredients so as to generate interest and appetite
  • frequent blood testing and monitoring of potassium and protein levels.
  • motivating the patient.
  • encouraging them to eat sufficient food to meet dietary requirements taking into consideration the restrictions.
  • frequent consultation with your nephrologist.
  • proper exercising.
  • maintaining a proper and timely sleep wake cycle.
  • yoga.
  • taking medications as prescribed by the doctor.

Recipes are favorable for the patient on dialysis.

  • Upma: Indian dish with semolina, vegetables of choice such as carrots, beans, and peas in limited quantities.
  • Poha: rice flakes or poha cooked along with the same vegetables.
  • Paratha: wheat flour along with grated carrots, cabbage, green leafy vegetables, radish, etc. in limited quantities.
  • Lemon rice.
  • Wheat bread toast.
  • Porridge made out of semolina or ragi.
  • Vegetable soup.
  • Boiled and drained vegetable bowl.
  • A few pieces of fruits like apples, and chikoo in limited quantities.
  • Water intake as directed by your nephrologist.

Home made foods are recommended strictly with low oils and spice content. Freshly cooked food if served to the patient will prove beneficial.

Summary:

Not all patients on dialysis are malnourished. Malnutrition can be due to various factors like lack of nutritious food as explained by the doctor can be due to abnormal absorption and the effect of dialysis. Dialysis unit filters excessive amino acids and promotes catabolism thereby paving the way for malnutrition. Signs and symptoms of protein energy Malnutrition especially consist of weakness, loss of appetite, and reduced social interactions or psychological demotivation. CKD patients especially need dietary restrictions on protein and potassium. Malnutrition can be avoided or delayed by motivating the patient and encouraging the patient to have a proper diet in required quantities and to frequently visit their nephrologist and dietician. Exercise regularly as directed.

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