Korean Journal of Nephrology 1988;7(3):63-65.

혈액투석 환자의 식사요법

엄영람

Abstract

The dietary management in hemodialysis patients is important to prevent deficiency and achieve good nutri- tional status, because the nutritional status may play a key role in the survival of hemodialysis patients. The intake of 1 to 1.2 gm of high biological value protein per kilogram of ideal body weight is recom- mended per day. However protein requirements in hemodialysis patients are influenced by several factors (Amino acids loss into the dialysate, Blood loss, Uremic catabolism, Proteinuria and so on.) Energy intake must be adequate in order to spare protein for tissue protein synthesis and prevent its metabolism for energy. Depending on the patients pres- ent nutritional status and degree of stress, between 35 and 50 kcal per kilogram of ideal body weight should be provided. The sodium and fluid intake are modified through measurement of urinary sodium excretion, urine output, blood pressure, presence of edema, serum sodium level and dietary intake. Usually the sodium intake of 40 to 120 mEq per day and the fluid intake of 500 ml per day plus the amount equal to urinary output are allowed. Potassium usually requires restriction, depending upon the individual's body size, the 24-hour urinary potassium excretion, the serum potassium level and the frequency of dialysis. Potassium is recommended 40 to 65 mEq (1.5 to 2.5 gm) per day. The daily recommended dietary phosphorus and cal- cium intake is 1200 mg or less, 1.5 to 2.5 gm, respective- ly, but calcium is increased by giving calcium supple- ments. There are several causes of vitamin deficiency in hemodialysis patients. So daily supplements of water- soluble vitamins and the recommended allowances for the other vitamins should be prescribed. Finally, the nutrient intake must always be adjusted according to the clinical response of the individual patient, even though dietary allowance for other nutri- ents are proposed.