Saturday, January 16, 2021

On dialysis, protein intake needs to be high, not low


I was diagnosed with Kidney Disease suddenly in July 1997. The doctors thought it was Acute Kidney Injury, which would resolve in a few days. Most dialysis patients, however, have Chronic Kidney Disease, so their kidney function deteriorates gradually. Most people realise something is wrong with them only when considerable damage has already been done.

Doctors recommend a low-protein diet for most patients in the early stages of kidney disease. This is because kidneys remove excess protein from the body and have to work harder if the patient eats more protein.

When the patient reaches the last stage of kidney disease (not life, mind you) and has to undergo dialysis, the reverse suddenly becomes true. Dialysis patients need a lot of protein. Dialysis removes protein from the body rapidly. The body now requires protein supplementation rather than protein restriction.

Unfortunately, some doctors and dieticians miss this important point while discussing diet with their patients. As a result, some patients continue to restrict proteins in their food, resulting in severe malnourishment and other associated problems.

This problem is even bigger with Peritoneal Dialysis where the protein removal is even greater and protein supplementation becomes a critical part of the patient's diet.

Most dialysis patients need around 1.2 g/kg body weight/day. But your nephrologist or dietician will typically prescribe this. 

See the table below to understand the amount of protein required for your body weight as per this calculation:

Body weightProtein required per day
80 kg96 g
70 kg84 g
60 kg72 g
50 kg60 g

To get an idea of what that means, see the following table that has the protein content of some commonly consumed vegetarian foods:

100 g of itemProtein content
Cooked Toor dal7 g
Paneer14 g
Cooked Soya beans17 g

This link has a table of several other foods and their protein content. So does this link.

So, it is quite difficult to eat 84 g of protein in a day. But eat, we must. Many patients use protein supplements specially designed for dialysis patients. This also helps in augmenting the protein intake per day.

One thing to watch out for is that many protein-rich foods are rich in phosphorus as well. So please ensure that you take your phosphate binders as prescribed by your nephrologist.

Whatever we do, we need to ensure that our protein intake is good. Have some protein with every meal. Do not miss protein in a single meal. If we don't do that, there is a high risk of muscle wasting and various types of physical disabilities like difficulty in walking, climbing stairs, sitting in and getting out of a chair and so on. A condition called Sarcopenia is also possible where the hands and legs become very thin but the stomach bloats up. 

So, please take this very seriously and evaluate how much protein you are getting per day and try to reach the prescribed amount as per your body weight.

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