PROTEIN REQUIREMENTS IN RENAL FAILURE
Protein requirements for patients with renal failure are dependent on the acute or chronic nature of renal failure and the presence and type of dialysis. The nutritional status and adequacy of current intake of patient should be considered.
Haemo- and peritoneal dialysis patients require a higher amount of proteins than healthy adults. The National Kidney Foundations US recommends 1.2 g protein/kg/day for stable maintenance haemodialysis patients, and 1.2-1.3gms protein/kg/day for stable peritoneal dialysis patients. See Table below for protein recommendations in renal failure:
Selected Nutritional Parameters for varying levels of kidney failure
Nutrtional
Parameter
Peritoneal |
Normal Kidney
Function |
Stage 1-4
Chronic Renal
Disease |
Stage 5
Haemodialysis |
Stage 5
Peritoneal
Dialysis |
Calories
(Kcal/kg/d) |
30-37 |
35<60yrs
30-35>60yrs |
35<60yrs
30-35>60yrs |
35<60yrs
30-35>60yrs
(incl calories dialysate) |
Protein
(gm/kg/d) |
0.8 |
0.6-0.75
50%HBV |
1.2
50%HBV |
1.2-1.3
50%HBV |
| Fat (%total kcal) |
30-35% |
Patients considered at highest risk forcardiovascular
disease; emphasis on PUFA, MUFA, 250-300mg
cholesterol/day |
| Sodium (mg/d) |
unrestricted |
2,000 |
2,000 |
2,000 |
| Potassium(mg/d) |
unrestricted |
Correlated
To lab values |
2000-3000
(8-17mg/kg/d) |
3000-4000
(8-17mg/kg/d) |
| Calcium (mg/d) |
unrestricted |
1,200 |
<2000 from diet/medications |
Phosphorus
unrestricted
(mg/d) |
unrestricted |
correlated
to lab values |
800-1000 |
800-1000 |
| Fluid (ml/d) |
|
Unrestricted
with normal
urine output |
1000+urine
output |
Monitored;
1500-2000 |
HPV- high Biological Value
PUFA- Polyunsaturated fatty acid
MUFA - monounsaturated fatty acid
Reprinted from the American Dietetic Association Vol 104: 404-409 |
