Nephrology

533 Dietary Management of Haemodialysis

  • Dietary Management of Haemodialysis

    As haemodialysis occurs less frequently than CAPD, the dietary restrictions need to be stricter to reduce interdialytic fluctuations

    Energy

    Adequate energy intake is encouraged to prevent excessive protein catabolism.  It is usual to aim for at least the RDI for height age

    Fats

    Children on haemodialysis often have elevated serum triglycerides and cholesterol; replacement of saturated fats with mono- or polyunsaturated fats should be made

    Protein

    Children on haemodialysis require RDI for height age protein intakes.  Adequate energy should be provided to ensure that protein is not used as an energy source.  For children and adolescents  60-70 % of protein intake should be high biological value protein

    Phosphorus

    A phosphorus restriction of about 2/3 of the RDI for age is advised. More severe restriction makes the diet unpalatable. Phosphate binders such as calcium carbonate need to be given with each meal or snack with high phosphorus content

    Potassium

    Potassium allowances need to be based on serum levels.  When the potassium level is consistently elevated restriction of high potassium foods will be required.  Hyperkalaemia often occurs in haemodialysis children who have a reduced urine output

    Sodium

    Sodium intakes need to be restricted to prevent large weight gains between dialysis.  A no added salt diet will usually be adequate

    Fluid

    Fluid intake is restricted also to control weight gain between dialysis, this is usually based on insensible losses plus urine output

    Insensible losses can be estimated as:

    35 ml/kg/day for infants < 10 kg
    15-20 ml/kg/day for children > 10 kg
    500 ml/day for bigger children and adolescents

     See diet sheet "Fluid Restriction"

    Vitamins and Minerals

    Children on haemodialysis often have a poor dietary intake because their diminished appetites result in a limited variety of foods being consumed.  A vitamin and mineral supplement which is low in phosphorus, potassium and sodium should be recommended.