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Managing Protein Intake When On Dialysis

Feb 13, 2023

For those with chronic kidney disease (CKD) or end-stage renal disease (ESRD), nutrition plays an important role in improving or maintaining a high quality of life. Adequate intake of protein and other macronutrients helps provide the body with energy, prevents disease, and allows the body to function correctly.

Key Points:

  • Albumin (a form of protein) plays an important role in several essential functions of the body.
  • Factors that are used to calculate individual protein needs, include body mass, the amount of protein in your urine, your kidney disease stage, and nutrition status.
  • Your care team and registered dietitian will advise you on an individualized diet plan to provide enough protein to meet your requirements while on dialysis.

Chronic Kidney Disease Stage Overview

There are five stages of CKD, and they refer to how well your kidneys are functioning. Kidney function, in this instance, is calculated by the estimated glomerular filtration rate (eGFR).

  • Stage 1: eGFR is 90 or higher, there may be mild kidney damage, but the kidneys work as well as usual.
  • Stage 2: eGFR is 60-90, the kidneys still work well, and there may be mild kidney damage.
  • Stage 3a: eGFR is 45-59, and the kidneys are no longer working as well as they should, with mild to moderate kidney damage present.
  • Stage 3b: eGFR is 30-44, and the kidneys aren’t working as well as they should, with moderate to severe kidney damage present.
  • Stage 4: eGFR is 15-29, with the kidneys close to not working. There is severe kidney damage present.
  • Stage 5: eGFR is less than 15, and the most severe kidney damage is observed in this stage. The kidneys have failed, or they are very close to not working.

Dialysis Overview 

Dialysis is a treatment option for patients whose kidneys are failing and have lost about 85 to 90% of kidney function (or GFR less than 15). When you reach kidney failure, your kidneys can no longer filter blood normally. This results in a build-up of waste products, extra fluid, and toxins. Dialysis is used to do some of the work the kidneys can no longer do.

There are two types of dialysis:

  1. Hemodialysis. During hemodialysis, a machine is used to clean the blood. The blood travels from your body and into the machine, which is filtered through a dialyzer (artificial kidney). The cleaned blood is then returned to the body through a different tube and needle. The dialysis machine also monitors blood pressure to adjust how fast the blood flows from the body and back into it. This process may take between 3-5 hours and takes place in a hospital or dialysis clinic. Dialysis may need to be done three to seven times a week, depending on your individual needs. Hemodialysis may also be done at home.
  2. Peritoneal dialysis (PD). In this dialysis process, small blood vessels inside the peritoneum (abdominal lining) filter blood with the help of a dialysis solution. The dialysis solution contains water, salt, and other additives. PD may take place at home and may be done in two ways. The first treatment is called automated peritoneal dialysis and uses a cycler. The second is called continuous ambulatory peritoneal dialysis (CAPD) and takes place manually.

How Much Protein Does a Dialysis Patient Need?

Protein is one of the three macronutrients and is an essential building block for human life. It can be found in both animal and plant food sources. This macronutrient helps repair and build all the muscles in the body, including the organs (heart, kidneys, liver, and lungs). If protein consumption is insufficient for the body’s needs, it may take protein from itself (muscles) to meet its needs.

Protein is found in the blood in the form of albumin and is made in the liver from the foods we consume. Albumin is responsible for delivering vitamins, nutrients, and minerals to the rest of the body. It also plays a role in homeostasis in cells and blood vessels and is involved in the immune system to help fight infection.

When you are on dialysis, your daily need for albumin may increase, as some albumin in your blood is removed during the process. Thus, you may need to consume more protein to help maintain albumin levels in your body. Albumin also helps retain fluid in the blood vessels, which is especially important during dialysis treatment. Your dietician can provide your recommended protein intake based on your CKD stage, and the type of dialysis treatment you are receiving.

When you are on dialysis, your care team will check your albumin levels monthly or as often as needed to ensure levels are not dropping or increasing drastically. When on dialysis, an albumin level of 4.0 and higher is the preferred level. Albumin levels may drop due to inflammation, infection, or recent hospitalization.

Dialysis protein needs

In CKD and ESRD patients, protein malnutrition and increased protein catabolism are commonly observed. As it is difficult to directly measure individual protein intake, a dialysis patient’s protein intake is based on the rate of increase in serum urea nitrogen levels between two dialysis sessions. This marker is called the protein equivalent of nitrogen appearance or the protein catabolic rate (PCR). Your renal dietician can then use the PCR to assess your dietary intake needs during dialysis treatment.

Protein intake above 1.4g/kg per day or lower than 0.8g/kg per day has shown to be a factor in an increased decline in health for patients on dialysis. Too little protein intake may also result in malnutrition for CKD or ESRD patients. Thus, it is crucial to work with your dietician and follow your diet plan.

Kidney-friendly protein options

Guidelines recommend that more than half of your protein intake should come from high biological value (HBV) sources. Biologic value provides a measurement of how efficiently the body uses the protein source that has been consumed. The key feature of HBV protein sources is the presence of essential amino acids.

Sources of animal protein include:

  • Milk
  • Eggs
  • Meat
  • Poultry
  • Fish
  • Other dairy products (cheese, greek yogurt)

Sources of plant protein include:

  • Nuts and nut butter
  • Whole grains
  • Legumes (lentils, beans, garbanzo beans)
  • Meat substitutes
  • Soy products (tofu)

It is important to pay attention to the nutrition label concerning the amount of sodium, protein, and potassium in food products. Avoiding processed meats may be recommended, as these typically contain high amounts of phosphorus and sodium.

While your dietician will show you how to measure your protein serving size, a general way to determine a serving size is by using your hand. Typically the size of the palm of your hand works out to about 3 ounces, with the size of your thumb being approximately one ounce.

Panoramic Health and Dialysis

At Panoramic Health, we are a physician-led value-based care platform with hundreds of providers across the country. Our platform manages patients by increasing planned dialysis starts and transplantations, which help minimize risks associated with emergency hospital admissions.

Our holistic care management provides CKD spectrum patients with a comprehensive care model that includes nutrition and services that are individualized to patients’ CKD stage and risk profile.

Panoramic health by the numbers:

  • 30% at-home dialysis starts
  • 56% reduction in hospital readmissions
  • 54% improvement in planned dialysis starts
  • 930+ partner dialysis centers and hospitals