When you first start dialysis, you may experience weight loss, and it’s usually caused by: fluid loss, inadequate calorie intake due to reduced appetite, excessive protein loss from dialysis treatments, and GI distress from nausea/vomiting/diarrhea/constipation.
Fluid loss is the only normal weight loss circumstance when starting dialysis. If you experience weight loss due to any of the other reasons mentioned above, and if left untreated over time, you may develop malnutrition.
What is malnutrition and what are the signs and symptoms?
Malnutrition is a condition that occurs when your body does not get enough nutrients long-term. As you might expect, malnutrition can be a serious health problem and can even lead to death. Therefore, it is good for both you and your care partner to pay attention to the following signs and symptoms of malnutrition while dialysis progresses:
Poor appetite with no interest in food
Rapid weight loss without previous signs of swelling (edema)
Can barely stay awake and feel weak
Dialysis access wound takes a long time to heal
Sunken eye and temples with clear locker bone outline
Long-term severe nausea, vomiting, constipation, or diarrhea
It is wise to consult your healthcare team if you are experiencing any of the above and see what steps you can take to meet your nutritional needs.
How to deal with malnutrition when on dialysis?
If your dialysis center provides you with oral nutrition supplements, take them
If your appetite is poor, talk to your dialysis dietician about removing some of the restrictions on your diet.
Increase your high-quality protein intake like fresh eggs, chicken, pork, beef, fish, etc.
More calories per bite - add oils, unsalted butter or margarine, mayonnaise, protein powders, and oral supplements to foods like cereals and oatmeal
Small meals throughout the day
Consult your nephrologist and dietitian to see if Intradialytic parenteral nutrition is right for you. Intradialytic parenteral nutrition (IDPN) is an intravenous infusion of a formula that contains macronutrients. It can be administered directly into the body via the same route as the dialysate during hemodialysis.
Learn more about adding more calories from the National Kidney Foundation.
Foods high in protein are the best options if you are malnourished. Examples of protein sources that can help you include:
Eggs, chicken, pork, beef, and fish. If you're not a vegetarian or vegan, you should be able to find at least one of these fresh protein sources in your local supermarket.
If you're vegan or vegetarian, beans and nuts are a great protein source in your diet.
It is critical to ensure you have a good amount of protein in your diet. Protein is critical for all bodily functions, it makes sure our organs like the heart and lungs work properly and helps build and repair muscles. If you don’t have enough protein in your diet, your body is forced to take protein from parts of your body including your muscles which can lead to loss of muscle mass.
Protein in the blood is in the form of albumin. An excellent way to measure how well you are doing with your protein levels is to keep track of your albumin levels from your monthly blood test results. You want to have a level of 4.0 or higher.
Hints to incorporate protein into your diet:
Make sure to incorporate protein in every meal
Have bedtime snacks that are high in protein readily available
Incorporate protein supplements into your meal plan (powder, protein bar, or liquid drink – remember to incorporate protein drinks in your tracking of the amount of liquid you drink, and ask your renal dietitian for recommended protein supplements)
Take phosphate binders with meals as recommended by your nephrologist and dietitian– high protein foods often have high phosphorus and you want to keep that in check. Keep an eye on your blood test results for phosphorus as well to ensure you are within the expected test ranges for a person on dialysis.
It’s never too late to start!
Even if you're well into your treatment, it's important to understand that malnutrition can still occur at any time. Treating malnutrition involves a lot of things, but the most important is to have a good appetite and a good mindset. You are in charge of your health and your body—what you put into it matters!
A Dietitian’s Guide to Protein for People on Dialysis | American Kidney Fund.
Evidence Brief: Use of Intradialytic Parenteral Nutrition (IDPN) to Treat Malnutrition in Hemodialysis Patients. Anderson, Johanna, et al. Department of Veterans Affairs (US), 2011.
Eating Right for Chronic Kidney Disease | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Potassium and Your CKD Diet. National Kidney Foundation.
Malnutrition: Causes and Consequences. Saunders, John, and Trevor Smith. Clinical Medicine, 2010 Dec; 10(6): 624–627.
Weight Loss - Unintentional: MedlinePlus Medical Encyclopedia. NIH
Malnutrition. World Health Organization.