Dietary problems of the dialysis patient

The patients on regular dialysis treatment (RDT) usually experience an adaption phase that may sometimes be complicated by intercurrent catabolic episodes before the steady state is reached. In all these clinical settings, and especially during the catabolic episodes, a correct nutritional evaluation is of great importance. The main abnormalities in body composition and metabolism, which may affect the nutritional status in these patients, are reviewed. The caloric intake should provide the ideal amount of 35 kcal/kg b.w., which seems to be critical in maintaining an ideal body weight. A protein intake of 1.0-1.2 g/kg b.w. is adequate to keep a nitrogen balance and to prevent excessive nitrogen-containing waste product accumulation. Carbohydrates should represent 45-50% of total caloric intake and monomeric carbohydrates should be limited. Lipids as 35-40% of total caloric intake are recommended with the polyunsaturated to saturated fatty acid ratio being 1.0. Phosphate intake should not exceed 900-1,200 mg. Calcium supplements are required up to a total intake of 1,500 mg. During the catabolic phases, however, both the caloric and nitrogen intakes should be increased to meet the increased needs of the patients.