Nutrition Guidance for Special Diet to Patients on Maintenance Hemodialysis

Recent progress of medical technology and elucidation of pathophysiology markedly improved prognosis of patients on maintenance hemodialysis. To learn response of patients on maintenance hemodialysis to festive meals such as for weddings and new year feast is important from the viewpoint of nutrition guidance with reference to the inevitable daily restrictions in these hemodialytic patients. The mode of ingestion of the food served on new year's day by the patients on maintenance hemodialysis and the influence of environmental factors on their dietary habit were surveyed and nutrition guidance was given based on these results.The results are summarized as follows.1) Mean daily intakes of nutrients were compared between basal hemodialytic diet, the new year festive meals taken prior to their receipt of the nutrition guidance (3 days during the new year holidays in 1983) and new year feast after the receipt of nutrition guidance (3 days in 1984). energy intake increased after the nutrition guidance. Excessive intake of protein, water and salt gradually decreased within the restriction limit.2) Sources for protein, salt and potassium taken excessively prior to nutrition guidance were examined. Fish, shellfish and their processed products ingested at a high proportion prior to nutrition guidance gradually decreased, and a pattern close to that during taking of basal hemodialytic diet for patients on maintenance hemodialysis was obtained.3) Protein score during ingestion of basal hemodialytic diet for patients on maintenance hemodialysis was 73, and the first limiting amino acid was isoleucine. The protein score prior to and after nutrition guidance was 75 and 84 respectively. The first limiting amino acid was tryptophan.4) Results of biochemical tests during the three days of new year feast after nutrition guidance was more stable than before the guidance. The effect of nutrition guidance for new year feast was thus recognizable.5) Prior to nutrition guidance, the patients on maintenance hemodialysis were more likely to be influenced by people around them. After the nutrition guidance, however, the pattern of food intake approached that of the basal hemodialytic diet for patients on maintenance hemodialysis, suggesting the positive attitude towards self management of the nutritional intake.