Protein needs while on dialysis

Your new needs

People who have been on a protein restricted diet before starting dialysis are often confused when they start dialysis and are told that they need to eat more protein. "How can you get too much protein, then not be able to get enough?" is often the question. The difference with dialysis is that you now have an artificial kidney. This "kidney" is not as efficient as your original kidneys, but it does remove much of the waste your body produces. This allows an increased protein intake without the danger of a dangerous buildup of its side products.

Additionally, both advanced kidney disease and dialysis cause a higher need for protein intake. The kidney disease causes certain changes in your body's metabolism, breaking down some of the protein you eat before your body can use it. Hemodialysis also causes some protein loss in the small amounts of blood that are lost each treatment.

Intake levels

As mentioned above, the dialysis treatment is not as efficient as your original kidneys. This means that there are still some restrictions in terms of types of protein eaten, if not the amounts. "High Biologic Value" (HBV) protein should still account for the majority of protein eaten to help further control the waste products. Protein intake with greater than 60% HBV protein is a good target.

For those on dialysis, the recommendation is 0.55 grams of dietary protein per pound of body weight. This is higher than the 0.36 grams recommended for the average healthy individual and, of course, higher than the 0.25 grams per pound of body weight used with the pre-dialysis diet.

How does this change the pre-dialysis diet of our average sized man? On the pre-dialysis diet he was allowed 37-41 grams of protein a day, now that he is on hemodialysis, his needs are increased to 82 grams per day.

Protein Intake Goals 0.55 grams/lb body weight or 1 ounce of HBV food per 13 lbs. Sample Intakes Weight (lbs) Protein Intake (grams) 100 55 125 69 150 82 175 96 200 110 1 ounce of HBV food = 7 grams of protein. [ For example, 3 oz. of turkey would provide 21 grams of protein. ]

Therefore, the diet now is:
65% of protein from HBV sources: 82 X 65% = 53 grams or 8 ounces of HBV foods (56 grams). 82 X 35% = 29 grams of protein from other foods.
These 29 grams could come from 4 vegetable servings (4 grams), 8 grain servings (16 grams), two milk servings (8 grams), and 4 fruit servings (0 grams) for a total of 28 grams. (See the Arizona Dietetic Project for serving sizes.)

As with the pre-dialysis diet, consistency is the key to success. A day or two of reduced intake, maybe due to a cold, is okay as long as intake goes back to usual afterwards. If intake is too low for extended amounts of time, there is a danger of developing a protein deficiency.

Checking your protein status

Your dietitian looks at your lab results to help determine if your intake is adequate. A main indicator is albumin (there are others). Albumin circulates in your blood and is your body's way of storing protein. A low albumin is an indication of poor protein status and your dietitian will work with you to try to increase your intake.

Since albumin reflects protein storage, it takes time to raise its levels. Increased protein intake may not be reflected in albumin levels for 1-2 months. If poor appetite or a dislike for HBV foods occurs, speak with your dietitian about ways to supplement your intake

Protein and muscles

Albumin Your body's protein storage. Blood levels should be 3.8 or higher. Corrective actions should be taken with levels less than 3.5.

Protein is important for keeping your muscles in good shape, but it does not help develop muscle. That's where exercise comes in. To maintain your muscle mass it is necessary to use those muscles ("use 'em or lose 'em"). Activity helps keep your muscles strong. Do stretching exercises and strength exercises on a regular basis to keep up your strength.