Nutrition and Anemia Management in Dialysis

nephroplus | February 27, 2013

By Akhila Gullapuram MS, RD

Every time I enter a dialysis unit, I first remind myself that the issues I’d like to address with my guests today may not be their agenda too. I often find myself facing questions from the guests which were left unanswered regarding the symptoms they might be experiencing at that time. Then whatever I say becomes irrelevant to them, if they haven’t understood the “how’s and why’s” first!

One of the big concerns for most of them is to manage their anemia. Anemia is a condition where blood does not have enough Red Blood Cells (RBC). Hemoglobin- an iron containing protein, is the main component of red blood cell which binds oxygen. Red Blood cells travel throughout the body and provide oxygen to different organs and tissues. By using oxygen, glucose from our food gets converted to energy. When your lab reports tell you that you have low hemoglobin levels, it means your tissues are not receiving enough oxygen. When you do not receive enough oxygen, you have low levels of energy and you may experience one or more symptoms such as:

Feeling week and tired
Shortness of breath
Rapid heartbeat
Poor cognition
Light headed
Chest pain
Most of you want to learn from me, how to fix anemia through food. To get things more clear, you have to understand that there are many types of anemia. Anemia in kidney disease is mostly due to low levels of erythropoietin and/ or iron in the body. Erythropoietin (EPO) is a hormone produced by kidneys that tells bone marrow in your body to make more red blood cells. Hence, if you have enough iron but no EPO or vice versa, your body may not still produce enough RBC.

Can we get enough iron through our food?

I conducted a random survey of foods in a popular store in the city to come up with some facts for you to know if the claimed product will improve your iron levels (as most of you ask me many times). Noticeable foods as sources of iron:

Health drink powders
Morning breakfast cereals
Diabetic health mixes
Whole wheat flour
Most morning breakfast cereals have 1mg iron per serving, which meets 3% of Recommended Daily Allowance (RDA) for normal adults. Health drink powders are in a range of 1.3 to 1.8 mg of iron per serving. Diabetic health mixes have1.5 to 1.7mg iron per serving and not to forget all the high phosphorus and calcium loaded in this category. Dates have 2.2mg of iron per serving and medium amount of potassium, calcium and phosphorus. Increasing the servings of dates to meet the iron needs will increase levels of potassium in blood. An increase of two more servings will be 430 mg of potassium, which can prove fatal when combined with the regular meal pattern. Consuming three rotis made of whole wheat flour will meet 12% RDA for iron. One cannot keep adding the amount of rotis to increase iron levels, as most of them are diabetics and many do not have great appetite. Iron needs are high for people with Chronic Kidney Disease (CKD) as their iron supply runs out quickly due to usage of EPO and decreased life span of RBC.

Nutrition: Adequate intakes of protein and total calories are needed for red blood cell production. Iron rich mineral is found in protein rich foods that help make hemoglobin. Protein rich red meat, green leafy vegetables, eggs are good sources. You can individualize your plan talking to a dietitian for iron rich meals to keep the constant supply of iron. However, your needs for iron with diet alone may not meet due to restrictions in the diet, poor appetite and absorption.

Things to remember:

1.Know your total calorie and protein needs for production of red blood cells.
2.Learn how to eat your total calories and protein needs.
3.Build up of waste in the blood stream can shorten the life span of existing RBC, so never miss or shorten your dialysis treatment.
4.Learn to eat from your dietitian to avoid building up too much waste in the blood if you are not coming for regular treatments.
5.Take your renal multivitamin tablet regularly that contains iron, vitamin B12 and folic acid.

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