PATIENT EDUCATION

Column Editor: Beth McQuiston, MS, RD, LD

Ways to Increase Protein IntakeMaria Karalis, RD, CSR, LD*

MALNUTRITION IS prevalent in bothhemodialysis and peritoneal dialysis pa-

tients. Many factors contribute to this problemincluding intercurrent illness, anorexia, catabolicstress, and loss of amino acids and proteins duringdialysis.

It is well known that a low serum albumin isstrongly correlated with increased morbidity andmortality and may be related to poor nutritionalintake. According to the Kidney/Disease Out-comes Quality Initiatives Nutrition Guidelines,serum albumin levels should be maintainedgreater than 4.0 g/dL. In their landmark studypublished in 1990, Lowrie and Lew1 revieweddata on 14,000 patients and found a strong asso-ciation between low serum albumin and mortal-ity. Of concern, nearly 70% of these patients hadserum albumin levels less than 4.0 g/dL. More-over, patients with a serum albumin level lessthan 2.5 g/dL were found to be particularly atrisk—having a 20-fold higher risk of death thanpatients with an albumin level greater than 4.0g/dL.1 Although serum albumin is a useful indi-cator of malnutrition, these values must be inter-preted with caution in chronic inflammatory

states, liver disease, pancreatic disease, and ne-phrotic syndrome.

When malnutrition truly exists, proper nutri-tional intervention is crucial to improve patientoutcomes. Adequate calorie intake is needed tomaintain energy stores and optimize protein me-tabolism. Current caloric recommendations fordialysis patients are 35 kcal/kg/d for patientsyounger than 60 years and 30 kcal/kg/d forpatients 60 years of age or older. Protein require-ments generally are 1.2 to 1.3 g of protein perkilogram of body weight per day, with 50% ofprotein from high biologic quality food sources.Importantly, adequate caloric intake is essentialfor its protein sparing effect. Otherwise, proteinwill be catabolized for energy.

These patient education tools were adaptedfrom materials developed by the patient educa-tion committee of Fresenius dietitians in the Chi-cago area (formally Everest Healthcare). Com-mittee members included Pat Cooper RD, CSR,LD; Maria Karalis RD, CSR, LD; Teila Licht-man RD, CSR, LD; Beth McQuiston MS, RD,LD; Fay Moore, RD, CSR, LD; and TerrieRydzon RD, CSR, LD. Special care was taken toensure these materials were written at a fifth-grade level, with a large font size to maximizereadability. These tools may be used as presentedor adapted to assist renal patients on increasingprotein intake. Information on how to add pro-tein powders to various foods is also provided.

Reference1. Lowrie EG, Lew NL: Death risk in hemodialysis patients:

The predictive value of commonly measured variables and anevaluation of death rate between facilities. Am J Kidney Dis15:458-482, 1990

Submitted by *Maria Karalis, RD, CSR, LD, Staff Developer,Fresenius Medical Care, Westchester, IL.

This Patient Information Form may be photocopied for thepurpose of distribution to patients only, but not for any otherpurposes, such as copying for general distribution, for advertising orpromotional purposes, for creating new collective works, or for resale.

Professional review and adaptation before patient use is encour-aged.

© 2002 by the National Kidney Foundation, Inc.1051-2276/02/1202-0766$35.00/0doi:10.1053/jren.2002.32671

Journal of Renal Nutrition, Vol 12, No 2 (April), 2002: pp 136-138136

PATIENT EDUCATION 137

MARIA KARALIS138