NUTRISI PASIEN HEMODIALISIS

8/17/2019 NUTRISI PASIEN HEMODIALISIS

1/25

PRINSIP NUTRISIPASIEN HEMODIALISIS

dr. Agung Susanto,SpPD

Divisi Ginja Hip!rt!nsi

RSUD Dr.Mo!"ardi Sura#arta


2/25

Pendahulua

n• GG$ % – P!nurunan &ungsi

– $roni# progr!si&

– 'ungsi nor(a !nd stag!

• )$D %

– $!ainan &* + anato(is -uan


3/25

CKD dibagi 5 stadium :

I. Kidney DamageG'R nor(a + / 01 22+(!nitA-u(inuria, prot!inuria, 3!(aturia

II. Kidney DamageG'R (!nurun s!di#it 451670 22+(!nit8

A-u(inuria, prot!inuria, 3!(aturia

III. Penurunan GFR SedangG'R 1690 22+(nt

R!na “insufciency”

IV. Penurunan GFR BeratG'R :96;0 22+(ntR!na “insufciency”

V. Renal Failure (CRFG'R


4/25

• Stadium I!IV – )$D -!u( diaisis 4pr!diaisis8

– T!rapi #ons!rvati& %• Diet

• "bat

• #u$uan nutrisi GGK

– M!n2!ga3 (anutrisi

– P!ning#atan =uait> o& Li&!

– P!nurunan (or-iditas + (ortaitas


5/25

GG$ GG$

Gangguan :

-Absorbsi

-Ekskresi

-Metabolisme

• Metabolisme Lemak :

- Kolesterol LDL, VLDL

- Kolesterol HDL↓

• Metabolisme Protein

• Asidosis katabolisme protein

imbunan sisa metab! "itrogen #remik

Kelu$ kesa$ uremi

• Gangguan sintesis protein % asam amino


6/25

GG$

R!t!nsi(!ta-ois(!%

6Prot!in6P!ptid!6Nu2!i2 a2id6Asa( a(ino6$ar-o3idrat

P!nurunan!#s#r!si %6Urin! +air6Gara(6$aiu(6Magn!siu(

6'os&at

P!nurunana-sor-si

6$asiu(6?!si6Ri-o@avin6'oat6it D

P!ning#atana#u(uasi

6AL

-Advancedglycosilationend product


7/25

Akumulasi ToksinUreum

Metabolisme Abnormal

Protein & Asam Amino

Metabolisme

Abnormal

Hormon & Vitamin

Peningkatan Katabolisme

Protein

Gangguan

Keseimbangan Elektrolit

GGGG$ $

M A

L

N

UT

R

IS

I


8/25

Penyebab %alnutrisi :

• Masu#an & 4naus!a + vo(itus8

• Asidosis (!ta-oi#

• R!spon ana-oi# 3or(on &

• In@a(asi #roni#


9/25

DUKUNGAN

NUTRISI

MENEGAH

MA!NUTRISI

MENGURANGI E"EK SAMPING

AKI#AT #ERKURANGN$A "UNGSI

EKSKRESI

%UT%ME

GAGA! GINA!

GGGG

$ $


10/25

MA!NUTRISI

TERGANGGUN$A

SISTEM IMUN

PEN$EM#UHAN

!UKA

TERGANGGU

M%R#IDITAS

&M%RTA!ITAS


11/25

• Pasi!n )$D % – Pasi!n pr! HD

– Pasi!n HD rutin

– Pasi!n )APD.

Sama dalam'enatalasanaan

'embatasan)balans

*airan

Berbeda dalam dietnutrisi+ terutama

'r,tein.


12/25

-. Pembatasan)BalansCairan

• P!rta(a daa( Di!t Ginja

• Pasi!n pr! HD, )$D stag! III6 (uta#(!(!ru#an -aans 2airan.

• Pasi!n gaga ginja t!r(ina HD rutinp!nurunan RR' diur!sis -!r#urang

-aans 2airan 3arus #!tat.

• P!(!i3araan RR' pada pasi!n HD rutindip!ru#an diur!sis r!ati& 2u#up(!(-!ri#an #!onggaran daa( inta#!2airan.


13/25

• P!(-atasan 2airan -!r-!da antara satupasi!n dan ainn>a.

• $ondisi ov!r3idrasi -aans 2airan3arus n!gati&.

• Saat d!3idrasi -aans 2airan 3aruspositi& sa(pai r!3idrasi.

• P!ni(-angan pra dan pas2a HD 3arusdia#u#an s!tiap #ai s!si HD.

• P!rta(-a3an ?? antara pas2a HD dan

pra HD -!ri#ut p!rti(-anganp!nari#an 2airan >ang dia#u#an.

• Ma#si(a daa( : s!si L


14/25

• Pada pasi!n )APD, -ia s!(ua

-!r&ungsi -ai# 2airan diaisat >angdi#!uar#an s!au !-i3 -an>a#.

• Pasi!n )APD (asi3 dapat (inu(

2u#up onggar, (!s#ipun t!tapdi-atasi.

• Daa( #!adaan !d!(a, -aans

2airan t!tap 3arus n!gati&.


15/25

• Pada )APD, RR' !-i3 a"!t di-anding

HD.

• )APD d!ngan !*23ang! id!a B #aip!r3ari, a#an (!(-!ri#an @u#tuasi

ur!u(, #r!atinin, dan to#sin >ang!-i3 #!2i dan -!rada daa( #adarr!ati& r!nda3 di-anding#an HD.

• ?!-an to#sin ur!(ia pasi!n HD !-i3-!rat C-rosis !-i3 2!pat RR'!-i3 2!pat turun


16/25

• $o(pi#asi pasi!n )$D d!ngan

ov!r3idrasi % – Ed!(a paru 2ito HD

– Ed!(a #a#i (!ngganggu pasi!n

– Asit!s, t!ruta(a -isa juga dia#i-at#an

3ipoa-u(in!(ia

• D!ngan HD rutin, di3arap#anp!r-ai#an #ondisi ov!r3idrasi.

• Ed!(a paru dan !d!(a #a#i !-i3(uda3 t!ratasi.


17/25

• Asit!s 2!nd!rung suit diatasi d!ngan HD.

• Daa( indi#asi t!rt!ntu dia#u#anparas!nt!sis

• U(u(n>a paras!nt!sis dia#u#an d!ngan-atasan a-u(in (g+d, dan indi#asi

j!as.• S!tiap #ai paras!nt!sis, di#!uar#an 6B L

2airan.

• Paras!nt!sis -isa dia#u#an s!ang ; 3ari.


18/25

.Kal,ri• $aori pasi!n )$D (!ngi#uti ?? id!a.

• M!nurut Nationa $idn!> 'oundationFs, #!-utu3an #aori padapasi!n 3!(odiaisis daa( #ondisi (!ta-oi# s!i(-ang adaa3169 #aori+$g.

• Rata6rata dip!ru#an :116:011 #aori+3ari.

• $aori s!-agian -!sar ditutup dari (asu#an #ar-o3idrat.

• Tida# -an>a# p!(-atasan.

• u(a3 #ar-o3idrat (!!ng#api tota #aori >ang 3arus dip!nu3i

p!r3ari, s!t!a3 di#urangi p!(-!rian #aori daa( -!ntu#prot!in.

/.Karb,hid

rat


19/25

• Aturan dasar adaa3 p!(-atasan prot!in.

• Pasi!n )$D -!u( HD di!t r!nda3prot!in 1,961,5 g+#g??+3ari, d!ngan prot!in

>ang (!(ii#i niai -ioogis tinggi.• Pasi!n )$D >ang HD rutin, (asu#an

prot!in s!p!rti orang u(u(, -!r#isar 91 grprot!in p!r3ari untu# rata6rata ?? 91 #g.

• Pasi!n )$D d!ngan )APD di!t prot!in!-i3 tinggi, #ar!na #!3iangan prot!in !-i3-!sar.

0.'r,tein

5 1l t li


20/25

• Natriu( dan #aiu( di-atasi.• 'os&at tida# -o!3 ada, o!3 #ar!na

suda3 t!rjadi 3ip!r&os&at!(ia.

• Au(iniu( tida# di-!ri#an #ar!narisi#o into#si#asi.

• Magn!siu( 3arus sangat 3ati63ati,

-!r3u-ungan d!ngan ost!odistroC.• ?!si, 3arus 2u#up, #ar!na

-!r3u-ungan d!ngan #!-!r3asian

p!(-!rian t!rapi !ritropo!tin.

5.1letr,lit


21/25

2. Pemberian Su'lemen3sam Ket,

• Sup!(!n asa( #!to u(u( di-!ri#an padapasi!n )$D pr! HD.

• P!(-!rian sup!(!n asa( #!to padapasi!n d!ngan HD rutin dapat

dirasionaisasi untu# (!(p!rta3an#an RR'>ang (asi3 ada.

• Titi# #!rja asa( #!to adaa3 sup!(!nasa( a(ino !s!nsia >ang dip!ru#an

-adan, d!ngan tanpa (!(-!ntu# ur!anitrog!n.

4 K b h


22/25

4.KebutuhanVitamin

• Pasi!n gaga ginja sangat ris#anuntu# d!Csi!nsi -!-!rapa(i#ronutri!nt.

• Pasi!n d!ngan diaisis dapat#!3iangan vita(in arut air.

• ita(in D (!rupa#an vita(in >ang

(!ngaa(i d!Csi!nsi #ar!na saa3satu &ungsi ginja adaa3 untu# a#tivasivita(in D.


23/25

Chronic renal failurea,b,c Maintenance hemodialysis

!"#eContinous ambulatory or cyclic

$eritoneal dialysis CA%" or CC%"#d

Minerals ran&e of inta'e#

Sodium m&(day#

%otassium me)(day# %hos$horus m&('&(day#

Calcium m&(day#

Ma&nesium m&(day#

Iron m&(day#

*inc m&(day#

+ater ml(day#

itamins

Thiamin m&(day#

Ribofla-in m&(day# %antothenic acid m&(day#

Niacin m&(day#

%yrido.ine !CL m&(day#

itamin /01 µ&(day#

itamin C m&(day#

2olic Acid

itamin A

itamin " itamin 3 IU(day#

itamin 4

0555 to 6555h

75 to 857 to 05

0755 to 0955

155 to 655

≥ 05 to 0:m

0;

U$ to 6555 as tolerated

0


24/25

KE#HA" "#'()( PADA PE"DE'(A GGK

Tabel< >umlah Nutrisi yan& dian?ur'an $ada $enderita @a&al @in?al 4roni', !emodialisis dan %eritoneal dialisis

Chronic renal failurea,b,c Maintenance hemodialysis

!"#eContinous ambulatory or cyclic

$eritoneal dialysis CA%" or CC%"#d

%rotein

Lo= $rotein diet

ery lo= $rotein diet

3ner&y 'cal('&(day

2at $ercent of total

ener&y inta'e#e,f

%olyunsaturatedsaturated

fatty acid ratiof

Carbohydrate f,&

Total fiber inta'e &m(day#f

5 015

$ercent or the $atient &ains or is afraid of

&ainin& un=anted =ei&ht

65 75

0


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NUTRISI PASIEN HEMODIALISIS