Eating during dialysis

Hubby Bo likes to have treatments quite early in the morning, (4or 5am) and have his breakfast during treatment. We were just snacking, but have now gone to the full breakfast at times. We do try to do that towards the latter part of treatment. Having a smaller protien snack seems better to me but is this ok?

Hi also has another question. He gets tired of laying down and likes to sit up with feet down on the ground. Is this allowing the fluids to be sucked out easily or should he just do that for short periods?

Thank you so much for input.

Broadly, we do not encourage more than small snacks during dialysis … and there is a physiological ‘reason’ for this …

It all has to do with the ‘splanchnic circulation’. The splanchnic circulation (splanchnic comes from the ancient Greek word to describe the ‘visceral organs’) is that circulation that supplies the gut and the abdominal organs.

When (or after) we eat, blood is diverted into the splanchnic circulation to aid in the absorption of nutrients from our bowel as the food we have eaten is munched up and acid-dissolved by our stomachs, squirted with bile and enzymes from the gallbladder (bile) and pancreas (enzymes) to break down the fats and sugars released by the munching and dissolving of the stomach, and then is milked by a muscular squeezing process along the many feet of intestine where the nutrients are absorbed into the blood stream of the splanchnic circulation. Finally, water reabsorption and mucous secretion in the large bowel formulates our final stool (poo) for elimination at the rectum and anus.

Phew … there’s our bowel function in a single paragraph!

Eating triggers a diversion of a significant dollop of our total blood volume to this circulation … a circulation that almost runs as a parallel but ‘segregated’ circulation from our ‘systemic’ blood flow … the blood that wooshes down into our legs and arms and that supplies our kidneys (if they are there!), our brains, our lungs etc.

Eating ‘compartmentalizes’ a significant volume of our blood for absorption … and makes it relatively unavailable for the systemic circulation.

This means that the blood volume that has been redirected to the gut is less available for dialysis! Dialysis can access the systemic circulation … but not the splanchnic circulation!

You may begin to see now that this reduces the potential efficiency of the dialysis treatment as a means to ‘cleanse’ the total blood volume.

There are also blood pressure implications that can arise from splanchnic diversion, with hypotension a more likely complication of dialysis therapy delivered to a patient who has eaten on dialysis than if no eating had been permitted.

A snack? … let’s be fair … a snack is ok – but make it very light, and make it of easily digestible food. If the patient isn’t desperate to eat, then not eating is ideal. If eating is essential (some patients just can’t hang that long without something to eat) … then small amounts.

As for a full breakfast? I’d not be so thrilled, if I were your physician, to encourage that. Anyway, I reckon it’d be more enjoyable to have a full breaky after dialysis, in the sun, together, with the morning paper, and without a bunch of tubes hanging from the arm!

As for your question of whether he should have his legs down or up during dialysis … this is a question that is of enormous interest to me. We published on this – or a parallel issue – back in around 2004 (in ‘Nephrology’) and again in 2007 (in HDI) … looking at the effects on the serum albumin and on volume of recumbent versus erect (seated) dialysis. It’s a complex issue. So complex, indeed, that it is a little over-complex to deal with here … suffice to say, it is a fascinating academic ‘ride’ to delve into this murky subject.

From a practical stand-point, while there do appear to be some circualtory ‘advantages’ from recumbent dialysis, I’d not be at all worried if he wants to plonk his feet down!

In Australia, almost all conventional dialysis is semi-recumbent, at best … and many dialyse seated with their feet down. I suspect (no, I know) that this is also the case elsewhere around the world.

If he wants to sit up a while … go for it. But … as his blood volume has been changing through dialysis, he may be more easily prone to a postural change (a fall) in his blood pressure when he sits up … so do it slowly … don’t make a too-sudden change. It may help avert an unexpected ‘flat’.

Wow finally!! This eating thing has gone round and round with us going from pretty close to what you explained about blood being diverted (as in not a good thing to do) , to, mabie we are replenishing his neutrents and he wont have this low albumin issue (he’s 3.4 at this time) because it’s getting back into him right away. So, we’re back to a light snack only, as he is diabetic and his lows come in the morn, and also, he likes to eat/SNACK! to pass a little time… :slight_smile: Im a bit concerned for his blood tests we drew today as he had his hefty-er breakfast during treatment. :frowning:

And, im glad to hear about the sit/lay down issue as well. He has had more of the restless body feelings going on latly and needs to move a bit during D and dropping his legs feels better. Normaly, he only does that for about 10 min at a time so we’re ok with that. Once again though, today, he wanted to sit up longer than normal so it was time to ask.

Your much appreciated Dr Agar, many thanks!

If he is diabetic - yes, he may need a snack … or some source of sugar … especially if he’s starting early in the morning after sleep. Your doctor is best placed to advise on this - you will understand that I can’t.

However, the issue re the splanchnic circulation and the ‘sequestering of volume’ remains a dialysis issue (in general) that leads to the broad advice in dialysis patients to avoid large meals (eg: a full breakie) where possible. I have seen an "American’ breakfast, and it put the ‘fear of God’ into me! THAT, he could do without when on dialysis!

Some of the American breakfasts I have seen have been big enough to divert half of the blood volume to the splanchnic bed!!!

So, no waffles with a side of bacon during dialysis? No Denny’s “Grand Slam” brekky? ha

oh my gosh MM, Grand Slam is what hubby now calls my" brekky’s" as we dont get to frequent the REAL Grand Slam too often. lol And that is exactly what he wants DURING dialysis… I do have a great dialysis frendly waffle recepie though that he gets for just ‘snacking’ once again while on D… Isnt it great to have this help here… WOW! We are so lucky!

And Dr. Agar, I do believe that he has had more than half “diverted” :frowning: He’s being cooperative now though. Thanks for the help! :slight_smile:

I finally found this photo I took in 1996, Dr Agar can you guess which dialysis unit served me ths during my treatment? They also offered beer or wine. I think the cheese course gives it away.

EDITED TO ADD That’s an entire grilled tomato next to the steak and potatoes to go with the tomatoes in my salad. That’s probably more tomato than I had eaten over the entire 6 years of dialysis prior to this trip.

Bill … a classic photo … and one to keep and treasure!

From the way you couched the ‘can you guess which dialysis unit served me this during my treatment?’, I can only think it must have been an Australian unit … but, then again, the ‘I think the cheese course gives it away’ makes me think fondly and only of France!

How close?

It still doesn’t deter me from the general comment that splanchnic re-direction of blood flow resulting from eating during dialysis does ‘compartmentalise’ blood flow … but, then again, longer, slower, more frequent dialysis should (and does) diminish the potential impact of this to the point of negligible. In that event, I guess I could more safely say … eat up!

Tassin, possibly?

Now why didn’t I say Tassin!

Is there a prize for the correct answer?

Tassin is correct MM. Well done - you receive the Most Knowledgeable CKD4er in the Country award (: very well deserved.

Tassin at the time could brag about having the best outcomes in the world for 20 years, due to in no small part the chef whose food helped to keep dialyzors dialyzin’ the splanchnic circulation be damned (:

BTW it was after this trip, and in no small part due to what I saw at units like Tassin, that I asked to have my blood flow turned down and my treatment time increased.

Well, according to my latest labs, I’m CKD5, so I hope my award is even more prestigious. You may send me my prize at your earliest convenience. Make it big and sparkly…