More about nutrition

I have posted here recently about my dad’s hemoglobin being very low. His protein, albumin?, also is consistently very low and I am concerned about this malnutrition, basically, compromising his ability to respond optimally to the PD. Is it common for PD patients to take heavy duty multivitamins and/or protein supplements? It seems like his dialysis nurse or a dietitian should be addressing this pretty aggressively. I try not to get overly involved but I know that he may not be doing everything they suggest, either.

What’s “very low,” Babboo? Your dad’s serum albumin (protein) level should be higher than 3.5 g/dL at minimum, and ideally 4.0 g/dL or more. If it’s lower, you’re right to be concerned. Sometimes people on dialysis (PD or in-center HD) have no appetite at all or for protein in particular if they are not getting enough dialysis. This IS something the dietitian should be addressing with your dad. Sometimes there is a tendency to forget about home patients when it comes to dietitian and social work services, and it’s important to insist that they get the same kind of help that someone who is in-center would receive. Dietitians have lots of ways to help increase protein in the diet. Here’s a link to a Life Options newsletter we wrote on the topic: You might also check out the Nutrition and Fluids module of Kidney School at Both of these are good background for having a talk with the dietitian about improving your dad’s protein levels.

You asked about the use of vitamins and protein supplements. Dialysis patients routinely are prescribed special vitamins that are made for patients with kidney disease. Some patients are prescribed nutrition supplements, including protein supplements. Like Dori said, the better his albumin level is, the better he’ll feel. When albumin is less than 3.5, it increases a patient’s risk of infection so it would be good to get more protein. If beef doesn’t taste good to him maybe he’d enjoy chicken, fish, or even eggs. Some dietitians suggest powdered egg whites that can be added to just about anything.

One thing to keep in mind is that the staff at the dialysis clinic can’t talk with anyone, even family, without permission because of federal privacy laws. Talk with your father and share you concern and interest in helping him to his best. Ask him to give the staff permission to talk with you. If your father doesn’t give permission for the staff to talk with you and you’re concerned that he may not doing what the dietitian and other staff suggest so far as eating to nourish himself, you can always share what you have observed. This will give the dialysis dietitian more information than he/she may have now.

Another thing that may be affecting your father’s health and nutrition is depression. Many people who have kidney damage and kidney failure become depressed. They may stop or feel unable to do things they enjoy and feel like their life is over. However, sometimes when they come to clinic, they put on a “happy face,” hiding their pain. Staff may believe the patient is coping OK so those patients don’t get treatment (counselor and/or medication). Every dialysis clinic has a social worker who should be able to counsel your father and/or refer him to a community counselor. Talk with your father’s social worker about his personality before and after kidney failure and seek suggestions for ways to give your father the emotional support that will help him cope well with kidney failure. If he needs antidepressant medication, the nephrologist may be willing to prescribe it or may want him to see a psychiatrist so he can medication that won’t be dialyzed off. Check out Kidney School for the coping module. Here’s additional info on depression:

Thank you for your responses.
My delay in getting back with some details has been due to the fact that I haven’t had any solid info for a few weeks. My dad is 1,100 miles away from me and he now has a sinus infection, I am surely partly because his protein has been so low he was more susceptible to infection. He hasn’t been able to get to me with a fax or the mail. Finally he called and read me “his numbers.”
Your responses are dead-on. First, his albumin currently is 3.6 and that is UP, a lot, from where it has been. Also, his hct is 33, which is also UP, dramatically, from where it has been the past couuple of months.
Also, my dad sure DOES put on a happy face when he goes to the clinic and this drives my family nuts! The nurse has no idea, but I think she is catching on…
He has been prescribed protein supplements (finally) to put in his food. Our challenge right now is to get him to eat anything at all. Between the sinus infection and the way he’s been feeling on PD–very low blood pressure, dramatically fluctuating blood sugar–I don’t blame the man for being depressed and not wanting to anything at all.
His 69th birthday is this week. I am hoping that we can renew some hope and keep optimistic about all this. I really appreciate your help and thank you.