Development of High Protein Low Potassium and Phosphorus Blenderized Diet Formula for End Stage Renal Disease Patients on Hemodialysis at Ramathibodi Hospital

Abstract

End stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) are at risk of malnutrition due to decreased appetite and require to restrict some dietary intakes, specifically, sodium, potassium, phosphorus and fluid. Currently, only standard hospital-based blenderized diet (BD) formula and diabetes formula are available. This pilot study aimed to develop a new BD formula for ESRD patients who are on MHD. Isocaloric, isonitrogenous BD formulas containing different carbohydrate sources and controlling for potassium and phosphorus contents were developed. The final three formulas with energy density of 1.5 kcal/ml were (1) banana and pumpkin formula, (2) bread formula, and (3) rice formula. Fifty ESRD patients on MHD were enrolled from the renal clinic at Ramathibodi Hospital. The sensory evaluation was performed using a 9-point Hedonic scale on appearance, texture, flavor, smell, color, overall acceptability. Physical properties, including appearance, viscosity, nutritive values and cost were also determined. Results showed that the rice formula had higher overall satisfaction score compared with the bread and banana/pumpkin formula (7.54 ± 1.28, 6.94 ± 1.68, 6.68 ± 1.88, respectively, p < 0.05). In conclusion, all developed formula were acceptable for use by ESRD patients, having highest satisfaction score with the rice formula. These new BD formula can be given orally or by tube feeding in addition to main meals for ESRD patients. It is important that patients are monitored by dietitians and physicians to ensure overall adequacy in energy and other required nutrients.