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Nephrisol គឺជាអារហារបំប៉នដ៏ពិសេស (អាចឆុងពិសារធម្មតានិងសុងតាមបំពង់អាហារ) ត្រូវបានផលិតឡើងដើម្បីបំពេញតំរូវការសម្រាប់អ្នកដែលមានបញ្ហាខ្សោយតម្រងនោម ដែលអាចជួយពន្យារការវិវឌ្ឍន៏របស់ជំងឺខ្សោយតម្រង់នោមរាំរ៉ៃមុនតំណាក់កាលលាង ឈាមបានយ៉ាងល្អប្រសើរ។

Nephrisol មានផ្ទុកនូវសារធាតុចិញ្ចឹមសំខាន់ៗដូចជា:

កម្រិតប្រូតេអ៊ីនទាប

អាស៊ីតអាម៉ីណេទាំង៩ប្រភេទដែលចាំបាច់សម្រាប់រាងកាយ (ជាប្រភេទប្រូតេអ៊ីនដែលមានគុណតម្លៃជីវសាស្ត្រខ្ពស់)

វីតាមីន១២មុខនិងសារធាតុរ៉ែ៧ប្រភេទ

គ្មានផ្ទុកLactose

លក្ខណៈពិសេស & អត្ថប្រយោជន៏

លក្ខណៈពិសេស	អត្ថប្រយោជន៏
ផលិតឡើងសម្រាប់អ្នកជំងឺខ្សោយតម្រងនោម	បំពេញតម្រូវការសារធាតុចិញ្ចឹមប្រចាំថ្ងៃហើយសមស្របតាមស្ថានភាពរបស់អ្នកជំងឺ
កម្រិតប្រូតេអ៊ីនទាប	ជួយថែរក្សាមុខងារតម្រងនោមរបស់អ្នកជំងឺមុនតំណាក់កាលលាងឈាម
សារធាតុរ៉ែតម្រូវតាមស្ថានភាពរបស់អ្នកជំងឺខ្សោយតម្រងនោម	ការពារផលរំខានផ្សេងៗដែលបណ្តាលមកពីការបរិភោគសារធាតុចិញ្ចឹមមិនត្រឹមត្រូវ
Maltodextrin ជាប្រភពកាបូអ៊ីដ្រាត	ងាយស្រួលរលាយនិងស្រូបបានល្អ(ដោយមិនចាំបាច់ប្រើទឹកក្តៅ), លាក់បាំងក្លិនឆ្អាបនិងរសជាតិល្វីងរបស់ប្រូតេអ៊ីន
មានបូកបន្ថែម whey និង casein	បង្កើតឲ្យមានការសំយោគប្រូតេអ៊ីនលឿននិងមានរយៈពេលវែង។
គ្មានខ្លាញ់សត្វ	សម្បូរ MUFA និង PUFA, MCT ព្រមទាំងមានផ្ទុក USFA (ខ្ពស់ជាង២ដង) ច្រើនជាង SFA។
Sucralose ជាសារធាតុផ្អែម	មិនធ្វើឲ្យប៉ះពាល់ដល់កំរិតជាតិស្ករក្នុងឈាម មេតាបូលីសកាបូអ៊ីដ្រាត ឬការផលិតអាំងស៊ុយលីនឡើយ។
ដង់ស៊ីតេ១,០៤	អាចច្រកតាម NGT/Sonde/សុងតាមបំពង់រំលាយអាហារ
មានកំរិតអូស្មូឡាលីតេទាប	ដែលអាចបញ្ជៀសរអ្នកជំងឺពីការរាគ

References :

1.Bellizzi V. Low Protein Diet or Nutritional Therapy in Chronic Kidney Disease?. Blood Purif 2013; 36:41-6.

2.Eustace JA, Coresh J, Kutchey C, Te PL, Gimenez LF, Scheel PJ, et.al. Randomized double-blind trial of oral essential amino acids for dialysis-associated hypoalbuminemia. [Internet]. [cited 2021 April 16th]. Available from: https://core.ac.uk/reader/82189560

3.Fouque D. Low Protein, Amino Acid and Ketoacid Diets to Slow the Progression of Chronic Kidney Disease and Improved Metabolic Control of Uremia. NutrManag Renal Dis. 2013; 209-31

4.Fouque D and Mitch WE, 2012. Dietary Approaches to Kidney Disease. In: Taal MW, Chertow GM, Mars PA, Skorecki K, Yu AS and Brenner BM. Editors. Brenner & Rector’s The Kidney. 9th ed. USA; Elsiver Saunders. 2170-204.

5.Garneata L; Mircescu G. Effect of Low Protein Diet Supplemented With Keto Acids on Progression of Chronic Kidney Disease. J Renal Nutr, 2013; 23: 210-3

6.Goldstein-Fuchs, D, LaPierre AM. 2014. Nutrition and Kidney Disease. In: Gilbert GJ, Weiner ME. Editors. National Kidney Foundation’s Primer on Kidney Diseases. Philadelphia; Elseiver Saunderz. P:467-74.

7.Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et.al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. [Internet]. [cited 2021 April 16th]. Available from: https://www.ajkd.org/article/S0272-6386(20)30726-5/fulltext

8.NEPHRISOL[Product Information] Jakarta. Indonesia. PT Kalbe Farma Tbk; 2017

របៀបឆុងៈ

Nephrisol អាចឆុងពិសារធម្មតា រឺសុងតាមបំពង់រំលាយអាហារ៖

ឆុងពិសារធម្មតាៈ ដើម្បីរៀបចំទឹកដោះគោ២៥០មីលីលីត្រ ត្រូវវាល់ម្សៅទឹកដោះគោ៤ស្រាបព្រា(ស្មើនឹង៦១ក្រាម) លាយជាមួយទឹកក្តៅអ៊ុនៗ ២០០មីលីលីត្រដោយកូរឲ្យសព្វ។ Nephrisol ក៏អាចពិសារជាអាហារសម្រន់, ស្ម៊ូតធី, ផាត់ឌីងបានដែរ…។ មិនត្រូវបានណែនាំឲ្យចំអិនរឺដាំដោយប្រើសីតុណ្ហភាពខ្ពស់ទេ (សីតុណ្ហភាពត្រូវស្ថិតនៅក្រោម៦០អង្សាសេ) ដោយសារអាចបំផ្លាញប្រូតេអ៊ីនដែលមាននៅក្នុង Nephrisol។ គួរតែពិសារ Nephrisol នៅចន្លោះអាហារ។

សុងតាមបំពង់អាហារៈ ត្រូវគោរពតាមការណែនាំរបស់គ្រូពេទ្យ។

មិនត្រូវបានផលិតឡើងសម្រាប់ចាក់តាមសរសៃរឡើយ។

សារធាតុចិញ្ចឹមៈ

អាហារបំប៉នមានផ្ទុកសារធាតុចិញ្ចឹមគ្រប់គ្រាន់ ហើយក្នុង១មីលីលីត្រអាចផ្តល់ថាមពល១.០៤គីឡូកាឡូរី ជាមួយនឹងអាស៊ីតអាមីណេ៩ប្រភេទដែលចាំបាច់សម្រាប់រាងកាយ អាស៊ីតអាមីណេ១១ប្រភេទផ្សេងទៀត រួមជាមួយវីតាមីន១២មុខនិងសារធាតុរ៉ែ៨ប្រភេទដែលចាំបាច់សម្រាប់តំរូវការប្រចាំថ្ងៃ។

សារធាតុចិញ្ចឹម	ឯក្កតៈ	ក្នុងមួយរង្វាល់	%តម្រូវការប្រចាំថ្ងៃ
កាឡូរី	kCal	260
កាឡូរីពីខ្លាញ់	kCal	50
ខ្លាញ់សរុប	g	6	9%
Saturated fatty acid	g	2	8%
Monounsaturated fatty acid	g	2.5
Polyunsaturated fatty acid	g	1.5
ប្រូតេអ៊ីន	g	5	8%
កាបូអ៊ីដ្រាតសរុប	g	48	16%
Sucrose	g	3
Lactose	g	0
វីតាមីន
វីតាមីន A	IU	250	15%
វីតាមីន C	mg	11	10%
វីតាមីន D3	IU	33	8%
វីតាមីន E	mg	1.7	10%
វីតាមីន B1	mg	0.23	25%
វីតាមីន B2	mg	0.28	25%
Niacin	mg	3.20	20%
វីតាមីន B6	mg	0.37	30%
វីតាមីន B12	μg	0.33	15%
Folic acid	μg	67	15%
Pantothenic acid	mg	1	15%
Biotin	μg	12
សារធាតុរ៉ែ
សូដ្យូម	mg	87	4%
ប៉ូតាស្យូម	mg	46	2%
កាល់ស្យូម	mg	120	15%
ផូស្វ័រ	mg	79	10%
ម៉ាញ៉េស្យូម	mg	20	8%
ស័ង្កសី	mg	1.53	15%
សេលេញ៉ូម	μg	4.9	15%
បរិមាណសរុប (ប្រូតេអ៊ីននិងអាស៊ីតអាមីណេ)	g	0.73
អាស៊ីតអាមីណេសារាវ័ន្ត
Leucine	g	0.6
Isoleucine	g	0.4
Valine	g	0.5
Tryptophan	g	0.1
Phenylalanine	g	0.4
Methionine	g	0.4
Threonine	g	0.3
Lysine	g	0.4
Histidine	g	0.2
អាស៊ីតអាមីណេមិនសារាវ័ន្ត
Aspartate	g	0.2
Glutamate	g	0.3
Serine	g	0.1
Glycine	g	0.04
Arginine	g	0.17
Alanine	g	0.1
Tyrosine	g	0.1
Proline	g	0.18
Cystine	g	0.04
Taurine	g	0.2
Glutamine	g	0.2

សមាសធាតុផ្សំៈ

Maltodextrin, ប្រេងរុក្ខជាតិ (កាណូឡា, ផ្កាឈូករ័ត្ន, Palm Kernel និង ប្រេងដូង), Sucrose, អាស៊ីតអាមីណេ, Whey Protein, សារធាតុរ៉ែ (កាល់ស្យូមកាបូណាត, ម៉ូណូសូដ្យូមផូស្វាត, ប៉ូតាស្យូមក្លរួ, សូដ្យូមក្លរួ, ម៉ាញ៉េស្យូមអុកស៊ីត, ស័ង្កសីអុកស៊ីត, សូដ្យូមសេលេនីត), Calcium Caseinate, រសជាតិវ៉ានីឡា, រសជាតិទឹកដោះគោពីធម្មជាតិ, វីតាមីន (L Sodium Ascorbate, , វីតាមីន E, កាល់ស្យូម Pantothenate, វីតាមីន A, Pyridoxine HCl, វីតាមីន D3, Cyanocobalamin, Thiamine HCl, Riboflavin, Folic Acid, Biotin),សារធាតុផ្អែម Sucralose ២២មីលីក្រាមក្នុង១រង្វាល់។

ការរក្សាទុកៈ

ក្រោយពេលបើកកញ្ចប់ត្រូវរក្សាទុកនៅកន្លែងត្រជាក់ ស្ងួត និងស្អាត។ ត្រូវពិសារឲ្យអស់ក្នុងរយៈពេល១ខែក្រោយពេលបើកកញ្ចប់រួច។

ការវេចខ្ចប់និងរសជាតិៈ

ក្នុង១ប្រអប់មានផ្ទុកម្សៅទឹកដោះគោ១៨៥ក្រាម ដែលមានរសជាតិវ៉ានីឡា។

ក្នុង១ប្រអប់ស្មើនឹង៣រង្វាល់។

FAQ

What is the content of NEPHRISOL?

NEPHRISOL is a special enteral nutrient for kidney dysfunction, has a composition of 63% carbohydrates, 7% protein and 30% fat and with mineral and vitamin contents that have been adjusted for pre-dialysis chronic kidney disease conditions. NEPHRISOL also has a low protein content, so it is in accordance with the recommended protein requirements for pre-dialysis kidney patients.

How many calories are produced from NEPHRISOL per serving?

NEPHRISOL contains calories of 260 Kcal / serving.

How many servings of NEPHRISOL can be consumed per day ?

If as a substitute food, NEPHRISOL can be given up to 6 times / day or adjusted to the needs and patient’s conditions. If as a complementary food can be given 2-3 times / day.

What is the calorie density of NEPHRISOL?

The calorie density of NEPHRISOL is 1.04 so that it can be given orally or tube feeding (the density does not exceed than 1.5).

What is the osmolality of NEPHRISOL?

NEPHRISOL osmolality is 354 mOsm / kg for vanilla variants

When can NEPHRISOL be used?

NEPHRISOL can be given to chronic kidney disease (pre-dialysis stage)

How is the presentation of NEPHRISOL?

Prepare 200 mL of warm boiled water with a temperature of <70 degrees Celsius then mix and stir until it is mixed homogeneously. Do not use hot water because it can damage the protein content.

How many times can NEPHRISOL be consumed a day?

NEPHRISOL if as a substitute food can be given up to 6 times / day or adjusted to the needs and conditions of the patient. If as a complementary meal can be given as much as 1-3 times / day.

Is it allowed if we put more than 4 spoons per serving to increase calorie?

Yes it’s allowed. Our product as complementary nutrition, that’s why the calorie is not high. It will be easier to adjust and patient can still eat their daily meals. Moreover we have amino acids premix which’s complying to the EAA: NEAA ratio following the guideline and is needed by patient, it is high biological value protein, an essential for every metabolic process, as main component to rebuild and maintain the balance of body functions, meanwhile other products don’t describe it.

If we put more than 4 spoons per serving, we need to add the water volume so we can maintain the density does not exceed than 1.5 kcal/mL

Can NEPHRISOL be combined with other enteral nutrients?

NEPHRISOL can be combined with other enteral nutrients if needed, but the dissolution process should be done separately.

What is the preparation for NGT patients?

The same with oral preparations depends on how many calorie patient needs. It can be accepted for the tube feeding size: 16 – 18 gauge and put each scoops gradually (while stirring and mix until dissolve to avoid the granules) and make sure that the density does not exceed than 1.5 kcal/mL

Can NEPHRISOL be given to patients with diabetes mellitus (DM)?

DM patients who are given NEPHRISOL to always monitor their blood sugar levels in order to stay controlled. Sometimes it is necessary to adjust the dose or adjust the type of diabetes medication so that the fulfillment of nutrition in DM patients is met.

What is the stability / method of storing NEPHRISOL before it is dissolved?

The unlocked NEPHRISOL lasts for 1 month as long as it stays in the aluminum bag. Store in a dry place with a temperature <25 degrees Celsius. It is not recommended to move NEPHRISOL into other places because it can interfere with its stability. If it is to be stored in a jar it should be together with the aluminum bag.

What is the stability / method of storing NEPHRISOL after dissolving?

NEPHRISOL which has been dissolved in 5 hours must be taken. If you have not finished drinking NEPHRISOL can be stored in the refrigerator, only afterwards it is not recommended to be heated (Microwave).

What is the source of carbohydrates used in Nephrisol?

Maltodextrin. Maltodextrin has the advantage of being easily absorbed so that it will optimize the formation of energy. Maltodextrin also dissolves easily, so the process of dissolving Nephrisol does not need to use hot water. Maltodextrin can help give volume (solid builder) by drawing water from dried products. Maltodextrin has a sweeter taste than sugar but has less sugar content, and serves to mask the fishy taste of fat and the bitter taste of protein content.

Why in the composition it has sucrose and sucralose together, what is their function?

The combination of those two sugars are to complement each other since we can't use too much sucrose to sweet the product, so we use sucralose to give the sweeter taste. However we also can't use sucralose as a single sweetener since: 1) Too much sucralose gives unpleasant aftertaste and give bad effect risk for glycemic and insulin response. 2) Sucralose itself doesn't have calorie, since this product aimed to meet the daily calorie needs for CKD patient, so sucrose addition may give worthy contribution to the calorie. 3) Sucralose is needed to mask the bitter amino acid taste.

What type of protein is used in Nephrisol?

Nephrisol contains a combination of whey protein (concentrate and isolate) and casein. Whey protein is fast digesting protein, so it is quickly used for protein synthesis. Casein is a slow digesting protein, which has the advantage of being able to last longer so that it can take over protein synthesis in the body when whey protein levels have started to fall. The combination of these has benefit in creating faster and longer protein synthesis.

Both of whey and casein contain amino acids, why in the composition stated: whey protein, casein, and also amino acids together?

To inform that beside the whey protein and casein, amino acid essential and non-essential amino acid is also clearly described, according with the guideline. Because we use premix AA, so we can describe the ratio EAA and NEAA, while other products don’t have it.

Why does Nephrisol have high biological value in protein?

Because it contains complete types of amino acids, which are needed for protein synthesis, namely essential amino acids and non-essential amino acids at the appropriate guideline ratio.

What is the source of fat used in Nephrisol?

Nephrisol is used vegetable fats: sunflower oil, canola oil and coconut oil which are rich in MUFA and PUFA, MCT, and also the content of unsaturated fatty acids higher (twice higher) than saturated fatty acids

What kind of sweetener that is used in Nephrisol?

Sucralose. Sucralose is non calorie sweetener, it is not metabolized in the body into energy and does not affect blood sugar levels, carbohydrate metabolism or insulin production

Why should Nephrisol not be dissolved in hot water?

When the protein is heated, the protein becomes clotted because the peptide bonds are destroyed by heat, because the middle group contains a positive charge and the carbonyl contains a negative charge whose kinetic increases when hot. After clotting, the peptidase enzyme can no longer work on the protein. The more peptide chains and the longer the structure, the greater the chance that the protein will be damaged by heat.

Is it possible to be given to diabetes patients?

Nephrisol can be given to diabetes patients whose glucose levels have been controlled. The calorie concentration is not categorized as high, which is 1 kcal/mL. After Nephrisol is given, as it is with nutritional therapy in general, glucose levels should be monitored accordingly.

What is the role of Nephrisol as a food supplement or substitute?

Both. As a food supplement Nephrisol can be consumed to meet the adequacy of protein and calories that are not met from the daily diet, as a substitute food Nephrisol can be consumed if the patient is completely unable to eat.