Nephrisol-D Nephrisol-D
Product
Product Nephrisol-D
Product

Nephrisol-D is a specialized nutrition formulated to meet the requirements for those with renal insufficiency in dialysis stage, to replenish protein loss during dialysis and prevent malnutrition. 

Nephrisol-D contains :

  1. High protein amount
  2. Completed with 9 essentials amino acids (High Biological Value Protein)
  3. Completed with 9 vitamins and 6 minerals 
  4. Lactose free

Brands Info

Feature Benefit

 

FEATURE BENEFIT
Formula is designed for Dialysis  Not only fulfill daily nutrition need, but also suit for patient’s medical condition.
High protein Replenish protein lost during dialysis
High Biological Value Protein with 9 essential amino acids To improve albumin level
Mineral adjusted for CKD (Dialysis) condition Prevent adverse event due to unproper micronutrient consumption.
Maltodextrin as carbohydrate source Easily dissolved & absorbed (no hot water), mask the fishy taste of fat and the bitter taste of protein
Combine whey and casein Creating faster and longer protein synthesis.
Non animal fat Rich in MUFA and PUFA, MCT, and also the content of USFA (twice higher) than SFA.
Sucralose as sweetener Does not affect blood sugar levels, carbohydrate metabolism or insulin production.
Density 1.04 Can be given through NGT/Sonde/tube feeding.
Low Osmolality to prevent adverse event (diarrhea) 

 

Precaution : Not suitable to those with renal insufficiency which is not in dialysis stage (predialysis).

 

References :

1.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

2.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.

3.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.

4.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

5.NEPHRISOL-D[Product Information] Jakarta. Indonesia. PT Kalbe Farma Tbk; 2017

6.Wolfson N. Management of Protein and Energy Intake in Dialysis Patients. JASN 1999, 10 (10) 2244-2247

Preparation

Nephrisol-D can be taken orally or administered via a nasogastric tube.

  • Oral feeding: To prepare a 250 ml feeding, gradually add 4 level scoops of Nephrisol-D (+ 61 gram) into a 200 ml warmed water and mix until dissolve. Other alternative, Nephrisol-D can be served like snack, smoothie, pudding, etc. It’s not advisable to cook or boil in high temperature (above 600 Celsius) as it may denature protein content of Nephrisol-D. Consume Nephrisol-D in between meals.
  • Tube feeding: Follow physician’s instructor.
  • Not intended to be used for parenteral administration

Nutrition Fact

1.04 kcal/mL nutritionally complete nutritional drink, with 9 essential amino acids, 7 non-essential amino acids, 9 vitamins, and 6 minerals

NUTRITION UNIT PER SERVING % DV
Calories kCal 260
          Calories from fat kCal 50
Total Fat g 6 10%
          Trans fat g 0
          Saturated fat g 1.5 9%
          Cholesterol mg 10
Protein g 13 21%
Total Carbohydrates g 39 13%
          Sucrose g 5
          Lactose g 0
          Dietary fiber g 0
Vitamins 
Vitamin A IU 250 15%
Vitamin C mg 10 10%
Vitamin E mg 1.68 10%
Vitamin B1 mg 0.23 25%
Vitamin B2 mg 0.28 25%
Niacin mg 3.2 20%
Vitamin B6 mg 0.37 30%
Folic acid μg 67 15%
Pantothenic acid mg 1 15%
Minerals
Sodium mg 75 3%
Potassium mg 55 1%
Calcium mg 183 25%
Phosphorus mg 85 15%
Zinc mg 4 10%
Selenium μg 5 15%
Total N (protein & amino acids) g 2
Essential Amino Acids
          Leucine g 1.43
          Isoleucine g 1.06
          Valine g 0.99
          Tryptophan g 0.19
          Phenylalanine g 0.79
          Methionine g 0.81
          Threonine g 0.73
          Lysine g 1
          Histidine g 0.43
Non Essential Amino Acids
          Aspartic acid g 0.9
          Glutamic acid g 2.28
          Serine g 0.53
          Glysine g 0.17
          Arginine g 0.41
          Alanine g 0.56
          Tyrosine g 0.35

Ingredients

Maltodextrin, Vegetable Oil (Canola, Sunflower, Palm Kernel and Coconut Oil), Whey Protein, Amino Acids, Calcium Caseinate, Sucrose, Minerals (Calcium Carbonate, Monosodium Phosphate, Sodium Chloride, Magnesium Oxide, Zinc Oxide, Sodium Selenite), Artificial Vanilla Flavor, Natural Identical Milk Flavor, Vitamins (L Sodium Ascorbate, Vitamin E, Nicotinamide, Calcium Pantothenate, Vitamin A, Pyridoxine HCl, Vitamin D3, Cyanocobalamin, Thiamine HCl, Riboflavin, Folic Acid, Biotin), Sweetener Sucralose 22 mg/serving

Storage

Opened package should be stored tightly in a cool, dry, and clean place. Consume within 1 month of opening.

Packaging & Flavor

1 box contain 185 gram nutrition powder with Vanilla flavor.

1 box available for 3 servings.

FAQ

What is the content of NEPHRISOL - D?
NEPHRISOL - D is a special enteral nutrient for kidney dysfunction in dialysis stage, has a composition of 60% carbohydrates, 20% protein and 20% fat and with mineral and vitamin contents that have been adjusted for dialysis patient. NEPHRISOL - D also has a high protein content to replenish protein lost during dialysis.
How many calories are produced from NEPHRISOL - D per serving?
NEPHRISOL - D contains calories of 260 Kcal / serving.
How many servings of NEPHRISOL – D can be consumed per day ?

If as a substitute food, NEPHRISOL - D 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 - D?
The calorie density of NEPHRISOL - D 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 - D?

NEPHRISOL - D osmolality is 367 mOsm / kg for vanilla variants

When can NEPHRISOL - D be used?
NEPHRISOL - D can be given to patients with end stage renal disease (dialysis stage)
How is the presentation of NEPHRISOL - D?

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 - D be consumed a day?

NEPHRISOL - D 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 - D be combined with other enteral nutrients?
NEPHRISOL - D 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 - D be given to patients with diabetes mellitus (DM)?

DM patients who are given NEPHRISOL - D 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 - D before it is dissolved?
The unlocked NEPHRISOL - D 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 - D 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 - D after dissolving?
NEPHRISOL - D which has been dissolved in 5 hours must be taken. If you have not finished drinking NEPHRISOL - D 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 - D?
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 - D 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 - D?

NEPHRISOL - D 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 - D 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 - D?
NEPHRISOL - D 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 - D?
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 - D 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 - D 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 - D is given, as it is with nutritional therapy in general, glucose levels should be monitored accordingly.

What is the role of NEPHRISOL - D as a food supplement or substitute?
Both. As a food supplement NEPHRISOL - D can be consumed to meet the adequacy of protein and calories that are not met from the daily diet, as a substitute food NEPHRISOL - D can be consumed if the patient is completely unable to eat.
Kalbe International

Kalbe International