Goals and Guidelines
Nutrition and Dialysis
1. Dietary Goals
- Control buildup of waste products and fluid in your blood
- Avoid complications of end stage kidney disease such as malnutrition, fluid overload, calciphylaxis (calcium deposits in soft tissues like skin), renal bone disease, heart disease.
- Includes protein, sodium, fluid, phosphorus, potassium.
- Meet your individual nutrition needs. Your renal dietitian will help you with a nutrition plan that meets your individual needs that includes your likes and dislikes, your lab results and your other problems such diabetes or hypertension.
- For growth, building muscles and repair tissues
- Goal: adequate protein to replace protein loss caused by kidney disease and meet your individual protein needs
- Rich sources of protein: eggs, lean meat, poultry, dairy, fish, seafood. (Food list is not complete. Your renal dietitian can provide a complete list.)
- Patients on dialysis rarely need to restrict protein. Ask your renal dietitian how much protein you need.
- High sodium intake can increase blood pressure and fluid retention (edema).
- High sodium foods: salt, canned soups, processed cheese, some canned goods, “fast foods”, pickles, olives, smoked and cured foods: bacon, ham, luncheon meats. (Food list is not complete. Your renal dietitian can provide a complete list.)
- Read labels. Choose products with less than 140 mg. sodium per serving and less than 600 mg. sodium per frozen dinner.
- If you are retaining fluids, you may need to limit liquid intake to 4-6 cups of fluid a day. Goal is not to gain more than 3 percen t o f your target (dry weight) between hemodialysis treatments. Your renal dietitian can help calculate what your weight gains should be between treatments.
- Measure any liquid or any food that melts in your mouth like ice cream, ice, jello, pudding, broth, coffee, tea, milk…
- Excess fluid in the body causes difficulty breathing, chest pain, edema, high blood pressure. Your dietitian can share tips on how to control thirst and dry mouth.
If you choose Peritoneal Dialysis or Nightly Home Hemodialysis, you may not need to restrict fluid.
- Your kidneys may not get rid of extra phosphorus at this stage of kidney disease.
- High levels of phosphorus weaken your bones and can cause them to break easily. Poor phosphorus control can lead to heart disease as blood vessels are clogged with calcium and phosphorus.
- Control phosphorus by:
- Avoid high phosphorus foods: dried beans and peas, nuts, liver and other organ meats, cola, beer, canned salmon. Limit dairy products to one serving per day (1 cup milk or 1 ounce cheese). (Food list is not complete. Your renal dietitian can provide a complete list.)
- Take phosphate binders as prescribed by your doctor. Examples of “binders” are Renagel (sevelamer HCL), Phoslo (calcium acetate), TUMS (calcium carbonate), Magnebinde (magnesium carbonate), Fosrenol (lanthanum carbonate). BINDERS MUST BE TAKEN WITH ALL MEALS and SNACKS as prescribed. They do not work if they are not taken with food.
- High levels of potassium may cause leg weakness or rapid heart beat. In serious cases, the heart may stop beating.
- Control potassium by:
- Avoid high potassium foods: bananas, orange, kiwi, greens, tomato products, dried beans and peas, any potatoes (white, red or sweet, instant, and chips,) “salt substitutes”, nuts. Dice and soak potatoes for 4 hours or overnight. Cook in fresh water. Limit tomatoes to 2 thin slices and milk to 1 cup per day. (Food list is not complete. Your renal dietitian can provide a complete list.)
- Do not skip dialysis.
If you choose Peritoneal Dialysis or Nightly Home Hemodialysis, potassium is usually not restricted.
7. Follow a healthy diet
- If you are diabetic, keep track of your carbohydrate intake.
- Include variety of allowed foods…meat, fruit, vegetables, grains.
- Choose “low fat foods”.
- Portion control is important: Your renal dietitian will help you select a menu plan with the correct portions for you.
8. Vitamins and Minerals
- Vitamins made for patients with kidney disease may be prescribed. This has extra B-vitamins, no Vitamin A and some Vitamin C. Do not take over-the-counter multivitamins.
- Medicare Part D does not cover renal vitamins. Ask your renal dietitian about the least expensive, best renal vitamin for you.
- Iron, if needed is usually given during dialysis through the machine.
- Vitamin D, if needed is usually given during dialysis through the machine.
- Review any other supplements you may be taking with your renal dietitian. Herbal supplements and many other over the counter supplements may be harmful and should not be used.
9. Nutrition Supplements
Some patients may need protein and/or calorie supplementation. There are many products available such as Nephro, Ensure, Boost and Proteinex. Your renal dietitian will help you decide if you need additional calories or protein.