Jeffrey Salazar
Dialysis patients are often required to follow a special diet, which typically involves limiting fluid intake and certain foods and condiments. This is because dialysis can only remove a certain amount of fluid at a time, and waste and fluid can build up in the body between treatments, leading to health issues. A renal dietitian can help patients create a personalised eating plan, which will depend on the type of dialysis and treatment schedule. For example, those who undergo frequent hemodialysis at home may not need to limit potassium, while those who have dialysis three times a week will likely need to restrict their intake.
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What You'll Learn
Limiting fluids
For dialysis patients, limiting fluids is crucial to prevent fluid buildup in the body, which can lead to serious health complications. Here are some detailed instructions and considerations regarding fluid restriction for dialysis patients:
Understanding Fluid Buildup
Dialysis is performed to remove waste and excess fluid from the body when the kidneys are unable to do so effectively. However, dialysis can only remove a certain amount of fluid at a time, and treatments are typically done at intervals. As a result, fluid can accumulate in the body between dialysis sessions. This buildup of fluid can lead to weight gain and, more concerning, put a strain on the heart and other organs.
Monitoring Fluid Intake
Dialysis patients must monitor their daily fluid intake to prevent excessive fluid accumulation. This includes keeping track of not only the liquids they drink but also the liquid content of the foods they consume. Soups, fruits with high water content, and some vegetables can contribute to fluid intake. It is important to work closely with a renal dietitian to determine the appropriate fluid limit for an individual's needs and treatment plan.
Sodium and Thirst
Sodium intake can impact fluid retention and thirst levels. Dialysis patients should be mindful of their sodium consumption, as it can lead to increased thirst and, consequently, higher fluid intake. Sodium is found in many canned, packaged, frozen, and fast foods, as well as condiments, seasonings, and meats. Checking nutrition labels and limiting high-sodium foods can help manage fluid intake.
Weight Monitoring
Weight monitoring is an essential aspect of managing fluid levels in dialysis patients. Patients are typically weighed before and after each treatment to track their progress toward their target or "dry" weight. This target weight represents the estimated weight of the patient when all excess fluid is removed. Maintaining the recommended fluid intake helps patients stay closer to their target weight and avoid the negative consequences of excessive fluid buildup.
Individualized Plans
It is important to note that fluid restrictions may vary depending on the type of dialysis and the frequency of treatments. For example, patients who undergo daily dialysis treatments at home may have fewer restrictions on fluid intake compared to those receiving treatments less frequently. It is always advisable to consult with a healthcare professional or dietitian to develop a personalized fluid and dietary plan that takes into account the patient's specific needs and treatment regimen.
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Limiting sodium, phosphorus, and potassium
Dialysis patients must monitor their daily intake of fluids and nutrients. This includes limiting fluids, sodium, phosphorus, and potassium.
Limiting Sodium
Sodium intake should be less than 2300 milligrams per day, which is equivalent to one teaspoon of salt. This means limiting the use of a saltshaker and avoiding high-sodium foods like deli meats and chips. Sodium is also found in many canned, packaged, frozen, and fast foods, as well as condiments, seasonings, and meats. Limiting sodium helps prevent fluid buildup between dialysis treatments, reduces thirst, and helps maintain healthy blood pressure.
Limiting Phosphorus
Limiting phosphorus helps improve bone health. Phosphorus is found in meat, milk, poultry, fish, nuts, peanut butter, beans, cola, tea, and dairy products. While these foods contain necessary protein, excessive phosphorus can pull calcium from bones, making them weak and prone to breakage. It can also cause skin itching. Renal dietitians may recommend phosphate binders to control phosphorus levels between dialysis sessions.
Limiting Potassium
Limits on potassium in the diet depend on specific blood levels. Potassium levels can rise between dialysis sessions, affecting the heartbeat and potentially causing heart problems or even death. Patients should avoid foods with additives like acesulfame potassium and potassium sorbate, as well as salt substitutes containing potassium. A plant-based diet is possible, but portion sizes may need adjustment for high potassium levels. Dialysis patients should closely monitor their potassium levels and consult their healthcare team for adjustments to the dialysate or medication to lower potassium levels.
Dialysis patients should work closely with their dietitians to create a personalized food and fluid plan that considers their treatment schedule, nutrition status, and health goals.
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Getting enough protein
For patients on dialysis, getting enough protein is crucial. Protein is a macronutrient and a building block that is essential for life, providing energy and helping to build and repair muscles. When the body does not get enough protein, it starts taking protein from the muscles. This is especially important for dialysis patients because dialysis also removes some protein from the blood, specifically a protein called albumin, which helps deliver nutrients and maintain fluid levels in the body.
Dialysis patients should aim for a higher amount of protein in their diet to maintain blood protein levels and improve health. It is recommended to include a protein source at every meal and sometimes with snacks. High-quality protein, which produces less waste for removal during dialysis, comes from animal sources like meat, poultry, fish, eggs, and dairy, as well as plant sources like beans, grains, and nuts. Animal sources of protein contain all the essential amino acids, but some options, such as fatty cuts of red meat and whole-milk dairy products, are higher in saturated fat, which is less heart-healthy.
The exact amount of protein needed depends on individual factors such as body size, nutritional status, and the specific kidney problem. It is always best to consult with a healthcare professional or a renal dietitian, who can help create a personalised food and fluid plan. They may recommend taking phosphate binders with meals or snacks, especially protein supplements, to control phosphorus levels in the blood between dialysis sessions.
It is important to note that if you are not on dialysis, a lower-protein diet is generally recommended to slow the loss of kidney function.
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Taking supplements
Dialysis patients may need to take supplements to ensure they are getting the right amount of vitamins and minerals. This is because dialysis and kidney disease can change the amounts of vitamins and minerals the body needs, and a dialysis diet may limit some food groups that would normally provide these nutrients.
Dialysis patients should only take supplements that have been ordered by their kidney healthcare professional. Certain vitamins and minerals can be harmful if taken while on dialysis, and some may interact with prescribed medicines. For example, vitamins A, E, and K can build up in the body and cause harm if taken in excess. Over time, this can cause dizziness, nausea, and even death. Patients should also be cautious about taking vitamin C supplements, as high doses may cause a buildup of oxalate in people with kidney disease.
Some supplements that may be recommended by a healthcare professional include:
- B-complex vitamins, which can help prevent anemia by working together with iron.
- Additional B vitamins, such as thiamine, riboflavin, pantothenic acid, and niacin, which can help change food into energy.
- Iron, which may be needed if the patient is taking medicine to treat anemia.
- Vitamin C, which can help keep tissues healthy and aid in wound healing.
- Vitamin D, which is important for maintaining healthy bones.
It is important to note that the need for supplements varies from person to person, and a healthcare professional can determine which vitamins and minerals a patient may need based on their health history and blood tests.
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Creating a food plan
Dialysis patients need to follow a special diet to help their body adapt to the change while keeping them well-nourished. A renal dietitian can help you plan your meals and create a food plan that will work for you. Here are some key considerations and steps to creating a food plan:
Understand Your Treatment and Body
Firstly, it is important to understand your treatment schedule and any residual kidney function you have. Those who do dialysis daily at home will have fewer limits on fluid, potassium, and phosphorus. Knowing your body's residual kidney function will help guide your diet plan.
Monitor Fluid Intake
Dialysis patients must monitor their daily fluid intake. Fluids can build up in the body and cause health issues, so it is important to limit or avoid beverages and foods with high liquid content. This will also depend on your treatment schedule, as the more frequent the dialysis, the less fluid build-up.
Limit Certain Nutrients
Dialysis patients often need to limit foods high in phosphorus, potassium, and sodium. High-phosphorus foods include beef liver, refried beans, and dairy products. Foods high in potassium include bananas, raisins, avocados, and cooked spinach. Sodium is found in salty snacks, cured meats, and processed foods. Your dietitian will advise you on which foods to avoid or limit.
Focus on High-Quality Protein
Renal dietitians recommend that dialysis patients eat high-quality protein as it produces less waste for removal during dialysis. High-quality protein comes from meat, poultry, fish, and eggs. The amount of protein needed varies from person to person, so ask your dietitian for guidance.
Take Supplements if Needed
Vitamin and mineral needs are specific to each person. Your healthcare professional may prescribe special vitamin and mineral supplements to ensure you get the required nutrients. However, always check with your healthcare provider before taking any supplements or herbal remedies.
Keep Track and Adjust
Your diet needs may change over time, so it is important to regularly review your food plan. Keep track of your food and fluid intake and get regular lab tests to monitor your nutrition. This will help you adjust your food choices as needed and ensure your body is getting the right balance of nutrients.
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Frequently asked questions
Yes, dialysis patients need to follow a special diet to reduce the amount of fluid and waste that builds up between treatments. This diet typically includes limiting fluids and certain foods and condiments.
Dialysis patients should avoid foods high in phosphorus, potassium, and sodium. High-phosphorus foods include beef liver, refried beans, sardines, tuna canned in oil, and bran cereal. High-potassium foods include bananas, raisins, avocados, cooked spinach, potatoes, tomato paste, and beans. Foods high in sodium include salty snacks, high-sodium sauces, and cured meats.
Yes, it is recommended that dialysis patients focus on consuming high-quality protein as it produces less waste for removal during dialysis. Good sources of protein include meat, poultry, fish, eggs, and garbanzo beans.
Each patient's dietary needs may vary, so it is important to consult with a renal or kidney dietitian who can help create a personalized eating plan based on their specific needs and treatment plan. Regular lab tests can also help monitor nutrition and guide daily food choices.
Dialysis patients may need to take vitamin and mineral supplements, especially if their diet is limiting certain food groups that normally provide these nutrients. However, it is important to consult with a healthcare professional before taking any supplements to ensure they are safe and appropriate for kidney patients.
