Dante Carrillo
When an individual undergoes dialysis, their diet undergoes significant changes. Dialysis patients are advised to consult a renal dietitian to plan their meals and keep track of their fluid intake. This is because the kidneys cannot efficiently remove waste products and fluids from the body, so the diet must be carefully regulated to manage this issue. The diet typically involves limiting fluids and certain foods, such as those high in phosphorus, sodium, and potassium, while focusing on high-quality protein sources. However, there is limited data to support the benefits of these dietary restrictions, and some restrictions may even be harmful. For example, restricting potassium may deprive patients of heart-healthy diets, and limiting fluids may lead to lower protein and calorie consumption. Therefore, it is essential for dialysis patients to work closely with a dietitian to create a personalized plan that ensures they receive adequate nutrition while managing their kidney disease.
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What You'll Learn
Limit phosphorus and sodium intake
Diet is a key part of hemodialysis treatment. The food and drink choices you make while on hemodialysis can make a difference in how you feel and can make your treatments work better. One of the ways to reduce waste buildup in the blood is by controlling what you eat and drink.
Limiting Phosphorus
Phosphorus is crucial to monitor in your diet as too much of it in your blood pulls calcium from your bones, making them weak and likely to break. This calcium goes to other parts of the body, causing serious health conditions. Phosphorus is tricky because it can be hidden in foods. For instance, whole grains, dried beans, nuts, and dairy foods contain phosphorus. Your body absorbs 70% of the phosphorus in dried beans, legumes, and nuts, but it absorbs 100% of the phosphorus in processed foods. Renal dietitians limit milk and foods made from milk to one serving a day, as their protein-to-phosphorus ratio is higher.
Effective strategies to control dietary phosphorus intake include restricting phosphorus-rich foods, preferring phosphorus sourced from plants, boiling as the preferred cooking procedure, and avoiding foods with phosphorus-containing additives. The amount of phosphorus you should get depends on your age, gender, and how much protein you need, but good ranges for people with kidney disease are between 800-1,000 mg/day.
Limiting Sodium
Sodium is a part of salt and is found in many canned, packaged, frozen, and fast foods. It is also found in many condiments, seasonings, and meats. Sodium intake should be less than 2,300 milligrams per day, which is equal to one teaspoon of salt. This means limiting foods with high levels of sodium listed on their nutrition facts label. Some foods that don't taste salty can have a surprising amount of sodium, such as deli meats and chips. Less sodium in the diet helps prevent fluid from building up between dialysis treatments, helps reduce thirst, and keeps your blood pressure within your goal range.
It is important to note that everyone's calorie and vitamin and mineral needs are different. Your dietitian at your dialysis center will help you plan a diet that fits your needs.
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Monitor fluid intake
Dialysis works to remove excess fluid from the blood, so it's important to monitor and manage your fluid intake. Fluids are typically limited on a dialysis diet, and the exact amount you should have each day may depend on your health and the type of dialysis you're on. For instance, people on home dialysis may have fewer dialysis fluid restrictions, while those on in-centre hemodialysis generally have greater limitations to their fluid intake.
Your doctor or nephrologist (kidney doctor) will discuss your specific fluid requirements. To help you monitor your fluid intake, keep a record of how much you're drinking or eating throughout the day. It may also help to plan what you're going to drink and when. For example, if you have a special occasion in the evening, consume less fluid throughout the day. Your dietitian can help you manage your thirst with dialysis fluid restrictions and recommend helpful products such as sugar-free hard candy, ice chips, or frozen grapes.
There are also some general tips to help you manage your fluid intake:
- Eat a piece of cold or frozen fruit, like grapes, strawberries, or blueberries.
- Freeze your favourite beverage in a bottle and sip as the fluid melts.
- Drink from small cups or glasses.
- Avoid "fluid traps"—situations where you may drink out of boredom or habit.
- Count to 100 and try to wait for a fluid craving to pass.
- Stay cool during hotter months with a misting fan and proper clothing.
- Try drinking cold liquids instead of hot beverages.
- Sip your beverages to savour the liquid longer.
- Limit the amount of sodium and spicy foods in your diet.
- Be aware of hidden fluids in foods. Foods with high water content include gelatin, watermelon, soup, gravy and frozen treats.
- Take your medicines with your meal, if possible. Try swallowing pills with applesauce instead of liquids.
- Try using a smartphone application (app) that allows you to track your fluid intake throughout the day and to compare it with your individual daily target set by medical staff.
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Eat high-quality protein
When on dialysis, it is important to eat a diet that helps your body adapt to the changes while keeping you well-nourished. This is because dialysis can also remove some of the albumin in your blood, a protein that helps keep fluid in your blood vessels. As such, it is recommended to eat high-quality protein as it produces less waste for removal during dialysis.
High-quality protein is a vital nutrient to kidney function and helps build and repair muscle and tissue. It is also important for fighting infection. When you are not feeling well, your body's protein needs are higher. If you do not eat enough protein, your body will take protein from your muscles.
High-quality protein comes from animal sources such as meat, poultry, fish, eggs, and dairy, or from plant sources like beans, grains, and nuts. It is recommended to have a protein source at every meal and sometimes with snacks.
It is important to note that many important sources of protein are high in phosphorus, which pulls calcium from your bones. Losing calcium may weaken your bones and make them more likely to break. Therefore, it is crucial to work with your dietitian and healthcare provider to understand which foods are high in protein and how much phosphorus they contain. They can help you make the best choices and ensure you are getting enough protein while on dialysis.
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Take supplements
Dialysis patients are often encouraged to take supplements to make up for the vitamins and minerals their diet may be lacking. This is because their diet may limit some food groups that would normally provide these nutrients. However, it is important to note that only supplements ordered or prescribed by a kidney healthcare professional should be taken, as certain vitamins and minerals can be harmful to those undergoing dialysis.
If you have chronic kidney disease (CKD) and are on dialysis, your doctor may have told you that over-the-counter (OTC) multivitamins may not be good for your health. This is because levels of vitamins A, E, and K can build up in the body as the kidneys stop working and cause dizziness, nausea, and even death. In addition, some multivitamins don't contain enough water-soluble vitamins like C, B-complex, and folic acid (folate), which people with CKD require in greater amounts.
Your healthcare professional and kidney dietitian can help you determine which supplements you may need by looking at your health history and blood tests. Depending on your health and other factors, your healthcare provider may recommend supplements like B-complex vitamins, additional B vitamins (thiamine, riboflavin, pantothenic acid, and niacin), iron, vitamin C, and vitamin D.
It is important to consult with your healthcare provider before taking any supplements, as some may interact with your prescribed medications or have other side effects.
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Limit potassium
When on dialysis, it is important to limit certain foods and fluids to reduce waste buildup in the blood. One of the key minerals that need to be monitored is potassium.
Limits on potassium in the diet are based on individual blood levels. If you have high potassium (hyperkalemia), your healthcare provider will advise you to limit foods that are high in potassium. On the other hand, if you have low potassium (hypokalemia), you may be advised to increase your potassium intake. Almost all foods contain some potassium, but foods with 200 mg or more per serving are considered "high-potassium".
If you are undergoing frequent hemodialysis at home, you typically do not need to limit your potassium intake. However, if you need to lower your potassium levels, there are a few strategies you can employ. One way is to avoid consuming the liquid from canned fruits, canned vegetables, or the juices from cooked meat. Additionally, you can consider leaching high-potassium vegetables to reduce their potassium content. Leaching involves soaking the vegetables in warm unsalted water for a minimum of 2 hours, using ten times the amount of water as the amount of vegetable. For example, 1 cup of vegetables should be soaked in 10 cups of water. It's important to note that leaching doesn't remove all the potassium, so the amount consumed should still be limited.
It is always recommended to consult with a renal dietitian or your healthcare provider to determine the appropriate dietary restrictions and to create a personalized eating plan that ensures you are well-nourished while managing your potassium levels effectively.
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Frequently asked questions
A hemodialysis diet is a diet that helps to decrease the effects of kidney failure on your body. It involves limiting phosphorus, fluids, sodium, and salt. It is important to consult a renal dietitian to create an eating plan that works for you.
It is recommended to limit foods with high levels of sodium, such as deli meats and chips. It is also important to restrict foods high in potassium, such as certain fruits, vegetables, and dairy products. Processed meats such as hot dogs and canned chili should be avoided due to their high sodium and phosphorus content.
Following a hemodialysis diet can help minimize the buildup of waste and fluid in the body, reducing the risk of health complications associated with kidney disease and dialysis. It can also help you feel more comfortable before and after dialysis sessions and maintain a healthy weight.
