Madeleine Hull
When kidneys are no longer functioning healthily, dialysis helps to do some of the work that they would usually do. However, dialysis cannot do everything that healthy kidneys can, and waste and fluid can still build up in the body, causing health problems. This is why it's important for dialysis patients to follow a kidney-friendly food and fluid plan. A renal dietitian can help patients plan their meals, taking into account the patient's individual needs and tastes. Typically, a renal diet involves limiting fluids and certain nutrients, including sodium, phosphorus, and potassium.
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What You'll Learn
Limit fluids and sodium to prevent waste and fluid build-up
For dialysis patients, it is important to limit fluids and sodium to prevent waste and fluid build-up in the body. This is because, during dialysis, excess fluid is removed from the body, along with unwanted waste and toxins. If a patient misses a treatment or ends it early, less fluid will be removed, and fluid and waste will accumulate in the blood, making the patient feel unwell.
Dialysis patients are therefore encouraged to limit their fluid intake and to keep track of the amount of liquid they consume. This can help to prevent fluid overload, or hypervolemia, a serious health risk that can lead to heart failure. It is recommended that patients aim for smaller amounts of water throughout the day, rather than drinking a large glass at once. To reduce thirst, patients can use mouthwash or suck on hard candies.
Sodium intake is also important to monitor, as it can lead to increased thirst and higher fluid consumption. The recommended daily intake of sodium for adults is 2,300 mg, or about one teaspoon of salt. However, sodium is found in many canned, packaged, frozen, and fast foods, as well as condiments, seasonings, and meats, so it can be difficult to avoid. Patients should be mindful of this and limit their consumption of high-sodium foods, such as deli meats and chips.
In addition to limiting fluids and sodium, patients on dialysis should also aim to eat high-quality protein, as it produces less waste for removal during dialysis. Good sources of protein include meat, poultry, fish, and eggs.
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Monitor blood potassium levels to prevent heart problems
For dialysis patients, diet is a key part of treatment. Dialysis patients are advised to monitor their blood potassium levels to prevent heart problems and even death. Potassium is an electrolyte important for the function of cells. When potassium in the blood is too high (hyperkalemia) or too low (hypokalemia), it can cause heart problems.
A potassium blood test is a simple procedure that carries few risks or side effects. A healthcare professional will clean a site on your arm, usually the inside of your elbow or the back of your hand, with an antiseptic. They will then wrap a band around your upper arm to create pressure so that your veins swell. A small needle will be inserted into your vein to collect a small amount of blood, which will be sent to a laboratory for analysis. The test usually takes less than five minutes.
There are also emerging technologies for rapid measurement and monitoring of blood potassium levels at home. These include fingerprick capillary blood sampling and microneedle technology, which allow for minimally invasive measurement of biomarkers. However, these technologies are still in development and may require additional steps, such as mailing the blood sample to a laboratory for testing.
Dialysis patients can work with a renal dietitian to plan their meals and keep track of their fluid intake. The dietitian will consider the patient's specific blood levels when making recommendations about potassium intake. For example, people who do frequent hemodialysis at home may not need to limit potassium in their diet. In addition to diet, dialysis patients can also work with their healthcare team to adjust the dialysate (the cleansing fluid used during dialysis) to help lower their potassium levels if needed.
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Limit phosphorus to prevent weak bones and heart issues
Phosphorus is a mineral found in bones and is necessary for building strong, healthy bones and keeping other body parts healthy. It also helps your body build cells and transfer energy throughout the cells. When your kidneys are functioning normally, they can remove excess phosphorus from your blood. However, when your kidneys are compromised, they cannot effectively eliminate phosphorus, leading to a build-up in the body. This build-up of phosphorus has detrimental effects, including weakening bones and forming harmful deposits in the heart and blood vessels.
To prevent these issues, it is crucial to limit phosphorus intake. Dialysis patients should aim for a normal phosphorus level of 2.5 to 4.5 mg/dL. This can be achieved by understanding your diet and medications for phosphorus control. Phosphorus is naturally present in protein-rich foods such as meats, poultry, fish, nuts, beans, and dairy products. Animal-based sources of phosphorus are more easily absorbed by the body compared to plant-based sources.
Inorganic phosphorus, added to foods as a preservative or additive, is also common in processed foods, fast foods, ready-to-eat meals, canned and bottled drinks, and enhanced meats. Therefore, one of the best ways to lower phosphorus intake is to avoid processed foods and carefully read labels, watching out for additives with "PHOS" like disodium phosphate.
It is important to work with a renal dietitian who can help you navigate your specific needs and create a meal plan that ensures proper nutrition while managing phosphorus intake. They can provide guidance on choosing lean, low-fat meats with lower phosphorus levels, such as chicken, fish, or roast beef, and advise on vegetarian sources of protein if you do not consume meat. Additionally, your healthcare team can adjust the dialysate (the cleansing fluid used during dialysis) to help manage phosphorus levels.
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Eat high-quality protein to reduce waste during dialysis
When on dialysis, it is important to eat a high-quality protein with every meal and sometimes with snacks. This is because dialysis also removes some of the albumin in your blood, and you need more albumin when undergoing dialysis. Albumin helps fluid stay in your blood vessels, and a level of 4.0 or higher has been associated with a lower risk of death and fewer hospitalisations.
High-quality proteins produce less waste for removal during dialysis. They come from meat, poultry, fish, and eggs. If you are a vegetarian, ask your dietitian about other ways to get protein. Low-fat milk is a good source of protein, but it is also high in phosphorus and potassium and contributes to your liquid intake. Processed meats such as hot dogs and canned chilli have high amounts of sodium and phosphorus and should be avoided. Instead, opt for lean, low-fat meats like chicken, fish, or roast beef.
You can also get your protein from plant sources like beans, grains, and nuts. However, plant sources are low in one or more of the essential amino acids, so a plant-based diet requires careful planning to ensure sufficient protein intake. Another bonus of plant proteins is that they are low in saturated fat and high in fibre.
If you are experiencing appetite problems, you may benefit from a kidney-friendly supplement that provides the protein and calories you need to regain your energy. Liquid supplements made specifically for dialysis patients are high in calories and protein, and low in sodium, potassium, and phosphorus. An 8-ounce portion can be used as a meal replacement or a supplement to your meals.
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Avoid processed foods to lower phosphorus intake
For dialysis patients, diet is a key part of treatment. It is important to limit certain foods and fluids to keep yourself well-nourished and to help your body adapt to the changes brought about by dialysis. One of the nutrients that dialysis patients need to keep in check is phosphorus. Phosphorus is a mineral found in bones that helps the body build cells and transfer energy throughout the cells.
When the kidneys are not working well, the body cannot get rid of the extra phosphorus. High phosphorus levels can affect the balance of other minerals in the blood, such as calcium. This can lead to weak and brittle bones, as well as dangerous calcium deposits in the blood vessels, lungs, eyes, and heart. Therefore, dialysis patients may need to limit phosphorus in their diet, depending on their lab results.
Phosphorus is commonly added to processed foods in the form of an additive or preservative (inorganic phosphorus). This type of phosphorus is completely absorbed by the body. Avoiding processed foods and phosphorus additives can help lower your phosphorus intake. Check food labels for additives with "PHOS" or "phosphate" in their names, such as phosphoric acid, sodium aluminum phosphate, pyrophosphate, polyphosphates, and calcium phosphate. These additives can be found in fast foods, ready-to-eat meals, canned and bottled drinks, enhanced meats, and most processed foods.
In addition to limiting phosphorus, dialysis patients should also pay attention to their sodium and fluid intake. Sodium intake should be limited to less than 2300 milligrams per day, which means limiting high-sodium foods like deli meats and chips. Reducing sodium intake helps prevent fluid buildup between dialysis treatments and keeps blood pressure within a healthy range. It is also important to carefully plan meals and track fluid intake to avoid excess fluid buildup in the body.
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Frequently asked questions
A good diet for dialysis patients is one that helps to reduce the amount of fluid and waste that builds up between treatments. This means limiting fluids and certain foods and condiments. A renal dietitian can help you plan your meals.
Dialysis patients should avoid processed foods and foods with high amounts of sodium, phosphorus, and potassium. Sodium is found in canned, packaged, frozen, and fast foods, as well as condiments, seasonings, and meats. Phosphorus is difficult for dialysis to filter from the blood, so it's important to limit foods that contain this mineral. Potassium can cause heart problems and even death if it builds up in the blood between treatments.
Renal dietitians encourage most people on dialysis to eat high-quality protein because it produces less waste for removal during dialysis. High-quality protein comes from meat, poultry, fish, eggs, and egg whites.
