Presentation on theme: "Eating well with chronic kidney disease"— Presentation transcript:
1Eating well with chronic kidney disease Becky JonesCCDHB Dietitian
2Content Introduction Nutrition and pre-dialysis Nutrition for dialysis Dietary thoughts for a kidney transplantSummaryQuestions
3Introduction Food has an important role in kidney disease. When the kidneys do not work properly waste products can build up in the blood.Dialysis will remove some of the waste products.Before starting dialysis you also need to be careful with your diet.If you start dialysis or change to a different dialysis type your diet will probably change too.Your diet depends on your kidney function.
4Introduction cont. Reduced kidney function can cause: Poor appetiteTaste changesFeeling sick, vomitingItching skinTirednessConstipationYou may find it hard to eat and may lose body weightSpeak to your doctor or nurse about this
5Before starting dialysis Protein:Used to build body tissues, fight infection and keep body fluid in balanceHigh protein foods:Meat, chicken, fish, eggs, milk, yogurt and seafoodToo much protein will cause more waste product build up that may cause more sickness, itchy skinYou should have small servings of protein at each mealIt is important to eat a nourishing diet
6Example of low protein Breakfast: Cereal and milk or yogurt Lunch: Sandwich with meat, chicken or eggDinner: Small serve of meat, fish or chicken (size of a deck of cards or small palm size) with rice / pasta / potatoes / bread and vegetables
7Salt (sodium)Usually kidneys get rid of extra sodium and water through the urine.This doesn’t work as well with reduced kidney function.Sodium and fluid can build up. This can lead to high blood pressure, feeling thirsty and weight gain from fluid gain.Foods high in sodium:processed meats e.g. corned beef, bacon, luncheon, hamFast foods:pizza, fried chicken, chips, Chinese takeaways, chowmein, piesSalted snacks:potato chips, corn chips, nuts, instant noodles, marmite, vegemiteCanned foods:soup, spaghetti, tinned fishStocks, pickles, gravy, tomato sauce, soy sauceIn the body sodium acts like a sponge for water.
8Salt (sodium) How much can i have? 2300mg = 1 teaspoon per day Look at food labels: aim for less than 150mg sodium per servingTry fresh foods and herbs and spicesLemon / lime juice, garlic, gingerBlack pepperMint, parsley, basilHoneyNutmegWhen preparing kai such as a boil up or stew, add onions, garlic, and herbs or sauce for extra flavour instead of salt.Instead of povi-masima try Wattie's tinned low salt version
9Potassium A mineral found in most foods. Healthy kidneys remove extra potassium from the blood.Diet, medications and high blood sugars can affect the level in the blood.The amount allowed in your diet depends on:Your kidney functionWhether you are on dialysisCannot taste it, so it is harder to control in your diet.When kidneys are not working properly this doesn’t happen
10Potassium cont. Your doctor will tell you if your level is too high. Not everyone needs to follow a low potassium diet.If your level is above 6 mmol/L you will need to restrict food high in potassium.You may be referred to a Dietitian.
11Phosphate A mineral found in many foods. Needed for healthy bones, teeth, muscle and energy.In kidney disease the kidney is not able to get of extra phosphate from the blood.High levels can cause:Bone damageItch and dry skinHardening of arteries
12Phosphate cont.The level can be controlled by medication called phosphate binders.May be called Osteo 500, Calcitab, AlutabsWork to bind the phosphate from the food.Take at meal times, just before or during,Avoid taking after you have eaten as they wont work as wellPrescribed by your doctor
13Phosphate cont. Some foods are high sources: Dried fruit and beans Chocolate, nutsMusselsProcessed meats like ham, pate, luncheon, liver, sausagesMilk (avoid high calcium milks) and cheese
14Dialysis and diet Haemodialysis: Peritoneal dialysis: Most people will need a diet high in protein, fibre and low in salt and potassium.May need to limit phosphatePeritoneal dialysis:Most people will need a diet high in protein, fibre and low in salt and sugar.May need to limit phosphate.
15Dialysis and protein High protein diet Some is lost during dialysis. Build muscle, repair body tissues, fight infectionSome is lost during dialysis.Needs to be replaced through eating enough protein.Dietitian will work out how much you need per day.Aim to have protein with each mealDairy products may need to limited if phosphate level is high.Good levels of protein = more energy, better dialysis, better quality of life
16Dialysis and salt (sodium) High intake of sodium will increase thirst and blood pressure.Must have a low salt diet when on a fluid restriction.Choose fresh foods rather than processed, flavour foods with herbs and spices to make tasty and attractive.
17Dialysis and fluid Ask what your fluid allowance is. Drinking too much will cause too much fluid gain between dialysis sessions.High blood pressure, swollen ankles, harder to breathe, can weaken heart muscles over time.Lower your sodium intakeYou need to be aware of how much fluid you have each day.
18Dialysis and fluid What are fluids? Drinks: Foods: Anything that is liquid at room temperatureDrinks:water, tea, coffee, milk, juice, soft drinks, cordials, wine, beerFoods:custards, gravy, ice-cream, jelly, soup, yogurt, juicy fruit e.g. watermelon, oranges
19Helpful hints for fluid Spread your fluids during the dayAvoid salty foodsUse a smaller cup / glass, measure out how much liquid it holdsHave part of your fluid as ice-cubesTry having pills in soft food to save fluidFor a dry mouth try:A lemon slice, sour lollies, chewing gum, a mint, rinsing your mouth (remember not to swallow!)
20Dialysis and potassium On dialysis potassium from foods builds up between dialysis sessions.High levels can affect your heartbeat and be dangerous.Some people will not need to restrict their potassium level as much as others.Changing food choices and cooking methods can help lower potassium levels.Cut vegetables into small pieces before cookingBoil in large amount of waterAvoid steaming, microwaving and baking vegetables
21Other food such as chocolate, potato chips, tomato soup, fresh coffee, nuts, coconut cream /milk / juice
22Dialysis and phosphate Remember to take your phosphate binders at the beginning of your meal.Can swallow tablets whole or chew or crushFoods to avoid: calcium enriched foods e.g. calci-trim milk, chocolate, cola drinks including diet versions, peanut butter, takeawaysYou may need to ask the dietitian for more information about phosphate in foods.
23Diet and Peritoneal dialysis High protein, high fibre, low salt and low sugar.Often can have more potassium in dietHigh fibre:Peritoneal dialysis can contribute to constipationLow sugar:Dialysis bags contain sugarWill need to cut down on sugary foods and drinks e.g. lollies, cakes, biscuits, jam, juices, soft drinksIf you are diabetic make sure you talk to a nurse about changes to your diabetes medication
24Nutrition and kidney transplants Pre-transplant aim to keep as healthy as possibleEat a balanced diet, take your medications, do some exercise if you able to.Keep a healthy weightCCDHB Body Mass Index (BMI) limits: under 18, over 35Body mass index = weight for heightHow in proportion you are
25Body mass index = weight in kilograms ÷ height in metres x by itself Example: weight 80kg, Height 1.75m (1.75 x 1.75 = )80 ÷ = 26 kg/ m2BMI’s between are about right for people on dialysis
26Summary Low salt for all stages of kidney disease Before dialysis: low protein, maybe potassium and phosphate reductionDialysis: high protein, fluid control, reduced potassium and phosphatePre-transplant: aim for a healthy weight, balanced diet
27Thank you for listening today! Any questions?Thank you for listening today!