Deborah Fairow, MS, RD, LDN The Dialysis Diet Deborah Fairow, MS, RD, LDN

Function of the Kidneys ► Eliminates waste products ► Regulates fluid balance in the body ► Balances chemicals that are necessary for the body to function ► Produces hormones that regulate blood pressure, prevent anemia, keeps bones strong

HEMODIALYSIS

Hemodialysis

Nutrition Guidelines for Hemodialysis ► Calories ► Protein ► Potassium ► Phosphorus/Calcium ► Sodium ► Fluid

Calories ► Gives the body energy ► Gives the body strength ► Helps the body save and use protein for other purposes

Sources of Calories ► Carbohydrates Bread Grains Dried beans Cereal Dairy Vegetables Pasta Fruit Sweets, sugars ► Fats, Oils

Protein ► Keeps muscles strong ► Helps fight infections ► Repairs body tissues ► Replaces protein lost during dialysis ► Helps to balance fluid in the body This Photo by Unknown Author is licensed under CC BY-SA

Sources of Protein Plant Bread Dried beans Cereal Vegetables Grains Nuts Pasta Nut butters

Sources of Protein (cont.) Animal (High Quality) Eggs Lamb Beef Wild game Chicken Fresh pork Turkey Fish Shellfish Dairy

How much Protein? 8 – 10 ounces per day on average 3 ounces: or 1 ounces: ¼ cup

Protein Supplements

Potassium Found in every cell in the body Helps maintain blood pressure Heart and muscle function

Sources of Potassium Oranges (juice) Potatoes Bananas Tomatoes (juice) Dried fruit Dried beans, legumes Nectarines Nuts Kiwi Chocolate Melons Milk, milk products Avocados Salt substitutes (AVOID)

Star Fruit Contains a toxin that causes mental confusion, seizures, hiccups, insomnia and even death Should not be eaten during any stage of kidney disease

Phosphorus and Calcium Minerals found in the bones and teeth Calcium also helps regulate muscle contraction and nerve function Healthy kidneys tightly regulate the amount of phosphorus and calcium in the bloodstream to keep bones strong

Three ways to Control Phosphorus Dialysis Diet Medication

Dialysis Come to every treatment Stay the full time

Diet Sources of Phosphorus Milk Nuts Ice cream Chocolate Yogurt Organ meats Cheese Dried beans, legumes Pudding Processed foods, fast foods Cream soups Colas

Types of Phosphorus Organic (natural) 30-60% absorption Inorganic (processed) 90-100% absorbed Examples: Phosphoric Acid Dicalcium Phosphate Monosodium Phosphate Sodium Hexametaphosphate

Medication Phosphate binders

Symptoms of High Phosphorus ► Itching ► Bone pain, broken bones ► Heart disease ► Blood vessel damage ► Damage to the parathyroid glands

Sodium ► Raises blood pressure ► Retains fluid ► Increases thirst ► Causes discomfort during dialysis

Sources of Sodium Table salt Salty snacks Processed/cured meat Canned soup Canned vegetables Condiments (soy sauce, catsup, salad dressings) Pickles, olives, relish Frozen dinners Fast foods, restaurant foods

Limiting Sodium Intake ► Try to avoid salt when cooking ► Don’t add salt at the table ► Use herbs and salt-free seasoning ► Read food labels

Fluid Fluid in ≠ Fluid out → WEIGHT GAIN ► Swelling or fluid weight gain (edema) ► Breathing or sleeping problems, due to fluid in the lungs ► Heart problems, such as CHF ► Discomfort during dialysis

Sources of Fluid Anything Liquid at Room Temperature Water Beverages Ice cream Popsicles Ice Soups Watermelon

Thirst Tips Alcohol-free mouthwash Frozen Grapes Brush Teeth Ice Chew Sugar-free Gum Keep Beverages Cold Sugar-free Hard Candy Control Sodium Intake Lemon Wedges Control Blood Sugar

PERITONEAL DIALYSIS

Peritoneal Dialysis (PD)

Nutrition Guidelines for Peritoneal Dialysis ► Calories ► Protein ► Potassium ► Phosphorus/Calcium ► Sodium ► Fluid

Calories Dialysate solution contains dextrose (sugar) Calories from dextrose is absorbed with each exchange PD patients require fewer calories from food Increase in physical activity

Protein Same requirements as HD Protein is lost during each exchange Must replace losses by eating a high protein diet

Potassium PD removes potassium more efficiently than HD Requirements are higher Potassium supplements may be needed

Phosphorus and Calcium Same restriction as HD Phosphorus removed by dialysis, diet and medication

Sodium Same restriction as HD Too much salt in the diet may require higher dextrose solution to remove extra fluid Can damage the peritoneal membrane

Fluid Typically more generous than HD PD helps preserve kidney function

Putting it all Together…

Resources Clinic dietitian Renal cookbooks Internet sites: National Kidney Foundation www.kidney.org Kidney School www.kidneyschool.org Fresenius www.freseniuskidneycare.com Davita www.davita.com

A good meal plan can improve your quality of life! In Summary… Renal disease is a complex condition with multiple nutrition implications. The renal diet is individualized for each person. A good meal plan can improve your quality of life!