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

2. 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

3. HEMODIALYSIS

4. Hemodialysis

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

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

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

8. 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

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

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

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

12. Protein Supplements

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

14. 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)

15. 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

16. 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

17. Three ways to Control Phosphorus
Dialysis
Diet
Medication

18. Dialysis
Come to every treatment
Stay the full time

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

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

21. Medication
Phosphate binders

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

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

24. 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

25. 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

26. 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

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

28. 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

29. PERITONEAL DIALYSIS

30. Peritoneal Dialysis (PD)

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

32. 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

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

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

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

36. 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

37. Fluid
Typically more generous than HD PD helps preserve kidney function

38. Putting it all Together…

39. Resources
Clinic dietitian Renal cookbooks Internet sites: National Kidney Foundation Kidney School Fresenius Davita

40. 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!