1. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Eating Well with Chronic Kidney Disease Pre-dialysis Education Queensland Health NEMO Renal Group

2. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Why Nutrition? To keep healthy and well nourished. To keep healthy and well nourished. To prevent build-up of unwanted nutrients and waste products. To prevent build-up of unwanted nutrients and waste products. To help help slow the progression of kidney disease. To help help slow the progression of kidney disease.

3. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Keeping Healthy is important! You need to be in tip top shape! Why? Why? Well nourished people do better. Well nourished people do better. –Less chance of problems with dialysis. –Improved ability to fight infection. -Less time in hospital. -You feel better.

4. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Hows your nutrition? Ask yourself a few simple questions. Ask yourself a few simple questions. –How is your appetite? –Have you gone off protein foods? –Have you lost weight without trying? –Are you in your healthy weight range?

5. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Your Healthy Weight Range BMI(body mass index) = weight(kg)/Ht x Ht(m)

6. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW If you are underweight… Eat small meals regularly. Eat small meals regularly. Make every mouthful count… Make every mouthful count… –Choose nutritious foods that are energy dense. –Make sure your drinks are nutritious. See a Dietitian. See a Dietitian.

7. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW If you are overweight… Your kidneys work harder if you are overweight. Your kidneys work harder if you are overweight. Losing weight can help your kidneys work as well as they can for as long as they can. Losing weight can help your kidneys work as well as they can for as long as they can. See a Dietitian. See a Dietitian.

8. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW The kidneys are your bodys waste disposal unit Healthy kidneys remove waste products from the bloodstream. Healthy kidneys remove waste products from the bloodstream. In Chronic Kidney Disease… In Chronic Kidney Disease… –Waste products can build up in your blood. –Some of these waste products come from the food we eat. –You may need to limit some foods.

9. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW How to tell if you need to limit some foods Regular blood tests will show if any waste products are building up in your blood. Regular blood tests will show if any waste products are building up in your blood. The Kidney Team will let you know if you need to limit any particular foods. The Kidney Team will let you know if you need to limit any particular foods.

10. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW When will you see a Dietitian? You will see a Dietitian through the Chronic Kidney Clinics. You will see a Dietitian through the Chronic Kidney Clinics. If you start dialysis, you will see a Dietitian as your diet will change. If you start dialysis, you will see a Dietitian as your diet will change.

11. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW What to expect from the Dietitian The Dietitian will look at your… The Dietitian will look at your… –Medical History, –Weight History, –Blood Levels, –Recent Dietary Intake with a Diet History.

12. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Taking a Diet History Your Dietitian will ask you lots of questions about what you normally eat. Your Dietitian will ask you lots of questions about what you normally eat. No right or wrong answers! No right or wrong answers! Used to see if you are getting too much or too little of any particular nutrient. Used to see if you are getting too much or too little of any particular nutrient.

13. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Which nutrients Protein, Protein, Sodium (Salt), Sodium (Salt), Fluid, Fluid, Potassium, Potassium, Phosphate. Phosphate.

14. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Protein Protein is found in red and white meats, fish, eggs, dairy products and legumes. Protein is found in red and white meats, fish, eggs, dairy products and legumes. Its important to have the right amount of protein you need for growth, healing and fighting infection. Its important to have the right amount of protein you need for growth, healing and fighting infection. too much protein can lead to a build up of a waste product called Urea. Too little protein could lead to under nutrition.

15. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Sodium or Salt Most people eat too much salt. Most people eat too much salt. You dont need to add salt to get too much salt. You dont need to add salt to get too much salt. –75% of salt comes from processed foods. –Corned, smoked, pickled and takeaway foods. Tinned and packet soups, sauces. Too much salt causes fluid retention and increases blood pressure. Too much salt causes fluid retention and increases blood pressure.

16. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Hints to cut down on Salt Salt is an acquired taste. Salt is an acquired taste. Limit processed foods, Limit processed foods, Limit takeaway foods, Limit takeaway foods, Avoid adding salt in cooking and at the table, Avoid adding salt in cooking and at the table, Do not use Salt Substitutes. Do not use Salt Substitutes.

17. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Fluid Excess fluid can cause: Excess fluid can cause: –High blood pressure, –Swelling in the ankles, hands and face, –Shortness of breath. Check with your Renal Team regularly about how much fluid you should drink. Check with your Renal Team regularly about how much fluid you should drink. Fluid is not just water. Fluid is not just water. –Count anything that is liquid at room temperature.

18. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Potassium Potassium is a mineral needed by the body to make your muscles and cells work. Potassium is a mineral needed by the body to make your muscles and cells work. High or Low blood levels can be dangerous for your heart. High or Low blood levels can be dangerous for your heart. Not everyone needs a low potassium diet. Not everyone needs a low potassium diet. –You will only need to start a low potassium diet if your blood levels are high.

19. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW What does a low potassium diet look like….? Potassium is found in a variety of foods. Potassium is found in a variety of foods. –not just bananas! If you need a low potassium diet, your dietitian will check… If you need a low potassium diet, your dietitian will check… 1.The amount and type of fruit you eat, 2.If you are having too many dairy foods, 3.Your intake of high potassium foods. e.g. dried fruit, nuts, seeds, juices, fruit cake, salt substitutes, caramels, chocolate, liquorice, potato chips, tomato sauces, coffee.

20. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Phosphate Phosphate is a mineral that is important for strong bones and teeth. Phosphate is a mineral that is important for strong bones and teeth. High levels can weaken your bones and damage your blood vessels. High levels can weaken your bones and damage your blood vessels.

21. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Treating a high Phosphate Phosphate binders Phosphate binders –Tablets that you take with meals. –Act like a sponge to suck the phosphate out of your food before you absorb it. –Cal-sup, Caltrate, Titrilac, Renagel, Alutab. Low Phosphate Diet Low Phosphate Diet –Not everyone needs a low phosphate diet. –You will only need to start a low phosphate diet if your blood levels are high.

22. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW What does a low Phosphate Diet look like…? Phosphate is found in a variety of foods. Phosphate is found in a variety of foods. If you need a low Phosphate Diet, the dietitian will check … If you need a low Phosphate Diet, the dietitian will check … 1.If you are getting the right amount of protein and dairy foods. 2.If you are getting too many high phosphate foods, particularly between meals. e.g. chocolate, cola drinks, nuts and seeds, some types of fish.

23. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Everyone is different… Your kidney team will tell you if you need to start a special diet. Your kidney team will tell you if you need to start a special diet. There is no need to avoid potassium or phosphate foods unless your blood levels are high. There is no need to avoid potassium or phosphate foods unless your blood levels are high.

24. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Everyone is different… There is no one special diet for people with renal disease. There is no one special diet for people with renal disease. It all depends on… It all depends on… –Your level of renal function. –What your blood tests show. –What kind of dialysis you choose.

25. This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011. Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW Any Questions?