When Chronic Kidney Disease (CKD) progresses on to dialysis, diet continues to play a vital role in a patient’s rehabilitative care. A well-balanced diet is necessary for them to stay fit as their kidneys are no longer functioning at its full capacity i.e. to get rid of the waste products and fluid from their blood. It is essential for dialysis patients to have the right amount of protein, calories, fluids, vitamins and minerals each day.
To strive towards being healthy and happy dialysis patients, they would need to:
- Eat the right kind and right amount of food on a daily basis
- Staying at a healthy body weight
- Take medication correctly as prescribed by the doctor
- Comply with their dialysis treatment, for instance, do not skip any dialysis session
- Being physically active as possible
Dialysis patient requires a much higher intake of protein than the average person. Too little protein and calorie intake often leads to protein energy malnutrition. To achieve good dialysis outcome, dialysis patient needs to carefully monitor their diet in order to control the waste products and fluids accumulated between dialysis treatments. Your doctor, nurse and dietitian will talk to you about how well you are eating and help you to plan proper balance meals.
Healthy Diet for a dialysis patients
Getting the right amount of calories
Food gives us energy. Getting the right amount of energy (calories) is important to overall health and well-being such as helping your body to use protein for building muscles and tissues. The energy need of each individual is different and depends on age, gender, body size, physical activity level, and medical condition. Some people need more energy to increase their body weight; others need to cut down their energy intake to reduce body weight.
Adequate in protein
Protein is essential for building and repairing muscles and daily growth. During peritoneal or haemodialysis, some amount of proteins is lost and therefore, patients require a higher protein intake compared to people who are not on dialysis. Eating the right amount of protein will help dialysis patients stay fit as insufficient protein intake could result in weight loss, muscle wasting, reducing the ability to fight infections and thus, leading to malnutrition.
Protein can be divided into two categories: high and low quality. For dialysis diet, high-quality protein, for example, meat, poultry, fish and egg whites are more desirable. Most dairy products such as yogurt, milk and cheese also contain high-quality protein.
REMEMBER, RIGHT KIND and CORRECT AMOUNT of protein is vital for dialysis patients to stay healthy. Protein food contains phosphate. Therefore it is very IMPORTANT that dialysis patients take their phosphate binders with ALL their meals.
Find out how 1 portion of protein looks like.
Low in sodium
Most people should limit the amount of sodium in their diet regardless of kidney disease. Even if salt (a major source of sodium) is not adding during cooking, sodium can still be found in other food sources. This is because sodium is naturally found in all different types of foods, and more commonly in packaged and processed foods. Sodium is like-hydrated sponge that absorbs fluid. It makes you feel thirsty and intends to drink more. As a result, weight gain from fluid arises and consequently, increasing in blood pressure can be observed. Sodium restriction in kidney disease helps to maintain normal fluid balance.
To help restrict salt intake:
- Limit the salt added to your cooking
- Avoid using stock cubes and gravy browning e.g. Bovril, Marmite
- Avoid taking bottled chicken extracts
- Read labels on processed foods and avoid items that has more than 250 mg of sodium per serving
- Minimise the usage of canned food. If you do choose to use them, do drain the brine
- Use fresh herbs and whole spices in replace of salt in cooking
- Use fresh lime, lemon juice or vinegar to flavour food
Potassium and Haemodialysis
Potassium is a mineral which is important for the nerves and muscles function. Potassium needs to be maintained at a safe level in the blood. Excessive potassium level in the blood can cause muscle weakness, abnormal heart rates and in extreme cases, heart failure.
Since haemodialysis can only remove a fixed amount of potassium, it is crucial to control the amount accumulated through patients’ dietary intake. Potassium is found mainly in fruits and vegetables, with small quantities found in nuts, dry beans and dairy and meat products. It is important to avoid high potassium food and take low and moderate potassium food in moderation.
AVOID high potassium foods such as
- Wholegrain cereals, bread and biscuit.
- Nuts, seeds and related products, e.g. chocolate, peanut butter.
- Coconuts and related products, e.g. coconut milk, kaya.
- All fresh/canned fruit and vegetable juice, herbal medicine drinks, strong tea/coffee, cocoa and malted beverage, milk, wine
- Brown sugar, molasses, maple syrup, toffees, liquorice
- High potassium salt substitute, bottled sauces, meat and vegetables extract, essence of chicken, stock cube.
- Fruits and vegetables from the high potassium group.
Read more on potassium
Low in phosphorus
As the kidneys become less effective at filtering waste products, blood phosphate level rises. When it begins to build up in the blood, calcium is drawn from the bone. The calcium phosphate product forms hard deposits in patient’s tissues leading to skin itchiness, joint pain, and eye irritation and hardens their blood vessels. Over time, patients’ bones become weak and brittle. This lead to fractures and constant pain.
Both haemodialysis and peritoneal dialysis patients need to control the amount of phosphate in their diet. Almost all patients with high phosphate levels will also need to take phosphate binders as most foods contain some amount of phosphate. Phosphate binders prevent the body from absorbing the phosphate from the foods eaten and thus helping to prevent renal bone disease.
Read more about phosphate
Food rich in phosphorus that patients need to avoid when they have high serum phosphate levels include:
- Oats, cereals
- Dairy products (e.g. milk, cheese, yogurt)
- Bone-based soups (e.g. chicken feet and pork bone)
- Bean products (e.g. all forms of nuts, seeds, bean soup)
- Chocolate and related products
- Malt drinks (e.g. Milo, Horlicks, Ovaltine)
- Processed food and canned food (e.g. canned meat or fish, sausage, meat patty)
- Organ meats (e.g. liver, intestine)
- All sorts of seafood, sardines, anchovies (ikan bilis) and dried shrimp paste
- Wholegrain and related products (e.g. wholemeal bread, brown rice, wholemeal noodles)
Control in fluids
Dialysis patients can no longer excrete large quantities of fluids consumed; therefore, excess fluid can be retained in the body resulting in overloading of the blood circulation. Symptoms such as shortness of breath, high blood pressure and swelling of the legs can occur. Thus, both peritoneal dialysis and haemodialysis patients will need to consider urine output, remaining kidney function, and body size to restrict their fluid intake. Hemodialysis patients may keep track of weight gain in between two dialysis sessions as a gauge.
Daily allowance for fluid intake can vary from 500ml to 1000 ml per day, depending on the patient’s urine output. Limited urine output does not indicate dehydration in dialysis patients. However, it is an indication of further deterioration of kidney functions.
Your daily fluid allowance includes plain water, tea, coffee, milk, gravy, soup and porridge. Other fluids that are liquid at room temperature such as ice-cube, ice cream, jellies are considered as fluid too.
Read more about fluid
Prevention of Anemia
Anemia is common among dialysis patients and it appears to be more common in those who suffer from malnutrition or protein energy wasting. Symptoms of anemia include fatigue, weakness, dizziness, headache, low immunity, breathless or shortness of breath, chest pain, low appetite and pale.
Anemia of chronic kidney disease is one of the complications of kidney failure. Its severity can be related to how well the kidney is functioning. The main reason for anemia among chronic disease patients is the reduced production of erythropoietin (EPO) by the kidneys. EPO prompts the bone marrow to make red blood cells. When the kidney’s function is decreasing, the amount of EPO produced will be reduced. Other factors that cause anemia among dialysis patients are:
- Reduced red blood cell lifespan due to accumulated urea toxic
- Lack of iron
- Lack of folate and other vitamins
- Blood loss during haemodialysis
Adequate intake of protein, iron, vitamin C, vitamin B 12 and folate are important in preventing and treating anemia as these nutrients are the important elements in making new red blood cells.
*The above information and recommendations are general guidelines, and should not be viewed as specific advice for any individual. Please consult your physician or other health care advisors for personal health decisions.