When 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
- Being physically active as possible
Dialysis patients require 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.
A Healthy Diet for 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.
Dialysate used by peritoneal dialysis patients provide extra calories in carbohydrate (sugar) form. To prevent excessive calorie intake, peritoneal dialysis patients need to take into consideration the calories (sugar) from the dialysate. You may need to cut down your daily carbohydrate (sugar) intake. Do check with your dietitian or doctor about the calories contributed by the dialysate used.
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
Read more about a low sodium diet
Potassium and Peritoneal dialysis
Potassium is a mineral which is important for the nerves and muscles function. Potassium is significantly removed during peritoneal dialysis. Thus, peritoneal dialysis patient may need to eat more potassium-rich foods. Signs and symptoms of low potassium are muscle cramps, difficulty breathing and irregular heart beat. Too low or high potassium can be dangerous, resulting in cardiac arrest. Be sure to speak with your dietitian about your potassium levels and which foods are best for you to have with your meals and snacks safely.
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.
Food rich in phosphorus that patients need to avoid when they have high serum phosphate level include:
- All sorts of seafood, sardines, anchovies (ikan bilis) and dried shrimp paste
- Processed food and canned food (e.g. canned meat or fish, sausage, meat patty)
- Dairy products (e.g. milk, cheese, yogurt)
- Bean products (e.g. all forms of nuts, seeds, bean soup)
- Malt drinks (e.g. Milo, Horlicks, Ovaltine)
- Oats, cereals
- Chocolate and related products
- Wholegrain and related products (e.g. wholemeal bread, brown rice, wholemeal noodles)
- Organ meats (e.g. liver, intestine)
- Bone-based soups (e.g. chicken feet and pork bone)
Read more about phosphate
Control in fluids
Dialysis patients can no longer excrete large quantities of fluid 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. Peritoneal dialysis patients will also need to see how much fluid is removed during an exchange.
Daily allowance for fluid intake can vary from 500 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.
You can refer to Helpful Resources for fluid leaflet
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 of anemia happen among chronic disease patients is reduced production of erythropoietin (EPO) by the kidney. 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.