Nutrition and Diet
There are many factors, including fluid and food intake, medications, level of kidney function, and other medical conditions, which affect how a patient feels on dialysis. Playing an active role in one’s health, a patient can monitor and adjust fluid and food intake accordingly. With the guidance of a Registered Dietitian, laboratory parameters are measured and assessed monthly. Appropriate diet education and resources are reinforced. It is important to note, every patient has specific dietary needs and these needs may change over time. Most patients on dialysis need to monitor fluid intake, sodium or salt intake, potassium and phosphorus intake, as well as have increased protein requirements. A renal vitamin is suggested to replenish vitamins lost during dialysis treatment. Listed below is basic renal diet information.
Protein is present in both animal and plant food sources. The protein requirement, in order to maintain adequate nutritional status, remains high. In addition, during each dialysis treatment, protein or albumin is lost, thus the diet includes extra protein. There may be a loss of muscle mass and weight, if an insufficient amount of protein is consumed. Some good sources of protein are fish, egg whites, pork chops, lean hamburger, and chicken. Patients can work with the Dietitian to incorporate plant proteins, for example, dried beans and grains. It is important to include a protein source at each meal and snack, to ensure adequate calories are consumed daily. Protein supplements, such as high protein liquid or bars, can be introduced if protein intake is insufficient.
Healthy kidneys can regulate phosphorus in the body. On dialysis, a phosphorus imbalance occurs. Too much or not enough phosphorus in the blood can cause bone disease, as well as heart disease. By limiting phosphorus intake, using phosphate binders, and getting adequate dialysis, the phosphorus level can be adequately maintained. Limit phosphorus intake to 800-1200 mg per day. This allowance can vary based on high protein requirements. Phosphorus in found in most foods like, enhanced (phosphate preservative) meats, bacon or lunch meats, dark cola, pancakes, dairy products, dried beans, nuts, and whole grains.
On dialysis, the kidneys cannot remove fluid as they did before, which results in a build up of fluid. During each treatment, the amount of fluid is removed, with the goal of reaching the estimated dry weight (EDW.) EDW is true body weight, minus all the fluid. Too much fluid between treatments can cause edema or swelling in the legs and lungs, increased thirst, increased work load on the heart, shortness of breath, and/or high blood pressure. Fluid is anything liquid at room temperature. Limit fluids to 1,000 mL (32 ounces) per day and strive for 1-2 kg or 2-4 lbs intradialytic weight gain (IDWG) or “weight gain” between each dialysis treatment.
On dialysis, the kidneys cannot balance sodium and fluids. Controlling sodium or salt intake will help control thirst and blood pressure, thus prevent edema or fluid retention. Limit sodium intake to 2000 mg per day. Sodium is found in table salt, salad dressings/condiments (ketchup and pickles, processed or convenience foods (frozen pizzas, dinners), canned foods (vegetables.)
Eating too much or not enough potassium can weaken muscles, especially the heart muscle. On dialysis, the kidneys cannot get rid of extra potassium in the urine. Controlling the amount of potassium-consumed daily is very important in reducing the risk of a life threatening heart attack. The key to remember is limiting the quantity (amount of food) and quality (low, medium, or high source of potassium) of food consumed between dialysis treatments. Limit potassium intake to 2000 mg per day. Potassium is found in many foods, especially fruits (banana, orange, and melon), vegetables (tomato, potato), dairy products, and salt substitutes.
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