Nutrition and Dialysis
These are the guidelines that I must followed in order to stay healthy.
Diet plays a vital role in dialysis patients’ 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.
To strive towards being healthy and happy dialysis patients, they would need to:
- Eat the right kind and amount of food on a daily basis
- Take their medication correctly as prescribed by the doctor
- Comply to the hemodialysis treatment, for instance, not “miss” any dialysis session.
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 patients need to closely and careful monitor their diet so as to help control the waste products and fluids accumulated between dialysis treatments. It is essential for dialysis patients to have the right amount of protein, calories, fluids, vitamins and minerals each day.
A Healthy Diet for a dialysis patient is:
- adequate in protein
- adequate in calories
- low to moderate in potassium
- low in sodium
- low in phosphorus
- controlled in fluids
Protein Protein is essential for building and repairing of muscles in the body and daily growth. 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.
During dialysis, some amount of proteins are 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, reducing the ability to fight infections and thus , leading to malnutrition.
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.
Potassium A mineral that is important for the nerves and muscles functions, potassium needs to be maintained at a safe amount in the blood. Excessive potassium level in the blood can cause muscle weakness, abnormal heart rates and in extreme cases, heart failure.
Since dialysis 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 foods that are high in potassium and to take in moderation food that have low to moderate content.
LOW POTASSIUM (less than 150 mg of potassium per serving)
| Fruits (½ cup or 1 small to medium size) | Vegetables (1 cup raw or ½ cup cooked) |
| Lemon, lime, grape, lychee, longan, apple pear | Lettuce, watercress, cabbage, kang kong, bean sprout |
MODERATE POTASSIUM (150 to 250 mg of potassium per serving)
| Fruits (½ cup or 1 small to medium size) | Vegetables (1 cup raw or ½ cup cooked) |
| Mango, peach, orange | Eggplant, capsicum, onion, cucumber |
HIGH POTASSIUM (more than 250mg of potassium per serving)
| Fruits (½ cup or 1 small to medium size) | Vegetables (1 cup raw or ½ cup cooked) |
| Banana, melon, persimmon, jackfruit, durian | Asparagus, carrot, cauliflower, broccoli, bitter gourd, tomato, potato, choy sam, corn, mushroom |
Phosphate In kidney failure, blood phosphate level rises and when it begins to build up in the blood, calcium is drawn from the bone. The calcium phosphate product forms hard deposits in patients’ tissues leading to skin itchiness, joint pain, eye irritation and hardens their blood 11vessels. Overtimes, patients’ bones become weak and brittle which may lead to fractures and constant pain.
Most food contain even a small amount of phosphate and patients must REMEMBER to take their phosphate binders with meals at all times. Phosphate binders, are an effective way in preventing phosphate from entering the bloodstream when taken together with meals. Generally, this tablet is prescribed in helping to prevent renal bone disease.
Food rich in phosphorus that patients need to avoid when they have high serum phosphate level include: (Not to be consume)
- All sorts of seafood and sardines, anchovies (ikan bilis), dried shrimp paste
- Dairy products e.g. milk, cheese, yogurt
- Bean products e.g. all forms of nuts, seeds, bean soup
- Malted drinks e.g. Milo, Horlick
- Oats, cereals
- Chocolate
- Organ meats e.g. liver, intestine
- Bone-based soups e.g. chicken feet and pork bone
- Colas
Sodium Sodium is naturally found in all different types of foods, but the common source is table salt and different types of bottled sauces used during cooking. Sodium is like-hydrated sponge that absorbs fluid and makes you thirsty and wanting to drink more.
As a result, fluid weight gain arises and thus, an increase in blood pressure can be observed. Sodium restriction is critical for patients and thus helps to maintain their 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.
- Try using fresh herbs and WHOLE spices in replace of salt in cooking
- Try to use fresh lime or lemon juice or vinegar to flavour food
Fluids Dialysis patients can no longer excrete large quantities of fluid consumed. Excess fluid will 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, it is important that fluid intake be restricted.
REMINDER: Dialysis will only remove restricted amount of fluids and the remainder will accumulate in the body. It is important that dialysis patients follow the fluid regime designed by your nurse or doctor.
Daily allowance for fluid intake can vary from 500 to 1000 ml per day, depending on the patient’s urine output, if any. Limited urine output does not indicate dehydration in dialysis patients. However, it means that 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.
Resources :: National Kidney Foundation (Singapore)
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