Dialysis and Nutrition Basics

PROTEIN

Protein is essential for building and repairing cells within your body, including muscles, skin, hair, and bones. Healthy protein levels also contribute to a strong immune system. Dialysis removes protein from your body, so part of your custom diet plan will focus on making sure you eat enough protein to keep your body strong.

Protein is commonly found in animal products, such as dairy and meat, as well as in some vegetables, nuts, bread, and legumes (beans). Not all protein sources, however, are healthy for the dialysis diet. In fact, some contain harmful levels of waste products.

As you work with your Dialyspa nutritionist, you will learn which protein sources to select and which to avoid. Below is a short list of healthy protein sources that are likely to become part of your diet plan.

Healthy Protein Choices

• Eggs and Egg Whites

• Beef, Poultry, Lamb, Fish, and Shellfish

• Cottage Cheese

• Protein Sources to Avoid

• Bacon, Ham, Sausage, and Cold Cuts

• Liver and Other Organs

• Dried Beans and Peas

• Nuts, Peanut Butter, Sunflower, and Pumpkin Seeds

FLUIDS

When healthy kidneys filter blood, they remove excess fluid, which exits our bodies as urine. ESRD has a substantial effect on urine production because, instead of the 24-hour filtration provided by normal kidneys, your body will have only the time spent during dialysis sessions (usually 12 hours per week).

Without close monitoring of your fluid intake, your dialysis treatments can become more uncomfortable and stressful than necessary.

Physical Symptoms of Too Much Fluid

• High Blood Pressure

• Puffiness and Swelling

• Loss of Energy

• Difficulty Breathing

• Heart Damage

• Shorter Life Span

Effects of Too Much Fluid on Dialysis

• Drop in Blood Pressure

• Fainting

• Rapid Heartbeat

• Muscle Cramps

• Headaches

• Nausea

• Weakness After Treatment

Fluids are more than what we drink. As you work with your Dialyspa nutritionist to determine your fluid intake goals, you will also learn about “hidden” sources that we don’t normally think of as fluids. For example, some fruits have high fluid content, and anything that becomes liquid at room temperature—such as ice cream, popsicles, and gelatin—contributes to your fluid intake.

Common Fluid Sources

• Water, Juice, and Tea

• Coffee and Soda

• Milk

• Ice, Sherbet, Ice Cream and Popsicles

• Gelatin and Syrups in Canned Fruit

• Soup

Adjusting to fluid restrictions can be difficult. Your thirst is affected by your level of activity each day. When you know you will be more active than normal, try to make a fluid plan beforehand to keep yourself hydrated. Here are some tips for managing thirst without exceeding your fluid targets.

Tips to Control Thirst

• Suck on ice chips or hard candy.

• Avoid salty snacks.

• Chew sugar-free gum.

• Rinse your mouth with lemon water.

• Avoid spending time outside in the sun when possible.

• Suck on a frozen grape or lemon slice.

SODIUM

Sodium helps regulate blood pressure and fluid levels within the body, but too much sodium can cause high blood pressure and water retention, both of which can quickly become problematic for dialysis patients.

Reducing sodium intake is difficult in any diet because many prepared foods include high levels of sodium—everything from packaged crackers and frozen dinners to many condiments. On the positive side, the better you monitor your sodium intake, the more improvement you will see in your ability to regulate your fluids and reduce thirst.

Your Dialyspa nutritionist will help you identify both low-sodium foods to enjoy and high-sodium foods to avoid.

Sodium Reduction Tips

• Eat home-cooked meals whenever possible, and add flavor with herbs and spices instead of salt.

• When dining out, request broiled meat prepared without salt. If you enjoy the taste of sauce or gravy, ask for it on the side, and dip your fork into the sauce before spearing a bite of meat. You’ll get the taste of the sauce while keeping your overall sodium intake much lower.

• Substitute salted snacks for unsalted varieties, such as natural or air-popped popcorn.

• Avoid processed meats, microwave meals, and fast food.

POTASSIUM

Potassium is instrumental in transmitting electrical currents to your muscles, which stimulates movement. Your body’s most important muscle is your heart, and potassium is a key element in regulating your heartbeat.

Healthy kidneys control the amount of potassium in the body, but dialysis can cause these levels to rise (hemodialysis) or fall (peritoneal dialysis) precipitously. Therefore, potassium is particularly important to monitor in order to avoid placing undue stress on your heart.

Symptoms of High Potassium Levels

• Irregular heartbeat

• Nausea

• Difficulty breathing

• Cardiac arrest

• Symptoms of Low Potassium Levels

• Increased heartbeat

• Muscle weakness

• Weakened reflexes

Your unique nutritional needs, along with your dialysis modality, will determine your optimum potassium targets. In general, all dialysis patients should avoid foods and fluids high in potassium.

Below is a list of the most common high-potassium sources to avoid. Keep in mind, however, that even fresh fruits and vegetables can be high in potassium.

Common High Potassium Sources to Avoid

• Chocolate and Molasses

• Dried Beans and Peas

• Dried Fruits

• Oranges and Orange Juice

• Bananas

• Melon

• Tomatoes and Tomato Juice

• Fresh Broccoli

• Nuts and Peanut Butter

• Potatoes

• Milk

PHOSPHOROUS AND PHOSPHATE BINDERS

When kidneys are functioning normally, phosphorous works with calcium to promote healthy bones. Phosphorous, however, is not cleared well through dialysis, and the build-up will eventually reduce the amount of calcium in the body and negatively affect bone health.

Because dialysis alone is not adequate to remove excess phosphorous, your diet plan will include a two-prong approach: intake regulation and medication called “phosphate binders” to be taken with every meal and snack. Phosphate binders “bind” to excess phosphate in your stomach to prevent it from entering your bloodstream.

Diligence in monitoring phosphorous levels and taking your phosphate binders is crucial, not only to your bone health, but to your personal comfort. If you eat food high in phosphorous or forget to take your binders, you can quickly experience painful physical side effects including severe itching and joint pain.

High-Phosphorous Foods to Avoid

• Cola

• Pizza

• Hot dogs and Sausage

• Pancakes

• Macaroni and Cheese

• Pork and Beans

• Ice Cream

• Chocolate

• Yogurt and Pudding