Food gives you energy and helps your body repair itself. Food is broken down in your stomach and intestines. Your blood picks up nutrients from digested food and carries them to all your body cells.
These cells take nutrients from your blood and put waste products back into the bloodstream. When your kidneys were healthy, they worked around the clock to remove wastes from your blood. The waste leaves your body when you pass urine. Other wastes are removed in bowel movements.
Hemodialysis removes wastes from your blood but between dialysis sessions, wastes can build up in your blood and make you sick. You can reduce the amount of wastes by watching what you eat and drink. A good meal plan can improve your dialysis and your health.
1.Protein
Patients on dialysis lose protein. Your body breaks protein down into a waste product called urea. If urea builds up in your blood, it’s a sign you have become very sick. Eating high biological value (HBV) proteins is important because they produce less waste than others. High protein intake is advocated for, that is 1.5g/kg body weight.
HBV (High Biological Value) protein of good quality is found in low fat milk and cheese, egg white, fish and other sea food, lean trimmed meats, chicken and turkey without skin.
LBV (Low Biological Value) protein lacks in one or more essential amino acids. It is found in legumes, grains, vegetables, cereals, white bread, potatoes and pasta.
2. Fluids
Fluid intake should be balanced with the body fluid losses (urine, sweat etc). The total fluid permitted is 500ml plus the previous day’s (24 hours) urine output.
Any food that is liquid at room temperature also contains water. These foods include soup, porridge, jellies and ice cream. Many fruits and vegetables contain lots of water, too. They include melons, grapes, apples, oranges, tomatoes, lettuce and celery. All these foods add to your fluid intake.
Fluid can build up between dialysis sessions, causing swelling and weight gain. The extra fluid affects your blood pressure and can make your heart work harder. You could have serious heart trouble from overloading your system with fluid.
3.Sodium
Sodium restriction may be necessary to help avoid fluid retention, control hypertension and to avoid congestive cardiac failure while maintaining a normal hydration status. The level of sodium intake can be achieved by omitting foods high in sodium like processed foods such as bacon, sausages, trimmed meat and canned foods. Limit salt used in cooking and do not add salt at table. Remember all foods and drinking water has varying amounts of natural sodium.
4. Potassium
Potassium is a mineral found in many foods, especially milk and dairy products, meats fruits and vegetables, bran cereal and bran products. It affects how steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Potassium levels can rise between dialysis sessions and affect your heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.
You can remove some of the potassium from potatoes and other vegetables by peeling them, then soaking them in a large amount of water for several hours. Alternatively bake potatoes with skin. Drain and rinse the vegetables before cooking them.
NB: Potassium intake should be restricted if serum potassium is elevated and urine output diminished. The recommended daily potassium is 30 – 50 mg (1120 – 1950) in acute renal failure and 38.5 – 60 mg (1500 – 2340gm) in chronic renal failure.
Foods high in potassium content should not be taken during the first or second hour of dialysis.
POTASSIUM CONTENT (IN MG) PER 100 GMS OF VARIOUS FOODS
VERY HIGH POTASSIUM CONTENT
| Peanuts | 701 |
| Peanut butter | 670 |
| Avocado | 604 |
| Peas (dry) | 567 |
| Garlic | 529 |
| Bananas | 370 |
HIGH POTASSIUM CONTENT
| Salmon 421 | Chicken 411 | Mushrooms 414 |
| Beans 416 | Turkey 411 | Cow peas 352 |
| Peas (green) 196 | Pork 390 | Carrots 341 |
| Beef 370 | Spinach 324 | Radish 322 |
| Plums 299 | Potatoes 407 | Sweet Potatoes 300 |
MODERATE POTASSIUM CONTENT
| Broccoli 275 | Guavas 289 |
| Chinese cabbage 253 | Apricots 281 |
| Okra 249 | Peach 202 |
| Tomatoes 244 | Orange 200 |
| Kales 221 | Strawberry 164 |
| Cauliflower 207 | Water lemon 160 |
| Turnips 188 | Grapes 158 |
| Asparagus 183 | Pineapple 146 |
| Pumpkin 178 | Lemon juice 141 |
| Cucumber 160 | Grape fruit 135 |
| Onions 157 | Pears 130 |
| Eggplant 150 | Apple 110 |
| Rhubarb 128 | Lime 104 |
| Macaroni 197 | Tangerine 18 |
| Corn meal flour 165 |
LOW POTASSIUM CONTENT
| Eggs 129 | Sugar NIL |
| Cottage cheese 85 | Marmalade NIL |
| Rice 70 | Oil NIL |
| Spaghetti 61 | Oats NIL |
| Noodles 44 | Cornflakes NIL |
1.Phosphorous and Calcium
Phosphorous is a mineral found in many foods. If you have too much phosphorous in your blood, it pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too much phosphorous may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts and peanut butter are high in phosphorous.
Usually people on dialysis are limited to ½ cup of milk per day
However, further restriction of dietary phosphate renders the diet nutritionally inadequate. Phosphate binders like Actal Tums, calcium carbonate should therefore be used in place of dietary restriction to control the phosphorous in your blood between dialysis sessions. These medications act like sponges to soak up, or bind, phosphorous while it is in the stomach. Because it is bound, the phosphorous does not get into the blood. Instead, it is passed out of the body in the stool.
2.Calories
The diet should provide adequate calories (35 – 40 kcal/kg/day) to maintain an optimal nutritional status and as a source of energy. Non protein kilocalorie intake without order to avoid hyperlipidaemia, fat consumption has to be modified. This is got by calculating 30 – 35% of total kilocalories for fat consumption.
Some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils-like olive oil, canola oil and safflower oil, are good sources of calories. Use them generously on breads, rice and noodles.
Butter and margarines are rich in calories. But these fatty foods can also clog your arteries. Use them less often. Vegetable margarine like Flora is better than blue band.
Sweets, sugar, honey, jam and jelly provide calories and energy without clogging arteries or adding other things that your body does not need. If you have diabetes, be very careful about eating sweets. A dietitian’s guidance is very important for people with diabetes.
Hyperlipoproteinemia increases the progression of renal disease. Therefore; there should be a modification on the fat and carbohydrate intake.
3.Nutritional Adequacy
Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Vitamin B12, folic acid, zinc, copper and vitamin C may be taken. Take only vitamins your doctor prescribes
Warning: Do not take vitamin supplements that you can buy off the store shelf. They may contain vitamins or minerals that are harmful to you.
Each item below contains approximately 7gms protein and should be spread out in the 3 meals taken in a day.
FOOD |
PROTEIN (gms)
|
| 1 egg white | 7 |
| 1 cup of milk (skimmed) | 8 |
| 1 oz (30gms) Lean meat | 7 |
| 1 oz (30gms) Chicken (no skin) | 7 |
| Total | 29gms |
SAMPLE MENU
BREAKFAST
| Starch: | 2 slices of bread or 1 cup porridge |
| Protein: | 1 egg white or½ cup low fat milk |
| Fruit: | ¼ small pawpaw, 1 small tangerine or 1 pear |
LUNCH/DINNER
| Starch: | 1 cup of rice, noodles, pasta, spaghetti, ugali or 1 chapati |
| Protein: | Small portion lean meat (1 – 2 times a week); chicken (no skin) or Tilapia 1 oz
(30gms) per serving or 1 cup lentils, beans, ndengu (1 – 2 times a week)
|
| Vegetables: | 1 cup of cabbage, cauliflower, turnips or carrots
Vegetable salad (lettuce, celery, radish or parsley)
|
| Fruit: | 1 portion i.e. 1 slice pineapple, 1 apple, 1 lemon or 1 peach |
MID-MORNING/AFTERNOON SNACKS
| 2 slices bread or 1 cup porridge or cereal |
| Nibble on some low potassium fruits and veggies (carrot sticks/apple wedges) |
| Unsalted popcorn |
| Unsalted crackers |
| Tea with milk (from daily allowance) – no sugar |