Transcript Dialysis and diet

Eating well with chronic kidney
disease
Becky Jones
CCDHB Dietitian
Content
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Introduction
Nutrition and predialysis
Nutrition for dialysis
Dietary thoughts for a
kidney transplant
Summary
Questions
Introduction
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Food has an important role in kidney disease.
When the kidneys do not work properly waste
products can build up in the blood.
Dialysis will remove some of the waste products.
Before starting dialysis you also need to be careful
with your diet.
If you start dialysis or change to a different dialysis
type your diet will probably change too.
Your diet depends on your kidney function.
Introduction cont.
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Reduced kidney function can cause:
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Poor appetite
Taste changes
Feeling sick, vomiting
Itching skin
Tiredness
Constipation
You may find it hard to eat and may lose body weight
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Speak to your doctor or nurse about this
Before starting dialysis
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Protein:
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Used to build body tissues, fight infection and keep body
fluid in balance
High protein foods:
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Meat, chicken, fish, eggs, milk, yogurt and seafood
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Too much protein will cause more waste product build
up that may cause more sickness, itchy skin
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You should have small servings of protein at each
meal
Example of low protein
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Breakfast: Cereal and milk or yogurt
Lunch: Sandwich with meat, chicken or egg
Dinner: Small serve of meat, fish or chicken
(size of a deck of cards or small palm size)
with rice / pasta / potatoes / bread and
vegetables
Salt (sodium)
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Usually kidneys get rid of extra sodium and water through the urine.
This doesn’t work as well with reduced kidney function.
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Sodium and fluid can build up. This can lead to high blood pressure,
feeling thirsty and weight gain from fluid gain.
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Foods high in sodium:
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Fast foods:
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potato chips, corn chips, nuts, instant noodles, marmite, vegemite
Canned foods:
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pizza, fried chicken, chips, Chinese takeaways, chowmein, pies
Salted snacks:
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processed meats e.g. corned beef, bacon, luncheon, ham
soup, spaghetti, tinned fish
Stocks, pickles, gravy, tomato sauce, soy sauce
Salt (sodium)
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How much can i have?
2300mg = 1 teaspoon per day
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Look at food labels: aim for less than 150mg sodium per serving
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Try fresh foods and herbs and spices
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Lemon / lime juice, garlic, ginger
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Black pepper
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Mint, parsley, basil
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Honey
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Nutmeg
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When preparing kai such as a boil up or stew, add onions, garlic, and herbs or sauce for
extra flavour instead of salt.
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Instead of povi-masima try Wattie's tinned low salt version
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Potassium
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A mineral found in most foods.
Healthy kidneys remove extra potassium from the
blood.
Diet, medications and high blood sugars can affect
the level in the blood.
The amount allowed in your diet depends on:
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Your kidney function
Whether you are on dialysis
Potassium cont.
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Your doctor will tell you if your level is too high.
Not everyone needs to follow a low potassium diet.
If your level is above 6 mmol/L you will need to
restrict food high in potassium.
You may be referred to a Dietitian.
Phosphate
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A mineral found in many foods.
Needed for healthy bones, teeth, muscle and energy.
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In kidney disease the kidney is not able to get of extra
phosphate from the blood.
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High levels can cause:
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Bone damage
Itch and dry skin
Hardening of arteries
Phosphate cont.
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The level can be controlled by medication
called phosphate binders.
May be called Osteo 500, Calcitab, Alutabs
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Work to bind the phosphate from the food.
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Take at meal times, just before or during,
Avoid taking after you have eaten as they
wont work as well
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Phosphate cont.
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Some foods are high
sources:
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Dried fruit and beans
Chocolate, nuts
Mussels
Processed meats like
ham, pate, luncheon,
liver, sausages
Milk (avoid high calcium
milks) and cheese
Dialysis and diet
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Haemodialysis:
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Most people will need a diet high in protein, fibre
and low in salt and potassium.
May need to limit phosphate
Peritoneal dialysis:
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Most people will need a diet high in protein, fibre
and low in salt and sugar.
May need to limit phosphate.
Dialysis and protein
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High protein diet
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Build muscle, repair body tissues, fight infection
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Some is lost during dialysis.
Needs to be replaced through eating enough protein.
Dietitian will work out how much you need per day.
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Aim to have protein with each meal
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Dairy products may need to limited if phosphate level is
high.
Good levels of protein = more energy, better dialysis,
better quality of life
Dialysis and salt (sodium)
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High intake of sodium will increase thirst and
blood pressure.
Must have a low salt diet when on a fluid
restriction.
Choose fresh foods rather than processed,
flavour foods with herbs and spices to make
tasty and attractive.
Dialysis and fluid
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Ask what your fluid allowance is.
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Drinking too much will cause too much fluid gain between
dialysis sessions.
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High blood pressure, swollen ankles, harder to breathe, can
weaken heart muscles over time.
Lower your sodium intake
You need to be aware of how much fluid you have each day.
Dialysis and fluid
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What are fluids?
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Drinks:
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Anything that is liquid at room temperature
water, tea, coffee, milk, juice, soft drinks, cordials,
wine, beer
Foods:
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custards, gravy, ice-cream, jelly, soup, yogurt,
juicy fruit e.g. watermelon, oranges
Helpful hints for fluid
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Spread your fluids during the day
Avoid salty foods
Use a smaller cup / glass, measure out how much
liquid it holds
Have part of your fluid as ice-cubes
Try having pills in soft food to save fluid
For a dry mouth try:
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A lemon slice, sour lollies, chewing gum, a mint, rinsing your
mouth (remember not to swallow!)
Dialysis and potassium
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On dialysis potassium from foods builds up between
dialysis sessions.
High levels can affect your heartbeat and be
dangerous.
Some people will not need to restrict their potassium
level as much as others.
Changing food choices and cooking methods can
help lower potassium levels.
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Cut vegetables into small pieces before cooking
Boil in large amount of water
Avoid steaming, microwaving and baking vegetables
Dialysis and phosphate
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Remember to take your phosphate binders at the
beginning of your meal.
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Can swallow tablets whole or chew or crush
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Foods to avoid: calcium enriched foods e.g. calcitrim milk, chocolate, cola drinks including diet
versions, peanut butter, takeaways
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You may need to ask the dietitian for more
information about phosphate in foods.
Diet and Peritoneal dialysis
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High protein, high fibre, low salt and low sugar.
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High fibre:
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Often can have more potassium in diet
Peritoneal dialysis can contribute to constipation
Low sugar:
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Dialysis bags contain sugar
Will need to cut down on sugary foods and drinks e.g.
lollies, cakes, biscuits, jam, juices, soft drinks
If you are diabetic make sure you talk to a nurse about
changes to your diabetes medication
Nutrition and kidney transplants
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Pre-transplant aim to keep as healthy as possible
Eat a balanced diet, take your medications, do some
exercise if you able to.
Keep a healthy weight
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CCDHB Body Mass Index (BMI) limits: under 18,
over 35
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Body mass index = weight for height
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How in proportion you are
Body mass index = weight in kilograms ÷ height in metres x by itself
Example: weight 80kg, Height 1.75m (1.75 x 1.75 = 3.0625)
80 ÷ 3.0625 = 26 kg/ m2
BMI’s between 23-26 are about right for people on dialysis
Summary
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Low salt for all stages of kidney disease
Before dialysis: low protein, maybe
potassium and phosphate reduction
Dialysis: high protein, fluid control, reduced
potassium and phosphate
Pre-transplant: aim for a healthy weight,
balanced diet
Any questions?
Thank you for listening today!