Healthy eating with kidney disease

If the human body produces less urine with renal failure, it is important to make sure you do not drink too much to prevent hazardous fluid build-up between dialysis sessions. Your health care team will tell you how much you may drink daily without risking complications. Some patients like drinking from bottles to keep track of fluid intake. Whatever method you use, make sure to monitor how much you drink.

See also FAQ below.

When you have renal failure, your body often can’t effectively regulate the sodium level (salt) anymore. Sodium can contribute to high blood pressure and cause you to feel thirsty and thus drink more.

• Use only small amounts of salt when cooking. Use of herbs and other spices will help you to reduce salt.
• Don’t add salt to your food at the table.
• When eating nuts or processed food, like pizza, make sure that they contain only little salt – also, in general, macadamia nuts are preferable to other varieties of nuts.
  

Raised phosphate levels can cause bone decalcification and arteriosclerosis in the long term. To protect your vessels and bones, you have to adapt your daily phosphate intake to your individual needs. Most of the phosphate we take in is contained in proteins, e.g. in meat and milk. It is also important to take your phosphate binders as prescribed. If you plan high phosphate intake, possibly due to a planned barbecue party, make sure to ask your doctor in advance how to take the phosphate binders that day.

If the kidneys no longer excrete enough potassium, potassium levels in the blood can rise (hyperkalemia), e.g. after eating food rich in potassium. Hyperkalemia is a very dangerous condition and can cause life threatening cardiac arrhythmias. Often this occurs without any symptoms, which is a major contribution to its threatening character. Even patients who have never had hyperkalemia before are threatened by a single episode of this disorder. Your doctor will support you on how to control your potassium levels.

Protein is an important nutrient for many bodily functions. As a dialysis patient, you will need sufficient protein intake in your diet. However, most proteins are rich in phosphate. Your diet should include enough protein and not too much phosphate. Your dialysis team will help advise how much and which types of protein are good for you.

Avoid processed and prepared food whenever possible as salt is often added for flavoring. When eating processed foods, check the labels for salt and sodium on the ingredients list. The lower the level of salt or sodium on the list of ingredients, the better. And don’t forget to check how much salt you have already intaken since your last dialysis treatment. When eating at a restaurant, you can ask about the salt, phosphate and potassium content. However usually it is better to check those contents by yourself using dietary listings.

You can help your body by preparing your food correctly. Even some foods containing high potassium, e.g. potatoes and fruits, can be eaten if prepared correctly. Put them into water to leach the potassium from them before eating. Overall, self-prepared, fresh food will contribute to your well-being.

In chronic kidney disease, especially in the early stages, a balanced diet can be essential for your well-being and to avoid further complications. However, diet cannot really help to improve your kidney function as such. Formulate a diet plan together with your doctor and dietitian that is right for you and your personal dietary goals.

Phosphate is found in many foods. The kidney usually keeps the balance right by removing it when there is too much in the body. It is needed for the maintenance of healthy bones, blood vessels, skin and other areas in the body. High phosphate levels may cause itching and sore eyes. Continuously high phosphate levels can cause a rise in PTH (parathyroid hormone), which can cause long-term damage to the bones. If your phosphate level is high you often are asked to keep to a lowphosphate diet and you may be prescribed tablets to bind the phosphate. These are called phosphate binders. Your dietitian will advise you on your diet and such matters as limiting dairy foods and the correct time to take your phosphate binders.

One of the main functions of the kidneys is to balance fluid in the body. In renal failure a common problem is not getting rid of excess fluid. This in turn causes fluid overload which can cause high blood pressure, long-term damage to blood vessels, and even damage to the heart. Your fluid restriction depends on your urine output which may decrease as time goes on. Your care team will tell you how much you can drink.

To help keep thirst under control, spread your fluid intake evenly through the day by using small cups. You can also gargle with iced water, suck ice cubes (which still contain 10-15mls of fluid per cube), or chew gum. Avoid salt and salty foods, e.g. crisps, bacon, and soup, as these will increase your thirst. Remember to be careful of hidden fluids, e.g. water for tablets, gravies, custards, and milk on cereal.

The fluid allowance for each patient is calculated on the basis of urine output, plus 500 ml in a 24-hour period. The 500 ml approximately covers the loss of the fluid through the skin and the lungs. The weight gains between dialysis sessions should be no more than 1-1.5 kg for a one day gap and 1.5-2.5 kg over 2-3 days. Generally speaking, the smaller you are, the less weight you should gain.

If you drink too much between dialysis treatments this could lead to excessive fluid in your body, called fluid overload. However, during dialysis because of the need to remove the extra fluid you may experience a drop in your blood pressure. This is called hypotension. Hypotension can make you feel unwell and light headed and can even harm you. Therefore, it is important to adhere to the recommended fluid allowance in order to keep the interdialytic weight gain low. This can help to protect you during your dialysis treatment.

When you start dialysis you will hear about your dry weight. This is the weight your body should have without excess fluid. It is also the weight used to calculate how much fluid you have put on between dialysis sessions and therefore how much needs to be removed each dialysis session. Your dry weight can change over time. It may need to be increased after a few months if you start eating more now that you are on dialysis and feeling better. However, it could also need to be decreased if you have been unwell and lost weight.

If the water content of the body reaches high levels, the accumulating fluid causes the body to swell, usually starting at the ankles due to gravity, and this may spread up the body. If not treated, the excess fluid can settle in the lungs causing a life-threatening condition called pulmonary edema. Shortness of breath is one the main symptoms of this condition. It can cause damage to your lungs, to your heart and to other organs. We can try to remove the excess fluid with dialysis, but frequent and marked ups and downs can cause permanent damage and leave you with chronic breathing and heart problems.

The fluid restriction is one of the most difficult aspects of dialysis to cope with for many patients, and it is not easy, but there are a number of tips you can follow to help you throughout the day.

• Make sure you know what your fluid restriction is. Ask your care team if you are unsure
• Avoid eating salty foods as this will make you thirsty
• Use a smaller cup or glass. It feels better to have a full small glass than half a large glass
• If you use the same cup, then you know how many you can have in a day, but make sure you know how much fluid it holds
• Some people suck on ice cubes (but remember this is part of your fluid restriction), or suck on boiled sweets if you feel thirsty (be careful if you are diabetic)
• Be aware of hidden fluids in foods such as melons, watermelon, soup, gravy and frozen treats like ice cream. This is all fluid