Dietary Modifications in Dialysis Patients
Dr Trisha Sachan
A Renal Nutritionist’s Guide
When a family member is on dialysis, dietary adjustments are crucial to manage their health effectively. While the entire cooking process doesn’t need to be done twice, careful planning and mindful cooking can ensure the patient’s needs are met without drastically altering family meals.
Here are 5 major points to keep in mind:
- Increase Protein Intake
- Sodium Management
- Potassium Control
- Phosphorus Management
- Fluid Intake
Increase Protein Intake
Increased Protein Needs:
Hemodialysis patients typically require 1.2 to 1.4 g/kg body weight of high biological value protein per day due to increased protein catabolism and losses during dialysis.
Low Phosphorus Protein Sources:
Encourage the consumption of protein sources with lower phosphorus content, such as egg whites, chicken (skinless), and fish, while balancing with phosphate binders as needed.
Vegetarian Section
- Tofu – Tofu is a good source of protein and is lower in phosphorus compared to many other plant-based proteins. Opt for fresh, unseasoned tofu to avoid added sodium.
- Paneer- prefer to home made – keep salt less ( market paneer has more salt).
- Greek Yogurt – choose unsweetened Greek yogurt.
- Quinoa – complete protein source, providing all essential amino acids. It is relatively low in phosphorus and potassium compared to other grains.
- Nuts and Seeds – Some nuts and seeds, like almonds and flaxseeds, provide protein but should be consumed in limited amounts due to their higher phosphorus content.
- Protein Supplements: Depending on individual needs, renal-specific protein supplements designed for CKD patients can be an option to ensure adequate protein intake without excessive phosphorus or potassium.
Sodium Management
Limit Sodium Intake:
Keep your sodium intake under 2 grams per day to control blood pressure and prevent fluid buildup, which helps manage weight and blood pressure between dialysis sessions.
Avoid High-Sodium Foods:
- What to Avoid: Stay away from processed meats like bacon, and sausages, as well as canned foods and pre-packaged snacks, which often have a lot of added salt.
- Be Careful with Salt Substitutes: Some salt substitutes contain potassium chloride, which can be harmful if you have kidney disease. Always check with your healthcare provider before using any salt substitutes.
Understanding 2 grams of Sodium
Table Salt:
1 teaspoon of table salt contains about 2300 mg of sodium. So, 2 grams of sodium is slightly lessthan 1 teaspoon of salt
Examples of Foods with Sodium Content:
Bread:
1 Slice of regular white bread contains about 150-200 mg of sodium.
2 Slices of bread would contribute roughly 300-400 mg of sodium.
Canned Soup:
1 cup (240 ml) of canned chicken noodle soup contains about 800-900 mg of sodium.
Cheese:
1 slice (28g) of American cheese has around 300-400 mg of sodium.
Eating two slices would contribute approximately 600-800 mg of sodium.
Processed Meats (Ham, Bacon):
2 slices of ham can have about 500-600 mg of sodium.
2 slices of bacon contain about 350-400 mg of sodium.
Condiments:
1 tablespoon of ketchup has about 150-200 mg of sodium.
Potato Chips:
A small bag of potato chips (about 1 ounce or 28g) contains roughly 150-200 mg of sodium.
Managing potassium
For dialysis patients, managing potassium is crucial to prevent complications. Here’s a quick guide
High-Potassium Foods (200+ mg per serving):
Limit or avoid these foods:
- Bananas: ~400 mg per medium banana.
- Oranges & Juice: ~240 mg per orange, 470 mg per cup of juice.
- Tomatoes & Sauce: ~290 mg per tomato, up to 800 mg per cup
of sauce. - Potatoes: ~930 mg per medium potato. Leach and boil to reduce potassium.
- Avocados: ~480 mg per half avocado.
- Spinach (Cooked): ~840 mg per cup.
Moderate-Potassium Foods (100-200 mg per serving):
Control portions of these:
- Apples: ~195 mg per medium apple.
- Berries: ~220 mg per cup of strawberries, 114 mg for blueberries.
- Carrots (Raw): ~230 mg per medium carrot.
Low-Potassium Foods (<100 mg per serving):
Safer options include:
- White Bread: ~35 mg per slice.
- Rice & Pasta: ~30-55 mg per 1/2 cup.
- Cabbage: ~150 mg per cup cooked.
- Cucumbers: ~150 mg per medium cucumber.
Tips:
Leach & Boil: Reduce potassium in vegetables.
Portion Control: Even low-potassium foods can add up.
Phosphorus Management
Phosphorus Restriction:
Recommend dietary phosphorus intake of 800- 1000 mg/day. High phosphorus foods such as dairy products, nuts, seeds, beans, and certain meats should be limited.
Phosphate Binders:
Encourage adherence to phosphate binders during meals to prevent hyperphosphatemia and subsequent complications such as secondary hyperparathyroidism and vascular calcification.
Fluid Management
Fluid management is crucial for hemodialysis patients to prevent complications like swelling, high blood pressure, and heart problems. Here’s how to effectively manage fluid intake:
1. Monitor Fluid Intake:
Limit Fluids: Generally, limit your fluid intake to about 1-1.5 liters per day, depending on your doctor’s advice. This includes all liquids (water, tea, coffee, juice) and foods that melt at room temperature (ice cream, soups, and gelatin).
Track Fluids: Keep a daily log of everything you drink and eat that counts as fluid.
2. Be Aware of Hidden Fluids:
Fruits and Vegetables: Some fruits and veggies have high water content (e.g., watermelon, cucumber) and should be eaten in moderation.
Salty Foods: Avoid salty foods, as they make you thirsty and lead to higher fluid intake.
3. Tips to Control Thirst:
Ice Chips: Suck on ice chips instead of drinking water. Chew Gum or Suck on Hard Candy: This can help keep your mouth moist without increasing fluid intake.
Use Small Cups: Drink from smaller cups to help control portions.
Sample Diet for a 60 kg Dialysis Patient - Non Veg
Breakfast:
- 1 slice whole-grain toast: 100 mg sodium, 80 calories, 3g protein
- 2 scrambled egg whites: 110 mg sodium, 34 calories, 7g protein
- 1 small apple: negligible sodium, 80 calories, 0.5g protein
- 1/2 cup cooked oatmeal (no salt): 0 mg sodium, 150 calories, 5g protein
- 1 tablespoon peanut butter: 80 mg sodium, 100 calories, 4g protein
- Total for Breakfast: 290 mg sodium, 444 calories, 19.5g protein
Mid-Morning Snack:
- Greek yogurt (plain, unsweetened, 6 oz): 70 mg sodium, 100 calories, 15g protein
- 1/4 cup blueberries: negligible sodium, 20 calories, 0.5g protein
- Total for Mid-Morning Snack: 70 mg sodium, 120 calories, 15.5g protein
Lunch:
- Grilled chicken breast (3 oz): 70 mg sodium, 140 calories, 26g protein
- 1/2 cup cooked quinoa: 7 mg sodium, 111 calories, 4g protein
- Steamed broccoli, no salt (1 cup): 30 mg sodium, 55 calories, 3g protein
- 1 small orange: negligible sodium, 62 calories, 1g protein
- Total for Lunch: 107 mg sodium, 368 calories, 34g protein
Afternoon Snack:
- 1 ounce unsalted almonds: 0 mg sodium, 164 calories, 6g protein
- 1 medium carrot (raw): 42 mg sodium, 25 calories, 1g protein
- Total for Afternoon Snack: 42 mg sodium, 189 calories, 7g protein
Dinner:
- Baked salmon (3 oz): 37 mg sodium, 175 calories, 19g protein
- 1/2 cup boiled potatoes, no salt: 30 mg sodium, 70 calories, 2g protein Steamed green beans, no salt (1/2 cup): 10 mg sodium, 20 calories, 1g protein
- 1/2 cup brown rice, cooked: 0 mg sodium, 110 calories, 2g protein
- Total for Dinner: 77 mg sodium, 375 calories, 24g protein
Evening Snack:
- 1 cup mixed fruit salad (e.g., berries, melon): negligible sodium, 60 calories, 1g protein
- Unsalted crackers (10 pieces): 150 mg sodium, 120 calories, 2g protein
- Total for Evening Snack: 150 mg sodium, 180 calories, 3g protein
Daily Total:
- Sodium: 736 mg
- Calories: 1,676 calories
- Protein: 103g protein
Sample Diet Plan for a 60 kg Dialysis Patient - Vegeterian
Breakfast:
- 1 slice whole-grain toast: 100 mg sodium, 80 calories, 3g protein
- 1/2 cup cooked oatmeal (no salt): 0 mg sodium, 150 calories, 5g protein
- 1 tablespoon almond butter: 0 mg sodium, 100 calories, 2g protein
- 1 small banana: negligible sodium, 90 calories, 1g protein
- Total for Breakfast: 100 mg sodium, 420 calories, 11g protein
Mid-Morning Snack:
- 1 small bowl (6 oz) plain Greek yogurt: 70 mg sodium, 100 calories, 15g
protein - 1/2 cup strawberries: negligible sodium, 25 calories, 0.5g protein
- Total for Mid-Morning Snack: 70 mg sodium, 125 calories, 15.5g protein
Lunch:
- 1 cup cooked quinoa: 14 mg sodium, 222 calories, 8g protein
- 1/2 cup cooked lentils: 5 mg sodium, 115 calories, 9g protein
- 1 cup steamed spinach (no salt): 60 mg sodium, 40 calories, 5g protein
- 1 medium apple: negligible sodium, 95 calories, 0.5g protein
- Total for Lunch: 79 mg sodium, 472 calories, 22.5g protein
Afternoon Snack:
- 1/4 cup unsalted mixed nuts: 0 mg sodium, 200 calories, 6g protein
- 1 medium carrot (raw): 42 mg sodium, 25 calories, 1g protein
- Total for Afternoon Snack: 42 mg sodium, 225 calories, 7g protein
Dinner:
- 1/2 cup cooked brown rice: 0 mg sodium, 110 calories, 2g protein
- 1/2 cup cooked chickpeas (no salt): 24 mg sodium, 120 calories, 7g protein
- 1 cup roasted cauliflower (with 1 tsp olive oil): 50 mg sodium, 100 calories,
3g protein - 1/4 avocado: 2 mg sodium, 60 calories, 1g protein
- Total for Dinner: 76 mg sodium, 390 calories, 13g protein
Evening Snack:
- 1 cup mixed fruit salad (e.g., berries, melon): negligible sodium, 60
calories, 1g protein
10 unsalted whole-grain - crackers: 150 mg sodium, 120 calories, 2g protein
- Total for Evening Snack: 150 mg sodium, 180 calories, 3g protein
Daily Total:
- Sodium: 517 mg
- Calories: 1812 calories
- Protein: 72g protein