Renal - What can I eat on haemodialysis?

An introduction to your diet

Healthy kidneys normally control the level of substances and water in the body, which come from what we eat and drink. When your kidneys stop working, waste products and fluid build up in your blood, which can make you feel unwell.

Haemodialysis is a treatment used to remove waste products and fluid from the blood using an artificial machine.

Why is diet important?

Having a healthy balanced diet, will help you feel well on haemodialysis. You should eat regular meals which include a variety of foods, however some diet and fluid restrictions may be necessary.

Dietary and fluid restrictions are individual and depend on your remaining kidney function, your current dialysis prescription, other medical conditions you may have, your eating pattern and your blood results (i.e. urea, potassium and phosphate).

Your dietitian will advise you on what diet to follow. Your diet on haemodialysis should be:

1. High in protein
2. Balanced in energy
3. Low in salt
4. Fluid balanced
5. Low-moderate in potassium and phosphate

1.    Protein

Protein is needed for growth and repair of all body tissues. People can lose muscle and protein stores as a result of the dialysis process. It is important to include two good sources of protein in your diet on a daily basis to prevent muscle wastage and to help maintain your strength.

If you have previously been restricting the amount of protein in your diet prior to starting haemodialysis, it is possible to relax this restriction now.

Good sources of dietary protein include:

Meat - beef, pork, lamb, chicken and turkey
Fish - cod, haddock, tuna, plaice
Eggs – please note that eggs are high in phosphate, so try not to eat more than 4 per week.
If you are a vegetarian, good sources of protein include pulses i.e. lentils, dhal, chickpeas.
Milk – up to ½ pint (300ml) per day remember to count as part of your fluid restriction.
Cheese – Cheddar and other hard cheeses up to 3-4 oz per week Try to include 2 servings of protein foods each day.

2.    Energy

It is important to gain sufficient energy/calories as well as protein in your diet to ensure you obtain good nourishment.

Foods which are good sources of energy include starchy foods i.e. bread, pasta, chapattis, potatoes, rice or noodles. These can be included as part of a healthy diet with each meal. (Potatoes, sweet potatoes and yams are high in potassium and may need to be limited).

If you have previously had a poor appetite before starting dialysis, many people find their food intake can improve once they begin having regular dialysis sessions. Dialysis helps to remove toxins/ breakdown products in your blood which can build up in people with reduced kidney function. Remember to contact your dietitian if you have a poor appetite.

3.    Salt

Your body cannot get rid of salt when your kidneys are not working properly. This may lead to fluid retention and oedema. Oedema is the fluid that can accumulate underneath your skin and it can show as a puffy appearance on your skin surface. A high salt diet can contribute to high blood pressure and breathlessness.

Eating less salt can help control high blood pressure and help you to keep to a fluid allowance.

Foods to avoid/or limit

• Avoid salt substitutes i.e. low salt (these are high in potassium)
• Adding salt at the table
• Smoked meat/fish products, i.e bacon ham
• Tinned fish in brine
• Ready meals/take-aways with high salt content and try to avoid adding additional salt to ready meal **
• Packaged soup/sauces

Foods to choose

• Herbs, spices, lemon juice, pepper, marinades to help flavour food
• Fresh meat/fish where possible
• Tinned fish in oil/springwater
• Choose ready-meals low in salt/sodim i.e <1.5g salt per 100g or <0.6g sodium per 100g

** If you do consume ready meals for convenience, try to include some fresh products/foods with these meals i.e. a small salad or fresh vegetables.

4.    Fluid balanced - Why do I need to monitor what I drink?

When first starting dialysis, you may still be passing urine, but it is quite common for urine output to decrease. This will mean decreasing the amount of fluid that you normally drink to prevent the extra fluid building up around your heart and lungs.

Some signs/symptoms of fluid overload

• Sudden increase in weight
• Swollen ankles, legs, tummy and/or face
• Shortness of breath
• Increased blood pressure

Your doctor may recommend a fluid restriction as part of your treatment. You are usually asked to measure your urine output over 24 hours to see what you typically pass in a day. This will help to determine your fluid restriction on haemodialysis.

You are usually allowed to drink 500ml per day plus the equivalent in volume of your urine output in 24 hrs.

For example, if you usually pass 400ml of urine in 24 hrs, your fluid allowance will be 400ml plus 500ml = 900ml

Remember as well as your drinks there is also fluid in some foods e.g. yoghurt, jelly, ice cream, soup and sauces.

'Controlling your fluid intake' is a more detailed booklet which offers practical tips on ways to manage your fluid restriction.  Please ask your dietitian for a copy.

Potassium

The kidneys are responsible for removing excess potassium from the body. Potassium is a mineral that is found in a wide variety of different foods and drinks. Your body needs a certain amount of potassium for functions in the body; it is important to prevent potassium from going too high or too low because it can affect the way your heart beats.

The blood range for potassium in the body is ____________________  

If you have been advised to follow a low potassium diet prior to commencing haemodialysis, please continue to follow this. Once you are established on haemodialysis, your dietitian will review your bloods and can provide further information about continuing on a low potassium diet.

Some tips to keep blood potassium levels in range

• Boil all potatoes and vegetables, and then discard the water you use in cooking
• Par-boil potatoes if making chips
• Avoid steamer, microwave or slow cooker if cooking potatoes/ vegetables
• Have no more than 4 portions of fruit and vegetables per day i.e. 2 fruit and 2 veg per day
• Avoid dried fruit and nuts
• Avoid potato crisps – choose corn-snacks instead
• Avoid mushrooms

Star fruit is considered to be toxic to renal patients and should be avoided.

More information on potassium can be obtained from a separate booklet which your dietitian will be able to provide you with if needed.

Phosphate

Phosphate is a mineral which you normally store in your bones with calcium. Your kidneys are responsible for removing excess phosphate from your body. On dialysis, phosphate levels may still go high and can go low on occasion.

High phosphate levels can lead to:

• itchy skin
• red eyes
• calcification of blood vessels which is a long term consequence of raised phosphate and calcium

The blood range for phosphate in the body is ____________________     

Some tips to keep blood phosphate levels in range

Weekly allowance
•    1/2 pint milk daily
•    3-4oz hard cheese per week, alternatives such as soft cheese, cottage cheese are encouraged.
•    3-4 milky puddings per week (which includes rice pudding, ice- cream, yoghurt, custard)
•    Aim for up to 4 eggs per week
•    Avoidance of packaged/ processed meat/fish products

Phosphate binders

You may be prescribed a phosphate binder to help control your blood phosphate level. These tablets bind the phosphate from your food and they need to be taken at meal times. Some common binders include renacet, sevelamer, lanthanum.

Suggested Meal Plan

Milk
Allowance - 1/2 pint per day for drinks, on cereal etc

Breakfast
Fresh fruit juice (small glass) or tinned fruit or fresh fruit

Cereal i.e cornflakes/rice krispies/weetabix/fresh porridge oats with milk from allowance and/or toast with butter or margarine and jam or marmalade

Tea or water

Snack Meal
This could be a sandwich or something on toast.

Bread/rolls/crackers with butter or margarine with meat e.g chicken/ham/turkey/beef
OR fish e.g tuna/tinned salmon
OR eggs from allowance e.g boiled, poached, scrambled or omelette
OR cheese from allowance
Plus salad (lettuce, cress, cucumber)

1 x fresh fruit or tinned fruit or jelly

Drink of your choice
 
Main Meal
Include a starchy carbohydrate i.e potatoes/rice/pasta/chapattis/ noodles/bread - make a roast or pasta based dish or casserole dish like shepherd's pie/casserole/curry.

Include meat e.g chicken/turkey/beef/lamb/pork OR fish e.g cod/ plaice/haddock/sole OR vegetarian options pulses, e,g lentils/baked beans/Quorn/ tofu.

Plus salad and/or vegetables.

Pudding: chocolate éclair/madeira cake/jam tart/sponge/milky pudding from weekly allowance e.g custard/rice pudding/ice- cream/yoghurt.

Supper
Toast/crackers/biscuits and a small drink.

Remember to take your phosphate binder before, with or after your meal/ snacks as prescribed.
 
If you require more meal and snack ideas, ask your dietitian.

Contact details

0161 206 1994 - renaldietitians@nca.nhs.uk

Useful websites
Greater Manchester Kidney Information network
www.gmkin.org.uk