Diet in dialysis patients
Once a patient with chronic kidney disease is put on dialysis, they need to be counseled again. Reframing of the diet is very important as otherwise the patient continues the same diet which was previously prescribed for conservative management of kidney disease.
High energy is recommended to meet the body needs and minimize tissue protein breakdown.
During every dialysis, 12-20g of protein is been lost. The protein requirement increases due to loss of protein during dialysis. If enough protein is not being consumed, there will be muscle breakdown leading to fatigue and weakness. Atleast 50% of the protein should be of high biological value (HBV). HBV sources are eggs, milk and milk products. This protein intake helps to maintain positive nitrogen balance, replace losses and prevent undue accumulation of nitrogen waste between treatments.
Sodium restriction is necessary to control fluid retention and hypertension. Most convenient and favorite foods items such as farsans, chips, biscuits, sandwiches, noodles, Chinese, chaats, panipuri, pizzas, papads, pickles etc all are high in sodium. Check all labels to see how much salt or sodium foods contain per serving Make use of herbs and spices such as imli, kokum, lemon, ginger and garlic.
Potassium should be restricted moderately to prevent high concentration of potassium in the blood. Fruit juices, coconut water, dry fruits, soups are high in potassium.
Phosphorus is a mineral which helps keep bones strong and healthy. It may be referred to as phosphorus or phosphate. As kidney function declines, the blood phosphate level will rise, causing itchy skin, painful joints, and loss of calcium from bones. Therefore, the amount of phosphorus in the diet needs to be controlled. Phosphorus rich foods include milk and milk products, meat, fish and poultry. However, milk products and protein foods are also needed for overall good nutrition. Generally, foods with very high levels of phosphorus, such as seeds, nuts, dried peas, beans and bran cereals, are not included in the daily eating plan. Read product labels carefully for hidden sources of phosphorus such as phosphoric acid and sodium phosphate.
Vitamins and Minerals:
A daily supplement of water soluble vitamins like vitamin B and C and minerals are usually given as these are lost during dialysis. Fat soluble vitamins (vitamins A, D, E and K) may be retained. Thus their supplements are avoided except vitamin D. Supplements of minerals like calcium, iron and zinc are recommended.
Usually 500 ml + urine output is recommended to avoid excessive fluid retention.
Limiting fluid may lead to increase in thirst. To help quench thirst, these options may be tried:
• Chew gum
• Drink from small cups
• Rinse your mouth
• Suck on a piece of ice, mints or hard candy (remember to pick sugar free candy if you have diabetes)