RENAL DIET BASICS

WHAT KIDNEYS DO
! Remove wastes from the blood via urine ! Balance fluid content in the body ! Produce the enzyme renin that helps control blood pressure ! Produce the hormone erythropoietin to help make red blood cells ! Activate vitamin D to maintain healthy bones ! Maintain the proper balance of acid and minerals, including sodium, phosphorus, calcium, potassium and magnesium

DIALYSIS AND DIET

DIALYSIS and a GOOD MEAL PLAN can help you maintain good health and feel good
TO MAINTAIN GOOD HEALTH, YOU WILL NEED TO CONTROL 6 THINGS:
! ! ! ! ! !

PROTEIN PHOSPHORUS CALCIUM POTASSIUM SODIUM FLUID

PROTEIN
YOU NEED PROTEIN TO KEEP YOUR BODY STRONG AND HEALTHY

PROTEIN IS IMPORTANT FOR:

! Fighting infections ! Growth and tissue repair ! Production of hormones, antibodies and enzymes ! Balance of acid-base, fluid and electrolytes
!

As a dialysis patient, your protein needs are HIGHER because each time you dialyze, you lose some protein. Animal protein is called HIGH QUALITY PROTEIN because it has all the building blocks (amino acids) that our body needs.

ALBUMIN is a type of protein found in the blood. It can be used to evaluate your nutritional status. A low albumin on your monthly lab report can mean that you are not getting enough protein. YOU WANT YOUR ALBUMIN IN A SAFE RANGE OF 4.0 5.2 G/DL

PROTEIN
HIGH QUALITY PROTEIN SOURCES INCLUDE:

Meat Poultry

Fish Game

Seafood Eggs

Most dialysis patients need to eat about 8 -10 ounces of HIGH QUALITY PROTEIN daily

ESTIMATING A SERVING OF PROTEIN

! ! !

1 oz cooked = a matchbox 3 oz cooked = a deck of playing cards or an average persons palm 8 oz cooked = a paperback book

3 oz also equals to: 2 thighs = 2 drumsticks = 1 thigh + 1 drumstick = 3 slices of luncheon meats (low salt) = !3/4 cup of tuna or chopped meat = 6 small spareribs = 4 medium shrimp

= 1 oz of protein

If you cant meet your protein needs with food alone, you may require a protein supplement

PHOSPHORUS
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Phosphorus is a mineral found in many foods, like nuts, dried beans, and dairy products. About 85% of phosphorus in the body is in bones. The body uses phosphorus to:
! Form strong bones and teeth ! Make energy ! Get oxygen to tissues ! Move muscles ! Produce hormones

! !

EATING TOO MUCH PHOSPHORUS CAN CAUSE:

! Itching ! Bone pain ! Bone weakening, causing bones to crack or break ! Hardening of soft tissue (calcification) ! Nausea, vomiting, diarrhea

PHOSPHORUS
HOW TO KEEP PHOSPHORUS UNDER CONTROL:
! !

Follow a low-phosphorus diet. Take the prescribed dose of phosphate binders (PhosLo, Tums, Fosrenol, Renagel, Renvela, calcium carbonate) with EACH meal and snack. It is also important to take your binders WITHIN 10 MINUTES of meals and snacks. Be sure to go to and complete ALL of your dialysis treatments.
HIGH PHOSPHORUS FOODS
1 cup Milk (236 mg) 1 cup Frozen Yogurt (353 mg) 1 oz Chocolate (200 mg) 12 oz Cola (44 mg) 1/2 cup Brown Rice (81 mg)

POSSIBLE ALTERNATIVES
1 cup Non-Dairy Creamer (132 mg) 1 cup Sorbet (19 mg) 1 oz Jelly Beans or Hard Candy (1 mg) 12 oz Ginger Ale or Root Beer (0 mg) 1/2 cup White Rice (12 mg)

PHOSPHORUS
LIMIT OR AVOID THESE HIGH PHOSPHORUS FOODS
DAIRY PRODUCTS (1/2 cup a day) " Milk and milk base drinks " Cheese (1 oz or 1 slice) " Yogurt " Cottage cheese " Cream soups " Ice cream " Pudding MEAT PRODUCTS " Liver (chicken and beef) " Organ meats " Luncheon meats: salami, pastrami, bologna " Processed meats: hot dogs, sausage, Spam " Potted, cured and spiced meats " Pickled and canned meats " Carp, crayfish, sardines, " Oysters, caviar, anchovies VEGETABLES OTHER: " Nuts and seeds " Peanut butter " Pizza " Mac and Cheese " Lasagna " Molasses " Brewers yeast " Self-rising flour SWEETS " Chocolates " Candy bars " Twizzlers " Coconut " Caramels " Cream pies STARCHES " Bran and barley products " Brown and wild rice " Oatmeal and rolled oats " Granola and wheat germ " Biscuits and cornbread " Waffles and pancakes " Whole grain products " Whole wheat products " Instant rice and cereals BEVERAGES: " Cola and pepper type drinks " Chocolate drinks " Hawaiian Punch drinks " Canned iced tea " Ale and beer " Hot cocoa " Bottled coffee drinks " Flavored water

! Field and/or dried beans and peas:

Chick peas, lima beans, black beans, navy beans, split peas, garbanzo beans, kidney beans, lentils, black eyed peas, pinto beans, chick peas, soy and butter beans

CALCIUM
! ! !

Calcium is the most abundant mineral found in the body. About 99% of calcium in the body is in bones and teeth. The remaining 1% is found in blood and soft tissues. YOUR BODY USES CALCIUM TO:
" " " "

Form and maintain strong bones and teeth Help muscles contract and relax Transmit nerve impulses Aid in blood clotting HIGH calcium can cause:
" " "

LOW calcium can cause:

" " "

Muscle spasms Bone loss Very low levels can cause seizures

Calcification of soft tissue Weakness Very high levels can cause confusion and vomiting

Calcium and phosphorus work together to help build bones. They do this by keeping a balance in your bloodstream. If they are off balance, trouble begins!

CALCIUM
! !

If calcium levels are too low, calcium supplements may be necessary. If levels are high, limiting exposure to calcium is very important. SOURCES OF CALCIUM MAY INCLUDE:

DIET - high calcium foods, enriched or fortified foods DIALYSATE CALCIUM BASED PHOSPHATE BINDERS such as PhosLo, Tums or calcium carbonate (Renagel and Fosrenol do not contain calcium) ANTACIDS such as Tums or Rolaids
!

Reading the food label is a good way to find out if a food product is calcium fortified and how much calcium is in a serving of food. Do not buy foods whose labels state that they are "good or excellent" source of calcium. Foods that provide 10% or more of the Daily Value (DV) for calcium should be avoided unless recommended by your dietitian.

POTASSIUM
!

Potassium is a mineral that is needed for your nerves and muscles to work properly. Fruits and vegetables are the major sources of potassium in our diet. To control your potassium level, limit your intake of combined fruit and vegetable servings to 5 per day. Serving size is important. One serving is usually !1/2 cup or 1 small. Low potassium levels can cause:
Muscle weakness Cramping Fatigue Irregular heartbeat

! !

Eating too much potassium can cause: ! piece.

Muscle weakness Irregular heart beat Slow heart beat Heart attack

Excessive vomiting or diarrhea, poor food intake, and certain medications, such as diuretics, can cause low potassium levels

POTASSIUM
AVOID THE FOLLOWING HIGH POTASSIUM FRUITS
MELONS: honeydew, cantaloupe, watermelon DRIED FRUITS: figs, apricots, dates, prunes, raisins CITRUS FRUITS: orange, orange juice, tangelo PASSION FRUITS: kiwi, mango, papaya, guava, nectarine, coconut, starfruit MISCELLANEOUS: bananas, avocados

AVOID THE FOLLOWING HIGH POTASSIUM VEGETABLES

POTATOES: baked, mashed, sweet, white, French fries, chips TOMATOES: juice, soup, spaghetti sauce, salsa, ketchup SQUASH: winter, acorn, hubbard, butternut, spaghetti, pumpkin DRIED BEANS: lima, red, garbanzo, navy, white, pinto, kidney, black DRIED PEAS: chickpeas, black-eyed, split peas, cowpeas, lentils MISCELLANEOUS: artichoke, baked beans, kohlrabi, spinach, parsnip, Swiss chard, beet greens, and rutabagas

SODIUM
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Sodium is a mineral found in all foods, and your body needs it in moderate amounts to stay healthy. Sodium is mainly found in table salt, processed and convenience foods. You need to control sodium intake to help control thirst and excessive fluid gains between your treatments. Limiting salt also helps control blood pressure.
EATING TOO MUCH SALT (SODIUM) CAN CAUSE:
" " " " "

Swelling in legs, hands and face Shortness of breath due to fluid build up in the lungs High blood pressure Heart failure Thirst and drinking too much fluid

SODIUM
TIPS TO KEEP YOUR SODIUM INTAKE IN A HEALTHY RANGE:
" " " " " " " "

Do not add table salt during or after cooking Avoid highly processed or canned foods Pick low sodium foods over regular foods when possible Rinse canned vegetables under cold water to reduce sodium Use regular flour, and omit baking soda and baking powder Use herbs and spices to season, instead of salt substitutes Do not buy items with > 300 mg of sodium per serving Avoid foods that have sodium listed as one of the first 5 ingredients on the INGREDIENTS LIST (food label)

1 teaspoon of salt = 2300 mg of sodium

FLUID
"

Since the kidneys are making much less urine or no urine at all, fluids need to be limited. Even though dialysis gets rid of excess fluid and wastes in the body, it is not as effective as healthy kidneys. Hemodialysis removes fluid as the blood is filtered through the dialysis machine. However, there is a limit on how much fluid can be safely removed during a dialysis session. It's recommended that you try to keep your fluid gains to less than 5% of your dry weight.

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Fluid overload can cause:

! ! ! !

Large shifts in fluid can cause:

! ! !

High blood pressure Swelling of the feet and hands Shortness of breath Congestive heart failure

Nausea and vomiting Muscle cramps Low blood pressure during treatment

FLUID
Usually fluid intake is limited to 4-6 (8 oz) cups a day
ANY LIQUID OR FOOD THAT MELTS AT ROOM TEMPERATURE COUNTS AS FLUID: " Ice Cream, Sherbet " Jell-O " Popsicles or juice bars " Sorbet or fruit juice " Wine, beer, or other alcoholic drinks " Ice cubes " Soft drinks, lemonade, fruit drinks " Sport drinks " Tea and coffee " Soup and broth " Custard and pudding " Milk and milk substitutes, shakes " Nepro, Magnacal Renal, and other enterals

FLUID
" Plan ahead to spread allowed fluids over the course of the day and measure liquids BEFORE you drink them. " Pour your daily fluid allowance (measured as water) into a pitcher. Whenever you drink or eat anything that counts as fluid, pour the same amount of water out of the pitcher. Throughout the day, you will know how much fluid you have left by seeing how much water is still in the pitcher. FLUID CONVERSIONS 1 cup = 8 ounces = 240 cc or ml 1 single popsicle = !1/4 cup fluid 1 cup crushed ice = !1/2 cup fluid 4 - 5 standard ice cubes = "1/2 cup fluid

!1/2 cup jello, ice cream or pudding = !1/4 cup fluid

2 cups of fluid = 1 lb or "1/2 kg

VITAMINS
!

Most people on dialysis cant get enough of some vitamins due to:
" " "

Vitamin losses during the dialysis treatment Dietary restrictions Poor appetite

On the other hand, some vitamins need be limited because they can build up to toxic levels in your body.

Special RENAL VITAMINS are usually recommended for dialysis patients to ensure that you get the right vitamins and minerals.

Since dialysis removes some vitamins from your body, you need to take your renal vitamins AFTER YOUR DIALYSIS TREATMENT! REMEMBER: Do not take any vitamin, mineral, or herbal supplements without consulting your dietitian or doctor first.

FOOD LABEL
The food label includes several sections: the nutrition panel, the ingredient list, manufacturer contact information, and possibly some health claims.
!

The NUTRITION PANEL part of the label identifies the serving size and how many servings are in that package. All of the nutrition facts are given per serving.

If the food is fortified or enriched with other nutrients, these must also be included on the nutrition panel. On this part of the label, nutrients may be stated as a Percent of Daily Value (DV). This includes calories, protein, fat, carbohydrate and various vitamins and minerals but as a percentage of a 2000 calorie reference diet.

Labels do not have to list phosphorus or potassium this is voluntary. If this information is given, it may be listed either as milligrams or percent DV.

Remember: since phosphorus and potassium information is optional, the food can still be high in either one or both of these even though they are not listed on the nutrition panel.

FOOD LABEL
!

Look for these things on the food label:

" " " "

Sodium: limit to no more than 10% DV or 250 mg per serving Potassium: limit to no more than 6% DV or 200 mg per serving Phosphorus: limit to no more than 15% or 150 mg per serving Calcium: limit to no more than 10% or 100 mg per serving

INGREDIENTS LIST- foods with more than one ingredient must have an ingredient list on the label. This part of the label lists ingredients by weight from the LARGEST to the SMALLEST. So, whatever is listed first, is mainly what this product has in it. Some ingredients that are used as preservatives or additives are better absorbed into the body than phosphates that are normally found within food. In other words, the phosphorus from preservatives and additives more easily gets into the blood stream and raises the phosphorus level.

Example of INGREDIENTS LIST

INGREDIENTS: SUCROSE, DEXTROSE, CITRIC ACID, SALT, SODIUM CITRATE, NATURAL LEMON AND LIME FLAVORS, MONOPOTASSIUM PHOSPHATE, YELLOW 5

FOOD LABEL
!

Watch for things that have phosphate or potassium as part of the ingredients listed. Examples are: phosphoric acid, sodium phosphate, monocalcium phosphate, dicalcium phosphate, monopotassium phosphate, or potassium chloride. It is best to avoid or limit foods containing these in the ingredient list, particularly if it is TOWARDS THE BEGINNING of the ingredient list.

NUTRIENT CONTENT CLAIMS are guidelines from the FDA on what terms can be used on labels. Examples of most popular claims:
" " " " "

REDUCED - means 25% or less of GOOD SOURCE OF means it has 10% or more of the Daily Value of ... HIGH IN - means it has 20% or more of the Daily Value of LOW SODIUM less than 140 milligrams of sodium per serving VERY LOW SODIUM - 35 milligrams or less sodium per serving

KNOW YOUR LAB VALUES

YOU WANT TO SEE THESE VALUES ON YOUR MONTHLY NUTRITION REPORT

Albumin:

> 4.0
3.5 - 5.5

Cholesterol: Hemoglobin: URR:

> 70

100 - 200

Phosphorus: Calcium:

11 - 12

8.4 - 9.5

Potassium:

3.5 - 5.5

eKt/v: PTH:

>1.2

150 - 300