and Digestive and Kidney Diseases (NIDDK) offers
the following general guidelines:
Fluids. A dietitian helps dialysis patients determine
how much fluid to drink each day. This is because
extra fluid can raise blood pressure, make the heart
work harder, and increase the stress of dialysis treat-
ments. Many foods, such as soup, ice cream, and
fruits, also contain plenty of water and the dietitian
is the best person to provide advice on controlling
thirst.
Potassium. Potassium is a bulk mineral found in
many foods, especially fruits and vegetables. It
affects how steadily the heart beats, and this is why
eating high-potassium foods can be very dangerous
for the heart. Foods like oranges, bananas, tomatoes,
potatoes, and dried fruits must be avoided. Some
potassium can be removed from potatoes and other
vegetables by peeling and soaking them in a large
container of water for several hours before cooking
them in fresh water.
Phosphorus. Phosphorus is another mineral found in
foods. It can weaken bones and make skin itch if
intake is too high. Control of phosphorus is very
important for the prevention of bone disease and
associated complications. High-phosphorus foods
include milk and cheese, dried beans, peas, colas,
nuts, and peanut butter and should be avoided.
Sodium (salt). Another mineral present in many
foods is sodium. Most canned foods and frozen din-
ners contain high amounts of sodium. A high sodium
intake causes thirst and drinking more fluids, which
makes the heart work harder to pump the fluid
through the body. Over time, this can cause high
blood pressure and congestive heart failure. Kidney
patients are accordingly advised to eat fresh foods
that are naturally low in sodium, and to look for
products labeled ‘‘low sodium.’’
Protein. Most kidney patients on dialysis are encour-
aged to eat as much high-quality protein as they can.
Protein helps maintain muscle and repair tissue, but
it breaks down into blood urea nitrogen (BUN) in
the body. However, some sources of protein, called
high-quality proteins, produce less waste than
others. High-quality proteins are found in meat,
fish, poultry, and eggs. Obtaining dietary protein
from these sources can reduce the amount of urea
in blood.
Calories. Calories provide energy to the body and
some dialysis patients need to gain weight. Vegetable
oils, such as olive, canola, and safflower oils, are
good sources of calories and do not result in choles-
terol problems. Hard candy, sugar, honey, jam, and
jelly also provide calories and energy. However, kid-ney patients with diabetes must follow the guidance
of a dietitian.Interactions
Since dialysis patients must avoid several types of
foods, their diet may be missing importantvitamins
and mineral micronutrients. Dialysis also removes
some vitamins from the body. The treating physician
may prescribe a vitamin and mineral supplement
designed specifically for kidney failure patients. The
physician may also prescribevitamin Cand a group of
vitamins called B complex. Acalciumtablet may also
be given to bind the phosphorous present in food and
provide the extra calcium needed by the body. Patients
should never take off-the-counter supplements since
they may contain vitamins ormineralsthat may cause
harmful interactions.Aftercare
Kidney patients on dialysis have very special diet-
ary needs that exceed restricting foods, because eating
poorly can increase the risk of complications. This is
why a dietitian is such a crucial member of the health-
care team. The dietitian will keep track of the fat and
muscle stores in a patient’s face, hands, arms, should-
ers, and legs. The dialysis care team will look for
changes in the blood level of proteins, especially the
albumin level, as a change in this protein can be indi-
cative of body protein loss. Special blood tests are also
done on a monthly basis. They include Kt/V and urea
reduction ratio (URR) tests. The tests are used by the
care team to evaluate the appropriate course of dialy-
sis required to help patients feel best. A change in any
of these tests could mean that a patient is not getting
enough dialysis. The tests also provide information
about a patient’s protein intake and on the protein
equivalent of nitrogen appearance (PNA). Using the
PNA, the albumin results and any changes in patient
appetite, the dietitian can determine if the intake of the
right foods is adequate.Complications
Kidney patients are at risk of developing compli-
cations such as high blood pressure, anemia (low
blood count), weak bones, poor nutritional health
and nerve damage. Also, kidney disease increases the
risk of heart and blood vessel (cardiovascular) disease.
Patients undergoing dialysis can also experience
side effects, caused by rapid changes in the body’s fluid
and chemical balance during treatment. Two common
side effects are muscle cramps and hypotension.
Hypotension can make the patient feel weak, dizzy,Renal nutrition