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DIET IN DIALYSIS
DR VARUN MAMIDI
CONSULTANT NEPHROLOGIST
AINU HITECH CITY BRANCH,
HYDERABAD.
Eating the balanced diet (right kind and amount of food)
Hemodialysis treatments
Taking medications
INTRODUCTION
• Balanced diet is important part of treatment in dialysis patients
• Not one-size-fits all approach
• Factors that can effect the diet are:
⚬ Stage of CKD - Dialysis patients
⚬ Type of RRT - HD / PD
⚬ Laboratory results - Hb, P, Ca
⚬ Presence of medical conditions - uBP, Cardiac, VO
DIET PLAN IN DIALYSIS PATIENTS
• Macronutrients
⚬ Carbohydrates
⚬ Proteins
⚬ Fats
• Micronutrients
⚬ Sodium
⚬ Phosphorus
⚬ Potassium
• Renal Dietician plays a major role
CALORIES
• 1800 Kcal/day (30Kcal/kg) is the average total calorie intake
for dialysis patients
• Calories per day should be spread across the 5 - 6 meals and
should be derived from:
⚬ carbohydrates
⚬ proteins
⚬ fats
CARBOHYDRATES
• Plant-based nutrients found in starchy foods like cereals and grains,
fruits and some starchy vegetables.
• Common foods include Chapatti, rice, beard, pasta and oats and
potatoes.
• Uses of carbohydrates:
⚬ Main source of energy to every cell of your body
⚬ Feeling of satiety
CARBOHYDRATES
Simple carbohydrates
• Fruits
• Vegetables
• Milk and milk products
• Processed and refined
sugars
Complex carbohydrates
• Whole grain breads
• Cereals
• Starchy vegetables
• Legumes
Good source of fibre
PROTEIN
• Protein is important for muscle maintanence and other bodily
functions.
• 75% of human body is made up of proteins. It allows the body
to counter:
⚬ Everyday's wear and tear
⚬ Heal from injury
⚬ Stop any bleeding
⚬ Fight infections
PROTEIN
• During each HD session ~ 6-9 gms of protein is lost
• Hence, more protein than average person is needed in dialysis patients
*Nutritional secrets - Kidney warriors foundation
PROTEIN
• Protein is made of a chain of 20 amino acids to keep the body healthy
(11AA - Liver, 9AA - Food)
• Complete proteins - consists of all the 9 amino acids that come from food
• Animal-based proteins are complete proteins: dairy(milk) and poultry,
cheese, eggs, fish, red meat and soybeans.
• Plant-based proteins are incomplete proteins: Grains, legumes, nuts and
seeds.
PROTEIN
• Complete proteins + Incomplete protein = Will give the daily protein needs
• Vegetarinas: Protein requirement from plant and vegetarian sources - mostly incomplete proteins
⚬ Paneer
⚬ Kidney beans and soya beans
PROTEIN SPARING EFFECT
*Nutritional secrets - Kidney warriors foundation
FATS
• Extremely essential component balanced dialysis diet
• The RDA for patients on dialysis is 20 - 25% calories from fat
• Fats - Broken into: Unsaturated fats + Saturated fats
Saturated fats cause:
⚬ Increases LDL cholesterol
⚬ Hypertension
⚬ Heart disease
⚬ Weight gain
Unsaturated fats :
⚬ Reduces LDL cholesterol
⚬ Skin and hair growth
⚬ Improves heart condition
⚬ Increases HDL
Saturated fats
• Meat, poultry, eggs
• Dairy products
(Cream, cheese, whole milk)
• Raise LDL cholesterol
Unsaturated fats
• Fish
• Nuts and Certain oils
(peanut oil and olive oil)
• Reduce LDL cholesterol
Limit saturated fats
Limit fat containing protein
sources
More fibre rich foods
More Omega-3 FA foods
Avoid fry foods
Take skim milk
Avoid whole milk
Daily physical activity
TIPS TO REDUCE BAD
CHOLESTEROL
FIBRE
• Advantages:
⚬ Cholesterol and blood sugar control,
⚬ Prevents constipation.
• In dialysis diet - tough to find fibre - Due to potassium and
phosphorus restriction foods
• High fibre and renal diet:
⚬ Eat all the quantity of fruits with peels allowed per day
⚬ Plain unsalted popcorn
⚬ Low potassium raw vegetables like cucumber and carrot.
SODIUM
• Salt restriction - not NIL salt
• Excess sodium:
⚬ Increases thirst - drink more fluids.
⚬ Retain more water in the body.
⚬ Rise blood pressure
⚬ Breathing difficulty
⚬ Strain on heart and kidneys
SODIUM
• All types of salt contain NACL
• 2 grams of sodium per day
• 2 grams of sodium is ~4g grams of salt.
• 3/4th teaspoon salt - 4gm of salt - 2gm sodium
• Techniques to restrict sodium intake:
⚬ Measured quantity of salt into a small box.
⚬ Look at sodium labels on packaged foods.
HIGH SODIUM FOODS - AVOID
*Nutritional secrets - Kidney warriors foundation
PHOSPHORUS
• Mineral that is excreted through urine. Builds up in dialysis
patients.
• Diet restriction to 1gm of phosphorus per day
• High phosphorus causes:
⚬ Muscle aches
⚬ Mineral bone disease
⚬ calcifications of heart, skin, joints and blood vessels
• Protein-rich foods contain more phosphorus like meat,
poultry, fish, nuts, beans and dairy products
HIGH PHOSPHORUS FOODS -
LIMIT/AVOID
Avoid
Limit
*Nutritional secrets - Kidney warriors foundation
LOW PHOSPHORUS FOODS
*Nutritional secrets - Kidney warriors foundation
HIDDEN INORGANIC PHOSPHORUS
• Avoid foods with additives or preservatives, such as fast foods, ready to eat foods, canned and
bottled beverages and precessed meats and foods
*Nutritional secrets - Kidney warriors foundation
PHOSPHATE BINDERS
• Don't forget phosphate binders with meals and snacks:
⚬ Should take phosphate binder with every meal and snack.
*https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf
*Comprehensive Clinical Nephrology - John Feehally. 6th Edition
POTASSIUM
• Safe zone: 3.5 - 5.0 mEq/L
• Healthy person: 3.5 - 4.5 gm/day (Avg diet: 8gm)
• Restricted potassium intake - 1.5 - 2 gm (40 mEq)
• High potassium levels cause:
⚬ Nausea
⚬ Weakness
⚬ Numbness
⚬ Cardiac arrhythmias
⚬ Cardiac arrest
POTASSIUM
• Potassium is found in all foods:
⚬ Pulses and whole lentils - staple foods with high K
⚬ Dairy products - Has needed protein but with high K
• Proper choice of vegetables / fruits / grains / dairy and meat
in proper portions.
• Leeching of lentils and vegetables
• Moderation is the key
POTASSIUM TABLES
• low potassium foods - consumed on daily basis without leeching
• Moderate potassium foods - Eaten in moderation
• High potassium foods - need to be avoided or leeched
• Do not depend on the internet values - as soil conditions change
so will potassium values - fruits grown in other parts of the world
may have different potassium values.
*Nutritional secrets - Kidney warriors foundation
*Nutritional secrets - Kidney warriors foundation
*Nutritional secrets - Kidney warriors foundation
Papaya
Guava
*Nutritional secrets - Kidney warriors foundation
FLUIDS
• Fluid restriction is not only water - all food in liquid
state - water, tea, coffee, health drinks, soups, juices,
sambar, buttermilk, curd and ice creams
• Daily fluid intake: Urine output plus 500ml.
• Expected daily weight gain/meal: 0.4 - 0.5kgs/meal
⚬ The expected amount of fluid in a typical day's
food meal is at-least 500ml
FLUIDS
• Fluid retention cause symptoms such as :
⚬ High blood pressure
⚬ Cardiac issues
⚬ Swelling of the legs
⚬ Pulmonary oedema
• Tips to limit fluid intake:
⚬ Drink in smaller size cups. Drink in SIPS.
⚬ Spray bottle, juice in ice cubes, mouth gargle with
ice cold water.
⚬ Medicines along with food
⚬ Low salt food - salt makes you thirsty.
TAKE HOME POINTS
• Diet plan in dialysis patients should include all macronutrients and micronutrients
• Protein-rich foods contain more phosphorus and potassium and staple foods such
as pulses are high in potassium.
• Hence, a Balanced diet is important part of treatment in dialysis patients
• Moderation is the key
• Fluid restriction is not only water
• Renal Dietician plays a major role
REFERENCES
• The Renal Diet - VCU Health System
• Nutritional Secrets - Kidney Warriors Foundation
• https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf
• Comprehensive Clinical Nephrology - John Feehally. 6th Edition
DIET IN DIALYSIS.pptx

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DIET IN DIALYSIS.pptx

  • 1. DIET IN DIALYSIS DR VARUN MAMIDI CONSULTANT NEPHROLOGIST AINU HITECH CITY BRANCH, HYDERABAD.
  • 2. Eating the balanced diet (right kind and amount of food) Hemodialysis treatments Taking medications
  • 3.
  • 4. INTRODUCTION • Balanced diet is important part of treatment in dialysis patients • Not one-size-fits all approach • Factors that can effect the diet are: ⚬ Stage of CKD - Dialysis patients ⚬ Type of RRT - HD / PD ⚬ Laboratory results - Hb, P, Ca ⚬ Presence of medical conditions - uBP, Cardiac, VO
  • 5. DIET PLAN IN DIALYSIS PATIENTS • Macronutrients ⚬ Carbohydrates ⚬ Proteins ⚬ Fats • Micronutrients ⚬ Sodium ⚬ Phosphorus ⚬ Potassium • Renal Dietician plays a major role
  • 6. CALORIES • 1800 Kcal/day (30Kcal/kg) is the average total calorie intake for dialysis patients • Calories per day should be spread across the 5 - 6 meals and should be derived from: ⚬ carbohydrates ⚬ proteins ⚬ fats
  • 7. CARBOHYDRATES • Plant-based nutrients found in starchy foods like cereals and grains, fruits and some starchy vegetables. • Common foods include Chapatti, rice, beard, pasta and oats and potatoes. • Uses of carbohydrates: ⚬ Main source of energy to every cell of your body ⚬ Feeling of satiety
  • 8. CARBOHYDRATES Simple carbohydrates • Fruits • Vegetables • Milk and milk products • Processed and refined sugars Complex carbohydrates • Whole grain breads • Cereals • Starchy vegetables • Legumes Good source of fibre
  • 9. PROTEIN • Protein is important for muscle maintanence and other bodily functions. • 75% of human body is made up of proteins. It allows the body to counter: ⚬ Everyday's wear and tear ⚬ Heal from injury ⚬ Stop any bleeding ⚬ Fight infections
  • 10. PROTEIN • During each HD session ~ 6-9 gms of protein is lost • Hence, more protein than average person is needed in dialysis patients *Nutritional secrets - Kidney warriors foundation
  • 11. PROTEIN • Protein is made of a chain of 20 amino acids to keep the body healthy (11AA - Liver, 9AA - Food) • Complete proteins - consists of all the 9 amino acids that come from food • Animal-based proteins are complete proteins: dairy(milk) and poultry, cheese, eggs, fish, red meat and soybeans. • Plant-based proteins are incomplete proteins: Grains, legumes, nuts and seeds.
  • 12. PROTEIN • Complete proteins + Incomplete protein = Will give the daily protein needs • Vegetarinas: Protein requirement from plant and vegetarian sources - mostly incomplete proteins ⚬ Paneer ⚬ Kidney beans and soya beans
  • 13. PROTEIN SPARING EFFECT *Nutritional secrets - Kidney warriors foundation
  • 14. FATS • Extremely essential component balanced dialysis diet • The RDA for patients on dialysis is 20 - 25% calories from fat • Fats - Broken into: Unsaturated fats + Saturated fats
  • 15. Saturated fats cause: ⚬ Increases LDL cholesterol ⚬ Hypertension ⚬ Heart disease ⚬ Weight gain Unsaturated fats : ⚬ Reduces LDL cholesterol ⚬ Skin and hair growth ⚬ Improves heart condition ⚬ Increases HDL Saturated fats • Meat, poultry, eggs • Dairy products (Cream, cheese, whole milk) • Raise LDL cholesterol Unsaturated fats • Fish • Nuts and Certain oils (peanut oil and olive oil) • Reduce LDL cholesterol
  • 16. Limit saturated fats Limit fat containing protein sources More fibre rich foods More Omega-3 FA foods Avoid fry foods Take skim milk Avoid whole milk Daily physical activity TIPS TO REDUCE BAD CHOLESTEROL
  • 17. FIBRE • Advantages: ⚬ Cholesterol and blood sugar control, ⚬ Prevents constipation. • In dialysis diet - tough to find fibre - Due to potassium and phosphorus restriction foods • High fibre and renal diet: ⚬ Eat all the quantity of fruits with peels allowed per day ⚬ Plain unsalted popcorn ⚬ Low potassium raw vegetables like cucumber and carrot.
  • 18. SODIUM • Salt restriction - not NIL salt • Excess sodium: ⚬ Increases thirst - drink more fluids. ⚬ Retain more water in the body. ⚬ Rise blood pressure ⚬ Breathing difficulty ⚬ Strain on heart and kidneys
  • 19. SODIUM • All types of salt contain NACL • 2 grams of sodium per day • 2 grams of sodium is ~4g grams of salt. • 3/4th teaspoon salt - 4gm of salt - 2gm sodium • Techniques to restrict sodium intake: ⚬ Measured quantity of salt into a small box. ⚬ Look at sodium labels on packaged foods.
  • 20. HIGH SODIUM FOODS - AVOID *Nutritional secrets - Kidney warriors foundation
  • 21. PHOSPHORUS • Mineral that is excreted through urine. Builds up in dialysis patients. • Diet restriction to 1gm of phosphorus per day • High phosphorus causes: ⚬ Muscle aches ⚬ Mineral bone disease ⚬ calcifications of heart, skin, joints and blood vessels • Protein-rich foods contain more phosphorus like meat, poultry, fish, nuts, beans and dairy products
  • 22. HIGH PHOSPHORUS FOODS - LIMIT/AVOID Avoid Limit *Nutritional secrets - Kidney warriors foundation
  • 23. LOW PHOSPHORUS FOODS *Nutritional secrets - Kidney warriors foundation
  • 24. HIDDEN INORGANIC PHOSPHORUS • Avoid foods with additives or preservatives, such as fast foods, ready to eat foods, canned and bottled beverages and precessed meats and foods *Nutritional secrets - Kidney warriors foundation
  • 25. PHOSPHATE BINDERS • Don't forget phosphate binders with meals and snacks: ⚬ Should take phosphate binder with every meal and snack. *https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf
  • 26. *Comprehensive Clinical Nephrology - John Feehally. 6th Edition
  • 27. POTASSIUM • Safe zone: 3.5 - 5.0 mEq/L • Healthy person: 3.5 - 4.5 gm/day (Avg diet: 8gm) • Restricted potassium intake - 1.5 - 2 gm (40 mEq) • High potassium levels cause: ⚬ Nausea ⚬ Weakness ⚬ Numbness ⚬ Cardiac arrhythmias ⚬ Cardiac arrest
  • 28. POTASSIUM • Potassium is found in all foods: ⚬ Pulses and whole lentils - staple foods with high K ⚬ Dairy products - Has needed protein but with high K • Proper choice of vegetables / fruits / grains / dairy and meat in proper portions. • Leeching of lentils and vegetables • Moderation is the key
  • 29. POTASSIUM TABLES • low potassium foods - consumed on daily basis without leeching • Moderate potassium foods - Eaten in moderation • High potassium foods - need to be avoided or leeched • Do not depend on the internet values - as soil conditions change so will potassium values - fruits grown in other parts of the world may have different potassium values.
  • 30. *Nutritional secrets - Kidney warriors foundation
  • 31. *Nutritional secrets - Kidney warriors foundation
  • 32. *Nutritional secrets - Kidney warriors foundation Papaya Guava
  • 33. *Nutritional secrets - Kidney warriors foundation
  • 34. FLUIDS • Fluid restriction is not only water - all food in liquid state - water, tea, coffee, health drinks, soups, juices, sambar, buttermilk, curd and ice creams • Daily fluid intake: Urine output plus 500ml. • Expected daily weight gain/meal: 0.4 - 0.5kgs/meal ⚬ The expected amount of fluid in a typical day's food meal is at-least 500ml
  • 35. FLUIDS • Fluid retention cause symptoms such as : ⚬ High blood pressure ⚬ Cardiac issues ⚬ Swelling of the legs ⚬ Pulmonary oedema • Tips to limit fluid intake: ⚬ Drink in smaller size cups. Drink in SIPS. ⚬ Spray bottle, juice in ice cubes, mouth gargle with ice cold water. ⚬ Medicines along with food ⚬ Low salt food - salt makes you thirsty.
  • 36. TAKE HOME POINTS • Diet plan in dialysis patients should include all macronutrients and micronutrients • Protein-rich foods contain more phosphorus and potassium and staple foods such as pulses are high in potassium. • Hence, a Balanced diet is important part of treatment in dialysis patients • Moderation is the key • Fluid restriction is not only water • Renal Dietician plays a major role
  • 37. REFERENCES • The Renal Diet - VCU Health System • Nutritional Secrets - Kidney Warriors Foundation • https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf • Comprehensive Clinical Nephrology - John Feehally. 6th Edition