Renal Diet

Food gives you energy and helps your body repair itself. Food is broken down in your stomach and intestines. Your blood picks up nutrients from the digested food and carries them to all your body cells. These cells take nutrients from your blood and put waste products back into the bloodstream. When your kidneys were healthy, they worked around the clock to remove wastes from your blood. The wastes left your body when you urinated. Other wastes are removed in bowel movements.

Now your kidneys have stopped working. Hemodialysis removes wastes from your blood. But between sessions, wastes can build up in your blood and make you sick. You can reduce the amount of wastes by watching what you eat and drink. A good meal plan can improve your dialysis and your health.

Your clinic has a dietitian to help you plan meals. A dietitian specializes in food and nutrition. A dietitian with special training in care for kidney health is called a renal dietitian.

Renal Diet and Fluids

You already know you need to watch how much you drink. Any food that is liquid at room temperature also contains water. These foods include soup, Jell-O, and ice cream. Many fruits and vegetables contain lots of water, too. They include melons, grapes, apples, oranges, tomatoes, lettuce, and celery. All these foods add to your fluid intake.

Fluid can build up between dialysis sessions, causing swelling and weight gain. The extra fluid affects your blood pressure and can make your heart work harder. You could get serious heart trouble from overloading your system with fluid.

Even though you are on hemodialysis, your kidneys may still be able to remove some fluid. Or your kidneys may not remove any fluid at all. That is why every patient has a different daily allowance for fluid.

Renal Diet and Potassium

Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Potassium levels can rise between dialysis sessions and affect your heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.

To control potassium levels in your blood, avoid foods like avocados, bananas, kiwis, and dried fruit, which are very high in potassium. Also, eat smaller portions of other high-potassium foods. For example, eat half a pear instead of a whole pear. Eat only very small portions of oranges and melons.

Dialyzing Potatoes and Other Vegetables - You can remove some of the potassium from potatoes and other vegetables by peeling them, then soaking them in a large amount of water for several hours. Drain and rinse before cooking. Your dietitian will give you more specific information about the potassium content of foods.

High-Potassium Foods To Avoid on a Renal diet

General - Clams - milk - peanuts - sardines - yogurt

Fruits - Apricots, Avocados, Bananas, Cantaloupe, Dates, Dried Fruits, Kiwi, Mango, Nectarines, Oranges, Papaya, Pears (fresh), Peaches (fresh), Prunes, Rhubarb, Watermelon.

Vegetables - Artichokes, Brussels Sprouts, Pumpkin, Squash (acorn, butternut), Spinach, Swiss Chard, Succotash, Tomato (fresh), Tomato (juice, paste, puree), Vegetable Juice, Beans (baked, lima, pinto, navy), Lentils.

Potatoes - Use potatoes cautiously! Limit baked potatoes (1 medium) or French fries (15 fries) to once a week. Limit mashed potatoes (soaked and boiled) to 1/2 cup a day. Noodles or rice are other choices that are lower in potassium than potatoes.

Fruit Juices - Grapefruit Juice, Orange Juice, Pineapple Juice, Prune Juice.

Chocolate - chocolate is high in potassium.

Low Potassium Fruits and Vegetables for a Renal Diet

The following fruits and vegetables are low in potassium and are good choices to use. One fruit serving is 1 medium fruit or 1/2 cup canned. One vegetable serving is 1/2 cup cooked or 1 cup tossed salad.

Fruits - Apples, Applesauce, Canned Apricots, Blueberries, Cherries, Cranberries, Coconut, Figs, Fruit Cocktail, Grapefruit (1/2 fresh), Grapes, Canned Peaches, Canned Pears, Pineapple, Strawberries, Tangerine.

Vegetables - Asparagus, Bamboo Shoots, Green Beans, Wax Beans, Beets, Bell Peppers, Broccoli (cooked), Cabbage, Carrots, Cauliflower, Celery, Chili Peppers, Corn, Cucumber, Eggplant, Greens (collard, mustard, kale), Lettuce, Mushrooms, Onions, Peas, Radishes, Squash, Tomatoes (canned, no salt added).

Juices - Apple Juice, Cranberry Juice, Grape Juice.

Renal Diet and Phosphorus

Phosphorus is a mineral found in many foods. If you have too much phosphorus in your blood, it pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too much phosphorus may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus. Usually, people on dialysis are limited to 1/2 cup of milk per day.

You probably will need to take a phosphate binder like Renagel, PhosLo, Tums, or calcium carbonate to control the phosphorus in your blood between dialysis sessions. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool.

Renal Diet and Protein

Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on dialysis changes this. Most people on dialysis are encouraged to eat as much high-quality protein as they can. The better nourished you are, the healthier you will be. You will also have greater resistance to infection and recover from surgery more quickly.

Protein helps you keep muscle and repair tissue. In your body, protein breaks down into a waste product called urea. If urea builds up in your blood, you can become very sick. Some sources of protein produce less waste than others. These are called high-quality proteins. High-quality proteins come from meat, fish, poultry, and eggs (especially egg whites). Getting most of your protein from these sources can reduce the amount of urea in your blood.

• Poultry and fish, like broiled flounder, are a good source of high-quality protein.
• Try to choose lean (low-fat) meats that are also low in phosphorus. If you are a vegetarian, ask about other ways to get your protein.
• Low-fat milk is a good source of protein. But milk is high in phosphorus and potassium. And milk adds to your fluid intake.

Renal Diet and Sodium

Sodium is found in salt and other foods. Most canned foods and frozen dinners contain large amounts of sodium. Too much sodium makes you thirsty. But if you drink more fluid, your heart has to work harder to pump the fluid through your body. Over time, this can cause high blood pressure and congestive heart failure.

• Try to eat fresh foods that are naturally low in sodium. Look for products labeled low sodium.
• Do not use salt substitutes because they contain potassium.

Renal Diet and Calories

Calories provide energy for your body. If your doctor recommends it, you may need to cut down on the calories you eat. A dietitian can help you plan ways to cut calories in the best possible way.

But some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Healthy cooking oils - like olive oil, canola oil, and safflower oil - are good sources of calories. Use them generously on breads, rice, and noodles.

Butter and margarines are rich in calories. But these fatty foods can also clog your arteries. Use them less often. Soft margarine that comes in tubs is better than stick margarine. Vegetable oils are the healthiest way to add fat to your diet if you need to gain weight.

Hard candy, sugar, honey, jam, and jelly provide calories and energy without clogging arteries or adding other things that your body does not need. If you have diabetes, be very careful about eating sweets. A dietitian's guidance is very important for people with diabetes.

Supplementing a Renal Diet with Vitamins

Take only the vitamins your doctor prescribes. Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Your doctor may prescribe a vitamin and mineral supplement like Nephrocaps.

Do not take vitamins that you can buy off the store shelf. They may contain vitamins or minerals that are harmful to you.

NOTE: Please talk over your options with your renal dietitian. Only a renal dietitian can offer you personal diet advice which is appropriate for your personal condition.

Sources include: National Kidney and Urologic Diseases Information Clearinghouse "Getting Started on Your Renal Diet" © N. Arizona Council on Renal Nutrition, Arizona Dietetic Project