Module 9—Nutrition and Fluids for People on Dialysis

Personal Action Plan

Nutrition and Fluids for People on Dialysis

If I learn how to take charge of my food and fluids, I can feel better, improve my lab results, and have a better quality of life. Here are some tools to help:

Nutrition Basics: Calories

A measure of the energy in a food. I plan to:

Nutrition Basics: Carbs

Starches that turn into sugar in my body and give me energy. Found in sugars, grain products, fruits, and vegetables. If I have diabetes, I need to talk with my dietitian about carb choices that won’t make my blood sugar go up too quickly.

Nutrition Basics: Fats

My brain and cell membranes are mostly made of fat. Fat gives me energy and helps me absorb some vitamins. To keep my heart healthy, I will try to use more unsaturated fats, which are liquid at room temperature, such as:

Nutrition Basics: Protein

Needed for healthy muscles, bones, teeth, and hair. At my monthly lab tests, my albumin level should be greater than 4.0 g/dL.

Getting the Right Amount of Sodium

My body needs sodium (found in salt) for healthy nerves and to balance fluid levels. But a high-salt diet may put me at risk for high blood pressure, heart disease, and stroke. Eating less sodium will help me to be less thirsty and may make standard in-center HD more comfortable. When I start eating less sodium, in a few weeks I’ll get used to it and food will taste better! Fresh or dried salt-free herbs can help.

Here are my ideas for eating less sodium:

Potassium: Key to Feeling Good and a Healthy Heart

In my body, potassium helps my nerves “talk” to my muscles, including my heart. Too much or too little potassium can make my heart skip beats—or even stop! My potassium level should be 3.5 to 5.5 mEq/L for my monthly blood tests

The best way I can check my potassium intake is to:

Ask my dietitian at each monthly lab test what my level is.
Choose fresh meats and poultry and small servings of high potassium fruits and vegetables
Avoid processed foods.

In general, I will choose low and moderate options, and watch portion sizes for others. I may be able to remove some potassium by soaking or boiling foods. This can make them safer for me. The more dialysis I get, the more potassium I can have.

What Is Phosphorus?

Phosphorus helps my body use energy, and builds strong bones and teeth. But too much hardens my arteries, harms my heart, and weakens my bones. If I keep my calcium and phosphorus levels in the safe range, the cycle won’t start, and my heart and bones can stay healthy. Safe ranges for my blood tests may be:

Calcium: 8.4 to 9.5 mg/dL
Phosphorus: 3.5 to 5.5 mg/dL
Calcium-phosphorus product: less than 55
Intact PTH: 150 to 300 pg/mL

I can keep my phosphorus in the safe range by taking my phosphate binders within 5 to 10 minutes of all meals and snacks, and by choosing lower phosphorus foods. I may need to limit my daily phosphorus intake to about 800 to 1,000 mg/day. The more dialysis I get, the more phosphorus I can have.

Phosphorus in Foods

Use the Food Value Chart to check the amount of phosphorus in fruits and vegetables.

Meat: Higher Phosphorus

Beef roasts, steaks, ribs 3 oz (136-231 mg)
Beef liver, pan-fried, 3 oz (412 mg)
Chicken breast, roasted, 1⁄2 breast (210 mg)
Crab 3 oz, cooked (109-240 mg)
Cod 3 oz, baked (117-190 mg)
Pork chops, ribs, roasts, 3 oz (166-242 mg)
Turkey breast, roasted, 3 oz (178 mg)

Meat: Lower Phosphorus

Bacon, 1 oz (40 mg – watch the sodium)
Beef tongue 3 oz (123 mg)
Beef tripe 3 oz (56 mg)
Canned tuna 3 oz (130 mg - watch the sodium)
Chicken thigh, 1 leg (91-108 mg)
Egg (96 mg per egg)
Ground beef 3 oz patty (165 mg)
Shrimp 3 oz, cooked (116 mg)

Dairy: Higher Phosphorus

Hot chocolate (with milk) 8 oz (262 mg)
Eggnog 8 oz (277 mg)
Cultured buttermilk, reduced fat 8 oz (201 mg)
Chocolate milk 8 oz (252 mg)
Swiss cheese 1 oz (159 mg)
Cheddar cheese 1 oz (143 mg)

Dairy: Lower Phosphorus

Unenriched almond milk 4 oz (50 mg)
1% fat milk 4 oz (116 mg)
2% fat milk 4 oz (138 mg)
Whole milk 4 oz (111 mg)
Unenriched rice milk 4 oz (29 mg)
Mozzarella 1 oz (115 mg)
Goat cheese 1 oz (105 mg)
Cream cheese 2 tbsp (32 mg)

Don’t Get Flooded by Fluids

Part of the job of dialysis is to take off extra fluids. This is vital because if I have too much fluid, I may have:

Headaches and low energy
Swelling in my face, hands, and feet (edema)
Trouble breathing from fluid in my lungs
Heart damage from stretching my heart with too much fluid
High blood pressure that can lead to a stroke

To limit my fluid and deal with thirst, I'd like to try:

Which Vitamins Do I Need?

Dialysis changes my need for vitamins. (I should not take more than 75-90 mg/day of vitamin C, for example.) I will check with my doctor before taking any over-the-counter supplements. My doctor will prescribe a kidney friendly vitamin for me.

Meal Planning and Eating Out

To plan meals that I can look forward to, I can:

Mix and match foods from the lists I get in this module or from my dietitian.
- Lower Potassium Menus
- Flexible Potassium Menus

I can also use the daily meal planning grid and food value charts to see if I want to try to put my own meal plans together.

When I plan to eat out at a restaurant, I will:

Ask the restaurant for what I need.
Ask the server about ingredients and how the food is made.
Avoid high sodium and high potassium choices.
Avoid soups, brined or marinated foods, and cream sauces.
Bring my phosphate binders with me.

I will try to avoid fast foods. When I go to a fast food restaurant, I will try to limit my sodium.

Strategies for Lifestyle Changes

I will try to see my food and fluid choices as chances to feel better and improve my quality of life.
I will plan ahead for meals by making a shopping list and thinking about how I will prepare my foods.
I will think about keeping a nutrition and health journal.
I will take charge of my food and fluid plan.

The obstacles in my own life that i need to overcome are:

The two people i will ask to help me reach my goal are:

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