Eating well with chronic kidney disease Becky Jones CCDHB Dietitian

Content Introduction Nutrition and pre-dialysis Nutrition for dialysis Dietary thoughts for a kidney transplant Summary Questions

Introduction Food has an important role in kidney disease. When the kidneys do not work properly waste products can build up in the blood. Dialysis will remove some of the waste products. Before starting dialysis you also need to be careful with your diet. If you start dialysis or change to a different dialysis type your diet will probably change too. Your diet depends on your kidney function.

Introduction cont. Reduced kidney function can cause: Poor appetite Taste changes Feeling sick, vomiting Itching skin Tiredness Constipation You may find it hard to eat and may lose body weight Speak to your doctor or nurse about this

Before starting dialysis Protein: Used to build body tissues, fight infection and keep body fluid in balance High protein foods: Meat, chicken, fish, eggs, milk, yogurt and seafood Too much protein will cause more waste product build up that may cause more sickness, itchy skin You should have small servings of protein at each meal It is important to eat a nourishing diet

Example of low protein Breakfast: Cereal and milk or yogurt Lunch: Sandwich with meat, chicken or egg Dinner: Small serve of meat, fish or chicken (size of a deck of cards or small palm size) with rice / pasta / potatoes / bread and vegetables

Salt (sodium) Usually kidneys get rid of extra sodium and water through the urine. This doesn’t work as well with reduced kidney function. Sodium and fluid can build up. This can lead to high blood pressure, feeling thirsty and weight gain from fluid gain. Foods high in sodium: processed meats e.g. corned beef, bacon, luncheon, ham Fast foods: pizza, fried chicken, chips, Chinese takeaways, chowmein, pies Salted snacks: potato chips, corn chips, nuts, instant noodles, marmite, vegemite Canned foods: soup, spaghetti, tinned fish Stocks, pickles, gravy, tomato sauce, soy sauce In the body sodium acts like a sponge for water.

Salt (sodium) How much can i have? 2300mg = 1 teaspoon per day Look at food labels: aim for less than 150mg sodium per serving Try fresh foods and herbs and spices Lemon / lime juice, garlic, ginger Black pepper Mint, parsley, basil Honey Nutmeg When preparing kai such as a boil up or stew, add onions, garlic, and herbs or sauce for extra flavour instead of salt. Instead of povi-masima try Wattie's tinned low salt version

Potassium A mineral found in most foods. Healthy kidneys remove extra potassium from the blood. Diet, medications and high blood sugars can affect the level in the blood. The amount allowed in your diet depends on: Your kidney function Whether you are on dialysis Cannot taste it, so it is harder to control in your diet. When kidneys are not working properly this doesn’t happen

Potassium cont. Your doctor will tell you if your level is too high. Not everyone needs to follow a low potassium diet. If your level is above 6 mmol/L you will need to restrict food high in potassium. You may be referred to a Dietitian.

Phosphate A mineral found in many foods. Needed for healthy bones, teeth, muscle and energy. In kidney disease the kidney is not able to get of extra phosphate from the blood. High levels can cause: Bone damage Itch and dry skin Hardening of arteries

Phosphate cont. The level can be controlled by medication called phosphate binders. May be called Osteo 500, Calcitab, Alutabs Work to bind the phosphate from the food. Take at meal times, just before or during, Avoid taking after you have eaten as they wont work as well Prescribed by your doctor

Phosphate cont. Some foods are high sources: Dried fruit and beans Chocolate, nuts Mussels Processed meats like ham, pate, luncheon, liver, sausages Milk (avoid high calcium milks) and cheese

Dialysis and diet Haemodialysis: Peritoneal dialysis: Most people will need a diet high in protein, fibre and low in salt and potassium. May need to limit phosphate Peritoneal dialysis: Most people will need a diet high in protein, fibre and low in salt and sugar. May need to limit phosphate.

Dialysis and protein High protein diet Some is lost during dialysis. Build muscle, repair body tissues, fight infection Some is lost during dialysis. Needs to be replaced through eating enough protein. Dietitian will work out how much you need per day. Aim to have protein with each meal Dairy products may need to limited if phosphate level is high. Good levels of protein = more energy, better dialysis, better quality of life

Dialysis and salt (sodium) High intake of sodium will increase thirst and blood pressure. Must have a low salt diet when on a fluid restriction. Choose fresh foods rather than processed, flavour foods with herbs and spices to make tasty and attractive.

Dialysis and fluid Ask what your fluid allowance is. Drinking too much will cause too much fluid gain between dialysis sessions. High blood pressure, swollen ankles, harder to breathe, can weaken heart muscles over time. Lower your sodium intake You need to be aware of how much fluid you have each day.

Dialysis and fluid What are fluids? Drinks: Foods: Anything that is liquid at room temperature Drinks: water, tea, coffee, milk, juice, soft drinks, cordials, wine, beer Foods: custards, gravy, ice-cream, jelly, soup, yogurt, juicy fruit e.g. watermelon, oranges

Helpful hints for fluid Spread your fluids during the day Avoid salty foods Use a smaller cup / glass, measure out how much liquid it holds Have part of your fluid as ice-cubes Try having pills in soft food to save fluid For a dry mouth try: A lemon slice, sour lollies, chewing gum, a mint, rinsing your mouth (remember not to swallow!)

Dialysis and potassium On dialysis potassium from foods builds up between dialysis sessions. High levels can affect your heartbeat and be dangerous. Some people will not need to restrict their potassium level as much as others. Changing food choices and cooking methods can help lower potassium levels. Cut vegetables into small pieces before cooking Boil in large amount of water Avoid steaming, microwaving and baking vegetables

Other food such as chocolate, potato chips, tomato soup, fresh coffee, nuts, coconut cream /milk / juice

Dialysis and phosphate Remember to take your phosphate binders at the beginning of your meal. Can swallow tablets whole or chew or crush Foods to avoid: calcium enriched foods e.g. calci-trim milk, chocolate, cola drinks including diet versions, peanut butter, takeaways You may need to ask the dietitian for more information about phosphate in foods.

Diet and Peritoneal dialysis High protein, high fibre, low salt and low sugar. Often can have more potassium in diet High fibre: Peritoneal dialysis can contribute to constipation Low sugar: Dialysis bags contain sugar Will need to cut down on sugary foods and drinks e.g. lollies, cakes, biscuits, jam, juices, soft drinks If you are diabetic make sure you talk to a nurse about changes to your diabetes medication

Nutrition and kidney transplants Pre-transplant aim to keep as healthy as possible Eat a balanced diet, take your medications, do some exercise if you able to. Keep a healthy weight CCDHB Body Mass Index (BMI) limits: under 18, over 35 Body mass index = weight for height How in proportion you are

Body mass index = weight in kilograms ÷ height in metres x by itself Example: weight 80kg, Height 1.75m (1.75 x 1.75 = 3.0625) 80 ÷ 3.0625 = 26 kg/ m2 BMI’s between 23-26 are about right for people on dialysis

Summary Low salt for all stages of kidney disease Before dialysis: low protein, maybe potassium and phosphate reduction Dialysis: high protein, fluid control, reduced potassium and phosphate Pre-transplant: aim for a healthy weight, balanced diet

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