Acknowledgment: Reviewed by Riham Albalbisi, Atef Al Taher, Wisam AlBadr, MD the Council on Renal Nutrition (02/2020)
Potassium is important for the heart and the muscles function. When the kidneys are not healthy, you need to limit certain foods that can increase the potassium. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack.
What foods are high in potassium (greater than 200 milligrams per portion?
The following table lists foods that are high in potassium. The portion size is ½ cup unless otherwise stated. Please be sure to check portion sizes. While all the foods on this list are high in potassium, some are higher than others.
High-Potassium Foods
Low-Potassium Foods
How do I get some of the potassium out of my favorite high-potassium vegetables?
The process of leaching will help pull potassium out of some high-potassium vegetables. It is important to remember that leaching will not pull all of the potassium out of the vegetable. You must still limit the amount of leached high-potassium vegetables you eat. Ask your dietitian about the amount of leached vegetables that you can safely have in your diet.
How to leach vegetables?
For Potatoes, Sweet Potatoes, Carrots, Beets, Winter Squash, and Rutabagas:
References:
https://www.kidney.org/
https://www.davita.com/
كتاب المرشد الشامل لمرضى الفشل الكلوي تاليف د.عبد الكريم السويداء_ الطبعة ألاولى_2010 - 1431
Acknowledgment: Reviewed by Riham Albalbisi, Atef Al Taher, Wisam AlBadr, MD the Council on Renal Nutrition (02/2020)
Sodium is an element your body needs to control blood volume and blood pressure. It helps your muscles and nerves work properly. Sodium is usually called salt since the main component of salt is sodium.
But too much salt can make you thirsty, and when you drink, fluids will build up in your body. This dangerous fluid buildup can cause high blood pressure, swelling of your legs and hands, shortness of breath and heart failure.
How should I control my sodium intake?
Most foods naturally contain sodium. In addition, salt is often added to food during preparation, and is already in most canned, pickled, smoked and processed foods.
You should not add any salt to your food when you are preparing it. Instead, try adding flavor with herbs, spices, lemon juice and vinegars. You should avoid canned foods, processed meats, ready-made meals and fast food, as they all tend to be very high in sodium.
Make sure you track sodium intake by reading food labels and keeping a food journal. Pay attention to the fluids you are drinking, since some of it can also contain sodium. Also, check with your dietitian to see what your recommended sodium amount is.
Salt or sodium is the core reason for water weight gain in between dialysis days. If you are not able to control sodium and water balance, you may experience the following:
By using less sodium in your diet, you can control these problems.
Limit The Amount Because Of Their High Sodium Content
- SALT & SALT SEASONINGS: Table salt, Seasoning salt, Garlic salt Onion salt, Celery salt , Lemon pepper, Lite salt, Meat tenderizer
- High Sodium Sauces such as: Barbecue sauce, Steak Sauce, Teryaki sauce, Soy sauce, Oyster sauce
- Salted Snacks such as: Cheetos, Rice Crackers, Edamame, Vegetable Chips.
Acceptable Substitutes For Sodium
- Fresh garlic, fresh onion, garlic powder, onion powder, black , pepper, lemon juice, low-sodium/salt-free seasoning blends, vinegar
Allspice:
Use with beef, fish, beets, cabbage, carrots, peas, fruit.Basil:
Use with beef, chicken, most vegetables.Bay Leaf:
Use with beef, chicken, most vegetables.Caraway:
Use with beef, chicken, green beans, cauliflower, cabbage, beets, asparagus, and in dips and marinades.Cardamom:
Use with fruit and in baked goods.Curry:
Use with beef, chicken, fish, green beans, carrots and in marinades.Dill:
Use with beef, chicken, green beans, cabbage, carrots, peas and in dips.Ginger:
Use with beef, chicken, green beans, cauliflower and eggplant.Marjoram:
Use with beef, chicken, green beans, cauliflower and eggplant.Rosemary:
Use with chicken, cauliflower, peas and in marinades.Thyme:
Use with beef, chicken, fish, green beans, beets and carrots.Sage:
Use with chicken, eggplant and in dressing.Tarragon:
Use with fish, chicken, asparagus, beets, cabbage, cauliflower and in marinades.Strawberry Smoothie, Sweet Potato Steak Fries, Roasted Sweet and Salty Chickpeas, Olive Oil Popcorn, Fruit Salad with Lemon Yogurt Jelly, Hummus, Quick and Easy Granola Bars.
Some information about reading labels
Fluids
Did you know that your body is composed of as much as 60% water? Fluids are vital for your body to function properly. One of the kidneys’ most important jobs is to remove extra fluid from your body. When your kidneys are not removing this fluid, it will build up in your body. This can cause swelling, make it harder for you to breathe, and put stress on your heart, which can lead to heart failure. Dialysis helps remove some of the extra fluids, but it’s very important that you control the amount of fluid you take in every day.
What should I do?
Anything you drink is a fluid. This includes things like water, tea, coffee, milk, juices and other drinks. Some foods count as fluids, including: sorbet, soup, popsicles, ice cream and ice cubes. Also, some fruits and vegetables have a high water content, like watermelons, cucumbers and tomatoes.
Pay special attention to these foods/liquids:
You need to keep track of all fluids and high-water-content foods you eat in order to stay within your allowed daily fluid intake. Your doctor and your dietitian will give you detailed information about this and will also help you learn how to control it.
How do I know if I am doing it well?
You will be weighed before and after each treatment. The so-called “target weight” is your weight without extra fluid. This is the weight that will help you feel good and stay healthier. The weight you gain between dialysis will be used as the basis for your fluid and salt (sodium) recommendation. To keep your heart in a healthy condition, you should not increase your weight by more than 4% between dialysis treatments.
At a Glance: Tips to Control Fluids
How can you control your fluid intake?
• Avoid salty food and additives.
• Use small cups/glasses.
• Space the liquids you can drink over an entire day.
• Measure/record the amount of fluid you consume.
• Be aware of your urine output.
• Take medications with mealtime fluids or soft foods.
• Suck on candy, lemon wedges or frozen fruit.
• Use a spray bottle to mist your mouth.
• Chew gum to keep your mouth moist.
How to calculate your daily fluid intake?
On average, an adult patient needs 500 ml of fluids to maintain the normal body functions. In case you still have urine output, your daily fluid allowance needs be adjusted. Talk to your care team to help you with your specific daily fluid allowance
Remember…
Salt = Thirst = Weight Gain
References:
كتاب المرشد الشامل لمرضى الفشل الكلوي تاليف د.عبد الكريم السويداء_ الطبعة ألاولى_2010 - 1431
Acknowledgment: Reviewed by Riham Albalbisi, Atef Al Taher, Wisam AlBadr, MD the Council on Renal Nutrition (02/2020)
Phosphorus is a mineral found in your bones. Along with calcium, phosphorus is needed to build strong healthy bones. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. This is a significant risk of heart attack, stroke or death.
Dialysis can remove some phosphorus from your blood. It is important for you to understand how to limit build-up of phosphorus between your dialysis treatments.
Medications for phosphorus control need to be taken with meals and snacks. This medicine will help control the amount of phosphorus your body absorbs from the foods you eat.
Your kidney dietitian and doctor will help you with this. Below is a list of foods high in phosphorous and lower phosphorus alternatives to enjoy:
Higher Phosphorus to Avoid:
- Beverages: dark colas, chocolate drinks, pepper type soda (Dr Pepper), drinks made with milk, canned iced teas, bottled beverages with phosphate additives
Dietary Products: Cheddar cheese, hard cheese, custard, milk, cream soups, ice cream, pudding, yogurt
Protein: oysters, beef liver, chicken liver, fish roe, sardines, organ meats
Other foods: chocolate candy, caramels, oat bran muffin, most processed/ prepared foods/ deli meats/ hot dogs/ pizza
Lower Phosphorus Alternatives to Enjoy:
- Water, coffee, tea, rice milk (unenriched), apple juice, cranberry juice, grape juice, lemonade, ginger ale, lemon lime soda, orange soda.
- Rice milk, almond milk, cottage cheese, vegan cheese, sherbet, popsicles, yogurt (Greek type acceptable)
- Turkey thigh meat, skinless, Turkey breast meat, skinless, Hamburger patty (90 percent lean), Chicken breast, skinless, Chicken thigh, skinless, Snow crab (acceptable) , Shrimp (acceptable).
- Apples, berries, grapes, carrot sticks, cucumber, rice cakes, unsalted pretzels, unsalted popcorn, unsalted crackers, pound cake, sugar cookies
Hidden Phosphorus:
Additives are found on the list of ingredients on the nutrition facts label. Look for “PHOS” to find phosphorus additives in the food.
Phosphorus additives found in foods include:
- Dicalcium phosphate
- Disodium phosphate
- Monosodium phosphate
- Phosphoric acid
- Sodium hexameta-phosphate
- Trisodium phosphate
- Sodium tripolyphosphate
- Tetrasodium pyrophosphate
References:
كتاب المرشد الشامل لمرضى الفشل الكلوي تاليف د.عبد الكريم السويداء_ الطبعة ألاولى_2010 - 1431
Some patients with chronic kidney disease (CKD) who are on dialysis may notice some unpleasant changes in their skin. Three skin conditions that sometimes affect those on dialysis include itching (pruritus), dry skin (xerosis) and skin discoloration (hyperpigmentation). Learning why these skin conditions happen, and what can be done to prevent or ease the problem, can help keep skin as healthy as possible.
Itching (pruritus)
A majority of dialysis patients, whether they do hemodialysis or peritoneal dialysis (PD), may experience itching at some point. Some feel itchy all the time, while for others it comes and goes. Many say itching is worse during or just after treatment. For some people the itching is in one area, while others feel itchy all over
A common cause of itching is a high level of phosphorus in the body. Because dialysis doesn't effectively remove phosphorus, a renal diet that limits foods high in phosphorous is prescribed. Additionally, taking phosphorus binders with every meal and snacks can help. Try to maintain a phosphorus level at 5.5 or less. Staying on dialysis for your full treatment time is also recommended, because it can remove some phosphorus as well as other wastes and toxins.
Allergies can cause itching. If you notice itching occurs at the beginning of dialysis treatments, you could have an allergy to the blood tubing, dialyzer (artificial kidney), the type of heparin being used or other elements associated with the treatment.
Antihistamines, such as Benadryl, are used to treat allergies and have helped to relieve itching. Creams that contain capsaicin, witch hazel, lanolin or camphormay also relieve itching. Some people report that getting sunlight or ultraviolet (UV) light treatments in a doctor's office or treatment center helps lessen itching.
Check with your doctor before trying any anti-itch method or product.
Dry skin (xerosis)
Dry skin is also a common condition for patients with end stage renal disease (ESRD). Kidney failure may make changes in the sweat glands and oil glands, which causes the skin to dry out. Dry skin can lead to infections and can cause skin wounds to heal slower than they should. Dry skin can also cause itching.
To prevent or treat dry skin, avoid long, hot showers or baths. Also, look for soaps that have natural, pure ingredients without harsh perfumes and chemicals. A moisturizing soap for sensitive skin can be a good choice. There are also bath products made with oatmeal created for dry, itchy skin that can be found at drug stores.
Apply a moisturizing, high-water content gel, lotion or cream to the body right after bathing, while the skin is still damp. Avoid creams or lotions with alcohol. Ask your doctor or pharmacist about dry skin treatments that are available.
Skin discoloration
Many reported cases of discolored skin, or hyperpigmentation, happen to people with ESRD. One cause of skin discoloration is related to pigments called urochromes being retained in the skin. Normally these are excreted by healthy kidneys. Patients with this condition tend to have a grayish, almost metallic color skin.
Another discoloration is called uremic frost. This is a white, powdery substance left on the skin surface after sweat dries. Uremic frost is prevented by getting adequate dialysis.
https://www.davita.com/treatment-services/dialysis/on-dialysis/skin-problems-and-dialysis
Protein is responsible for building muscle and is essential for normal body function. Not enough protein in your diet can make you feel weak and tired, cause you to retain fluid, and make it hard for your body to fight infection and heal wounds.
Albumin is a protein in your blood that tells your care team how good your protein intake is.
What should I do?
Adequate protein intake is around 1.2g per kg of body weight per day. On average, this is equivalent to two to three portions of quality protein per day (size of your palm).
Quality proteins can be found in eggs, fish, shellfish, chicken, turkey, beef and lamb.
Albumin is affected by non-nutritional factors as well. One of the main factors is infection. So make sure you avoid infections by keeping good hygiene practices. (For further information, refer to Controlling Infections Station)
How do I know if I am getting enough protein?
You should closely follow your dietitian’s nutrition instructions about protein intake. A few examples are shown on the next page to help you estimate your daily protein. (For further information, refer to Labs Station)
At a Glance: Protein Portion Sizes
30 grams of protein
• 1 chicken wing
• 1/4 cup lowfat cottage cheese
• 1/4 cup water-packed tuna
• 1 egg or 2 egg whites
• 2 tablespoons peanut butter
60 grams of protein
• 1 chicken drumstick or thigh or 2 wings
• 2 lamb chops
• 1/2 cup lowfat cottage cheese
• 1/2 cup water-packed tuna
• 2 eggs or 4 egg whites
• 1/2 cup ground meat
90 grams of protein
• 3 lamb chops
• 1 split chicken breast
• 1 medium hamburger patty
• 3/4 cup water-packed tuna
• 3/4 cup ground meat
Acknowledgment: Reviewed by Riham Albalbisi, Atef Al Taher, Wisam AlBadr, MD the Council on Renal Nutrition (02/2020)
Vitamins and minerals are substances your body needs to help carry out important functions. If you are on dialysis some of the vitamins and minerals are removed as part of the dialysis procedure. Classically the vitamins and minerals that are removed are part of the “water- soluble” group. In addition, some of the medicines you take can change the way your body uses certain vitamins and minerals.
Which supplements will I need to take?
It is important to talk to your healthcare professional or kidney dietitian before taking additional supplementations, herbal remedies and over the counter nutritional supplements.
References:
https://www.kidney.org/
https://www.davita.com/
كتاب المرشد الشامل لمرضى الفشل الكلوي تاليف د.عبد الكريم السويداء_ الطبعة ألاولى_2010 - 1431
