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Managing what you eat when you have kidney disease can be a challenge but can have a positive influence on how you feel and the other treatments you might need. It is important to recognise that as kidney disease progresses your dietary needs will more than likely change. Every person with kidney disease is different with individual food preferences and dietary needs.
A dietitian experienced in kidney disease is the best person to speak to about what you can eat and drink. The dietitian will assess what you are currently eating and advise if changes are needed.
Dietary assessment includes review of your intake of energy and important nutrients such as protein, sodium/salt, potassium, phosphate, fluid, fat, carbohydrate.
Advice is given on a personal basis, taking into account what you like to eat, how you are feeling, your age, lifestyle, weight, muscle size, health status and blood test results. You may find that initially the suggested changes might be small, but as kidney disease progresses more significant changes may be required.
Things you can do to set the most of your dietitian appointment.
Accredited Practising Dietitians experienced in diet and kidney disease can explain how it all works and help plan meals. This Dietitian will take into account how you are feeling, your age, lifestyle, weight, muscle size, health and blood test results. Ask your GP for referral. Dietitians Association of Australia provide contact details for a local renal dietitian - call 1800 812 942.
- write down what you eat for a few days and bring it with you to your appointment
- bring your medication list with you
- if someone else normally cooks for you – bring them with you to the appointment
- ask questions so that you know what you need to do and why
- organise regular follow up appointments to monitor your own progress
IMPORTANT COMPONENTS OF A HEALTH DIET
Just like your car needs petrol, your body need fuel. Getting the right amount of energy (kilojoules or calories) is important to your overall health and well-being as well as body weight.
Carbohydrate and fat are the body's main energy sources:
- if protein has been restricted in your diet, your energy needs may be met by increasing your intake of fats and carbohydrates.
- carbohydrates come from foods such as breads, cereals, rice, pasta, noodles and grains.
- choose ‘good fats’ such as polyunsaturated and/or monounsaturated found in olive, canola and sunflower oil.
Getting the right amount of protein is important to your overall health. Your body needs protein for: building muscles, repairing tissue and fighting infections.
However, if you have kidney disease it is often important to control the amount of protein-rich foods you eat to minimise waste build up. Protein requirements also change when you are on dialysis and should be discussed with your dietitian.
Protein comes from:
- animal based foods including eggs, fish, meat, chicken
- dairy foods such as cheese, milk and other dairy foods
- plant foods like nuts, peanut butter, lentils, baked beans, bean soup mix, beans salad mix, chickpeas also contain protein, but are sometimes less suitable because of potassium and phosphorus content
Controlling dietary phosphorus is important at all stages of kidney disease. In many cases reducing protein intake will also reduce phosphorus intake. Sometimes phosphate binder medications medications are also needed to reduce the amount of phosphate that reaches the bloodstream.
Phosphate binders work in your gut by binding to the phosphorus in the food and the end result is some of the phosphate is removed through your bowel movements. For this reason it is very important to take phosphate binders when eating. A dietitian can help to guide you how best to take phosphate binders with your meal plan.
Sodium is a mineral found naturally in foods. It is also commonly added to packaged and processed foods. It affects the amount of fluid that your body retains.
Too much sodium and fluid may cause:
Eating a lot of sodium also makes you thirst, which becomes even more important when urine output slows down (usually after starting dialysis).
- high blood pressure
- swelling of ankles, feet, hands and puffiness under the eyes
- shortness of breath
- increased protein in urine
Typically foods that have a lot of sodium include:
- seasonings including season-all, lemon pepper, garlic salt
- sauces like soy, fish, black bean and teriyaki sauce
- canned foods and some frozen foods
- processed meats like ham, bacon, sausage and cold cuts
- salted snack foods like chips and crackers
- stock mixes and packaged soup
- most restaurant and take-away foods
- beware of salt substitutes as some contain potassium instead of sodium
Australian World Action on Salt & Health - Drop the Salt Campaign
Nearly all goods contain some potassium. Many health foods like fruit, vegetables and dairy are high in potassium. If you have kidney disease your intake of these foods often needs to be controlled. This may mean avoiding some fruits and vegetables altogether, while for others a small serve and eating them less often may be enough. It is important to get advice from a dietitian on how best to include foods from all food groups to maintain an overall healthy low potassium meal plan.
The amount:of potassium you should eat when you are on dialysis will depend on which type of dialysis you choose. It is more common to need to restrict your potassium intake if you are having haemodialysis. In fact, if you are having peritoneal dialysis, you may have to increase your potassium intake. Some people also need to take medications to control the amount of potassium in their blood.
Tip for reducing potassium intake: Cut vegetables into small pieces and soak in a large volume of water for 1-2 hours before cooking, drain and cook normally. Alternatively boil and drain off water. Not all fruits and vegetables have same amount of potassium.
The amount of fluid intake varies for different stages of kidney disease. Some people need to drink large amounts of fluids but others may need to limit their fluid intake. Your suggested fluid intake will depend on your urine output, fluid build-up and blood pressure. Urine output usually drops off the longer you are having dialysis. As this happens fluid intake should be adjusted. Remember that fluid-type foods need to be included in your fluid allowance.
Fluids include: water and ice cubes, tea, coffee, juices, soft drinks, milk and milk products, gravy sauces and soups, ice-cream, jelly, custard and yoghurt.
Tips for restricting fluids: Sip small amounts of fluid throughout the day, use smaller cups and glasses.
STAYING AT A HEALTHY WEIGHT
Maintaining a healthy weight can make it easier to manage your health. Some people with kidney disease do not feel like eating or have difficulty eating enough food to stay healthy. Malnutrition can develop when food intake is inadequate and the body does not get the right amount of the vitamins, minerals and other nutrients it needs. This is more common for people who are getting close to needing dialysis, but it can also persist when dialysis starts.
It is very important to try to stick to the eating plan your dietitian suggests even if you do not feel like eating. Tell your doctor or dietitian if you are losing weight that is not planned, or have any concerns about your diet.
Weight gain can also be a serious problem. It can be harder to gain access for dialysis if you are overweight. Being overweight may also mean you are not suitable for a transplant operation. If weight gain is a problem your dietitian can assist you with a kidney-appropriate weight loss eating plan.
There are times when managing a renal diet can be difficult. If you would like to ask further questions or order resources, contact our Kidney Health Information Service, or email firstname.lastname@example.org
Alternatively your kidney specialist or GP may refer you to a renal dietitian for individual advice and support who can design a specific diet for your needs. Contact Dietitians Association of Australia or call 1800 812 942.
Links to KHA resources
iKidneyDiet - iTunes app Highly recommended app for iTunes and Android phones
Refer to this at any time - gives instant levels for the 3 Ps - Potassium, Phosphorous, Protein - useful when watching your food intake for a renal diet. Some USA products are noted.
Kidney Friendly - for a variety of recipe delights for those living with kidney failure
Updated 21 September 2015 Disclaimer: This information is intended as an introduction to this topic and not meant to substitute for your doctor's or health professional's advice. All care is taken to ensure the information is relevant and applicable to each Australian state. It should be noted Kidney Health Australia recognises each person's experience is individual and variations occur in treatment and management due to personal circumstances. Should you require further info always consult your doctor or health professional.