Diet for Hemodialysis

What is hemodialysis?

Hemodialysis involves clearing of blood toxins with help of a machine wherein the impure blood goes into the machine, it gets purified and then is sent back to the body. This procedure is carried out thrice in a week for a period of four hours. In this procedure, blood is made to pass through an artificial filter (dialyser) which helps in clearing the waste products.

What kind if diet is recommended for hemodialysis patients?

For hemodialysis patients, a diet providing high quality protein is recommended as hemodialysis usually involves losses of proteins through several sources. Hence, it is essential to replace these losses in order to preserve the protein pool of body.

Additionally, the diet should be:

  • Low in fluid,
  • Low in salt,
  • Low in potassium and
  • Low in phosphorus.

Why is fluid and salt restriction required?

Normal kidneys are well equipped with mechanism that can balance your salt and water.    However, when they become weak, they can no longer fulfill this function completely, leading to complications like accumulation of fluid in the body which can be seen either in the form of swelling on feet or puffiness of face or raised blood pressure. Hence, it is essential to decrease the intake of salt and water.

NOTE: Always remember to ask your Nephrologist about the daily intake of salt and water.

How can one reduce salt and water consumption?

Following are the tips to reduce salt and water:

  • Always ask your Nephrologist about the amount of fluids that are allowed for you.
  • Anything that turns into liquid at room temperature is considered as fluid, for example, ice cream.
  • Always bottle up the recommended amount of fluid in a measured bottle to keep a track on amount consumed.
  • You may consume your morning medicines with tea or milk in order to save water.
  • Always prefer gargling after meals, this can help you in preventing excessive water intake.
  • Avoid salty and spicy food items as they make you feel thirsty.
  • Avoid going out for walks or exercises in too hot climates. You may prefer the same indoors.
  • Diabetics should maintain sugar level under control as high sugars can make you feel thirstier.
  • Avoid all fluids that have their solid substitutes, for example, you may use salads instead of soups, fruits instead of juices, thick curd instead of thin butter milk.
  • Avoid all alcoholic beverages and cold drinks.
  • Instead of water you may suck ice cubes as they can help you overcome dryness of mouth.
  • During outings or vacations, avoid consumption of beverages like tea, coffee, etc; instead you can have additional snacks containing less salt.
  • Chewing gums can be used to resist frequent urges of thirst (sugar free chewing gums can be used by diabetics)
  • Weigh yourself daily (preferably on same weighing scale) and keep a record of your weight in a dairy.
  • Regularly check your feet for swelling and if any, report it to your dialysis clinic.
  • Avoid using low sodium salts as they are high in potassium.
  • Foods containing baking soda like papads, bakery products such as cakes, kharis, puffs, pasteries, cookie, etc should be avoided.
  • Foods which are an additional source of salt in diet such as sauces, chutneys, pickles, seasoning mixes should be used sparingly.
  • To make food palatable, you may add few drops of lemon juice, vinegar, tamarind pulp or raw mango pulp to your recipes.
  • To compensate for taste of salt, you may add seasonings like amchur powder, pudina leaves, tulsi leaves, oregano, mixed herbs, ginger green chilli paste, garam masala powder.
  • Avoid processed cheese and salted butter, instead you may use paneer and homemade butter respectively.
  • Avoid packed non veg sources like processed meat, broths, canned fish, etc as they contain high amount of salt.
  • Avoid packed dry snacks like chips, chiwdas, farsan, cookies etc. Instead prefer homemade dry snacks with low amount of salt.
  • In daily routine, avoid adding salt to recipes that do not need its presence like chapatis, bhakaris, parathas, rice ,salads ,curds.
  • Avoid adding salt during bulk cooking, separate your portion first and then add salt in it as this will reduce overall consumption of salt. If this may not seem to be practical, add minimum amount of salt to the bulk receipe and portion it out first for yourself.

Why is potassium restriction required?

Potassium is a mineral present in the body and maintaining a balance of it is one of the several functions of our kidneys. When kidneys fail their ability to remove potassium from the blood decreases and hence, potassium level may begin to rise in the blood. This raised potassium can affect the normal rhythm of heart causing complications which can lead to loss of life. Hence, restriction of potassium through diet is extremely important.

How can one reduce the intake of dietary potassium?

Following are tips to control potassium through diet:

  • Potassium is widely present in a number of foods .Hence, careful selection of foods is necessary.
  • High amounts of potassium is present in coconut water and hence they should be strictly avoided.
  • Fruit juices too contain high amounts of potassium ,hence they should be avoided.
  • Chocolates , nuts and dry fruits too should be avoided.
  • Soups (veg /non-veg/broths/ preserved gravies should be avoided.
  • Canned or tinned food items should be avoided.
  • Before consuming any packaged food items, always read its contents carefully and if its potassium content is more than 200 mg/serving, it is best avoided.
  • If your potassium level tends to remain on a higher side, you may switch over to jowar flour chapatti or rice flour and maida based chapatti (avoid rice flour and maida if you are a diabetic) instead of wheat flour chapatti .
  • Remember that even a food item which has low potassium content can turn into high potassium if consumed in excess.
  • To reduce the amount of potassium from vegetable, especially green leafy vegetables like spinach and roots like potato, sweet potato, etc, you can use a process called as leaching. For leaching you need to peel, chop the vegetables and soak them in generous amount of water for 1-2 hours. Then discard the water and the cook the vegetables. Although this process does not remove the entire amount of potassium but it can be used to include more variety of vegetables in diet.

Why is dietary phosphorus restriction required?

Phosphorus is a mineral found in many food items. The dialysis machine is not efficient enough to remove phosphorus from your blood. If you have higher levels of phosphorus in blood, it tends to pull out calcium from your bones making them weak and fragile. High levels of phosphorus are also associated with itchy skin. Hence, it is important to lower phosphorus amount through diet. Additionally, several patients need medications called as phosphate binders to maintain phosphorus under control. Almost all foods that are rich in proteins are rich sources of phosphorus too. This leads to careful selection of proteins when phosphorus in the blood increases.

How can one reduce the intake of dietary phosphorus?

Following are tips to control phosphorus through diet:

  • Limit the intake of milk and its products.
  • For vegetarian, curds (cow’s milk) should be preferred over paneer as paneer has higher amount of phosphorus.
  • Amongst vegetable, cut down on carrots as they are high in phosphorus.
  • Non –vegetarian may continue eating egg whites, however it is advisable to include phosphate binders as prescribed by the Nephrologist to maintain phosphorus levels.
  • Consider replacing animal milk with soya milk which is lower in phosphorus.
  • Avoid wheat flour items and use plain flour instead.
  • Avoid brown rice, use plain rice instead.
  • Avoid chocolates, cocoa based drinks, nuts and dry fruits.

How can one make sure whether the diet he/she is taking is adequate nutrition?

To make sure about the adequacy of nutrition on dialysis, it is important to check the following parameters:

  • Serum albumin - it reflects the protein stores of your body. In case your serum albumin level is less than 3.8 mg/dl, you are more likely to become malnourished. Hence, maintaining the target albumin level is important in dialysis patients. To achieve this, a high protein diet is required.  
  • Dry weight: Before the onset of dialysis, it is usually seen that the muscle mass of the patients reduces (sometimes to a remarkable extent) due to decreased appetite. Once dialysis is begun, appetite is regained and this helps in regain of the muscle mass which can be seen by the increase in the dry weight of the patient. (Dry weight is that weight at which there no signs of swelling, breathlessness and patient has normal BP).

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