Diet and nutrition are important components of healthy living, helping the body stay strong and managing chronic illnesses like diabetes, high blood pressure, and kidney disease. For individuals in the late stages of kidney disease, when transplantation isn't immediately available or an option, home dialysis therapies, like peritoneal dialysis (PD), offer freedom and a more active role in their care. However, diet plays a crucial role in the effectiveness of PD treatments and overall well-being.
Why a Special Diet for Peritoneal Dialysis?
When kidneys aren't functioning properly, they can't remove enough waste products and fluids from the body. Peritoneal dialysis helps to filter out toxins in your blood using a fluid that contains carbohydrates. Dietary changes become necessary to maintain body weight and prevent excess weight gain due to the calories from the dialysate, and to address the altered nutritional needs that come with daily dialysis. It is important that you have the right amounts of protein, calories, vitamins and minerals in your diet.
Understanding Calories in Peritoneal Dialysis
The fluid used in PD, called dialysate, contains carbohydrates, which means it has calories. These calories are the fuel for your body. The amount of carbohydrates used during PD treatments, also called exchanges, can vary, but PD dialysate can add approximately 500 extra calories each day, depending on the dialysate used.
Maintaining energy balance is necessary when on PD to ensure appropriate energy levels. Your dietitian will coach you on an eating plan that will be in the right caloric range determined for your body type, health condition and level of activity so you can stay at a healthy weight.
Protein Intake for Peritoneal Dialysis Patients
Protein is essential for building and repairing the body and preventing infections. With PD, protein is constantly drained from the body, increasing protein needs. If peritonitis occurs, protein losses increase further. Follow your dietitian’s advice to eat more protein to help your body ward off infections and replenish the protein lost during treatments. Generally, you need about eight to 10 ounces or more of protein a day, which is about 1.3 grams of protein per kilogram of body weight (there are 2.2 pounds per kilogram).
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Good sources of protein are lean beef or pork, tuna, tilapia, salmon, shrimp, eggs (or egg whites/substitute), and skinless chicken and turkey. Try to choose lean, or low-fat, meats that also are low in phosphorus, such as chicken, fish, or roast beef.
Maintaining Bone Health: Calcium and Phosphorus
Calcium and phosphorus help build and maintain bone, but too much of these minerals can be detrimental for PD patients. Eating foods high in phosphorus will raise the phosphorus in your blood and this can cause calcium to be pulled from your bones. This will make your bones weak and cause them to break easily. To help control the phosphorus in your blood, you may need to take medicine called a “phosphate binder”. It should be taken with your meals and snacks as ordered by your healthcare professional. Your kidney dietitian can also tell you about protein foods that are lower in phosphorus.
Potassium Considerations
Potassium, an electrolyte important in heart function, is significantly removed with PD treatments; thus, you may need to eat more potassium-rich foods. Signs and symptoms of low potassium are muscle cramps, difficulty breathing and irregular heart beat. Too low or high potassium can be dangerous, resulting in cardiac arrest. The general potassium recommendation for those on PD is 3,000-4,000mg a day.
Typically fruits and vegetables are associated with potassium, but chocolate, dairy products like milk, cheese and yogurt all contain significant sources of potassium.
Sodium and Fluid Intake
PD requires awareness of sodium and fluid intake. Sodium is found in table salt and is plentiful in processed meats like bologna, sausage, hot dogs, bacon, corned beef, lunch meat, pickles, frozen meats, and canned soups and vegetables. Fluid is anything liquid at room temperature: coffee, soda, ice, juice, soup, popsicles, sherbet and gelatin. Sodium is connected to fluid intake and how much fluid your body holds on to; if you eat foods high in sodium you will get thirsty and drink more fluid. If you drink too much fluid than you need, your dialysis treatments can be compromised with poor drains.
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The recommended intake of sodium is approximately 2,400mg. Try to choose foods that have less than 10 percent of the daily value per serving. Herbs and spices like garlic, cumin, cayenne pepper, lemon, onion, basil, bay leaves, nutmeg, ginger and thyme can be used in place of salt to give foods a variety of flavors.
Vitamins and Minerals
The dialysis treatment washes some water-soluble vitamins out of your body. If you are not getting all the vitamins and minerals you need from the foods you eat, vitamin and mineral supplements may be recommended. It is important to take only what is ordered for you. Certain vitamins and minerals can be harmful to people on dialysis. Never take vitamin and mineral supplements you can buy over the counter (OTC). OTC vitamin and mineral supplements may be harmful to people with kidney failure. For safety reasons, talk with your health care provider before taking any medicines, vitamin and mineral supplements, or probiotics that he or she hasn’t prescribed for you.
Additional Dietary Considerations
- Limit Foods High in Phosphate: Usual dialysis procedures cannot remove all the excess phosphate. Elevated blood phosphate concentration causes calcium to be removed from your bones, making them weak and more fragile -renal bone disease. Limit foods rich in phosphate such as dairy products, nuts and beans although they are high in protein.
- Fluids: Limit how much liquid you eat and drink. Foods that are liquid at room temperature, such as soup, contain water. Gelatin, pudding, ice cream, and other foods that include a lot of liquid in the recipe also count. Some fruits and vegetables, such as watermelon, contain a lot of water.
- Potassium Control: You can remove some of the potassium from potatoes and other vegetables by peeling, cutting and soaking them in a large container of water for several hours. Replace the water before cooking.
Working with Your Dietitian
Being on PD brings many different factors into play and nutrition is just one participant. Because each patient is different, your dietitian can help create a meal plan just right for you and your health care needs. With proper support and planning as well as educating yourself, confidence will grow. Making food choices will not be a chore or a feat to conquer, but something to enjoy that becomes like second nature.
Your dietitian will give you specific instructions regarding your fluid intake. You will follow the peritoneal dialysis diet for as long as you are on PD. You will notice improved appetite and energy level, better blood pressure and less swelling. Lab tests are another way to determine if the peritoneal dialysis diet is working. Once the renal team will test to see whether you are getting enough protein by checking your blood albumin level. Several times a year your doctor will order a peritoneal dialysis adequacy test to check the effectiveness of your dialysis. Your dietitian will also monitor your health and conduct a nutrition assessment when you start on PD and then every year thereafter. This assessment will check your body for any signs of nutrition problems, changes in weight and energy levels or any issues that may interfere with eating.
The Goal of the Peritoneal Dialysis Diet
The PD diet cannot reverse existing kidney damage. The goal of the PD diet is to help make your treatment more effective, as well as keep you healthy and feeling well. By limiting foods that contain minerals such as phosphorus and sodium, you lessen the risk of developing certain complications.
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