Dietary information for patients new to haemodialysis

It is important to ensure that you are eating the right amount of food to maintain a healthy weight, support your immune function and body processes, and maintain good energy levels to be able to carry out your daily activities.

Some HD patients struggle with taste changes and poor appetite, which makes it difficult to eat enough food to meet nutritional needs.

If you suffer from the above symptoms try eating little and often and add a few extra snacks between your meals.

Protein provides the building blocks needed for the growth and repair of body tissues. Protein is lost from your body during each HD session, therefore it is important to replace these losses with more protein in your diet, to protect your body tissues.

We recommend that you eat a portion of protein with two to three meals per day, to make up for these losses.

A portion of protein is one of the following:

• Palm size of meat / chicken / fish / tofu
• Two eggs
• Two tablespoons of high protein yoghurt/ quark cheese or cottage cheese
• Three to four tablespoons of beans and pulses

Milk, hummus, and cheese also contain small amounts of protein. Your dietitian can advise you on eating the right amount of energy and protein for your needs.

Phosphate and potassium are minerals which come from food. Kidneys are responsible for removal of their excess from the body. If kidney function is low and sufficient amounts cannot be removed with HD, these minerals start building up in the body dietary restriction may be required to maintain healthy levels of these minerals in your blood.

High phosphate levels may cause itchy skin. Over time high phosphate levels may cause weakening of the bones and hardening of blood vessels, which can lead to the development of heart disease.

Your dietitian will help you to reduce high-phosphate foods while maintaining a good quality diet. You can also ask your HD nurses for a diet sheet before seeing your dietitian.

TIP: Many processed foods, like meats or soft drinks, contain phosphate additives. Check the ingredients list and avoid those containing additives with ‘phos’ in their name (e.g., Phosphoric acid).

Most foods contain phosphate and so is not possible to remove all phosphate from your diet. You may be prescribed a phosphate binder medication (e.g., Sevelamer, Osvaren or Fosrenol) in addition to a low phosphate diet if dietary changes alone are not sufficient to maintain good phosphate levels.

Remember: phosphate binders need to be taken around your mealtimes to bind phosphate from your food, like a magnet, preventing it from getting into your blood. 

High potassium levels can interfere with heart rhythm and in severe cases even lead to a heart attack. Dietary potassium restriction may be required if your potassium is too high but is not necessary if your potassium levels are well controlled.

Most fruit and vegetables contain potassium and HD patients often avoid these due to fear of high potassium.

We would like to strongly discourage this practice. If you have high potassium levels aim to restrict less nutritious high potassium foods first, such as chocolate, crisps/ other potato and nut-based snacks, coffee, fruit juices, processed meats with potassium additives (check the ingredients list); and boil rather than steam your vegetables.

Fruit and vegetables are very nutritious and reduce the risk of development of many HD related conditions, such as heart disease. They also improve bowel habits, which in turn helps to remove more potassium from your body.

You should aim to enjoy five to six portions of fruit and vegetables per day. Portion = 80g (a handful)

Ask your dietitian to help you choose fruit and vegetables with lower potassium content. You can also ask your HD nurse for the pictorial low potassium diet sheet prior to seeing
dietitian.

Fluid is removed from your body by dialysis and when you pass urine. Drinking more fluid than is removed can cause ‘fluid overload’. This is harmful to your heart, will increase your blood pressure and can lead to shortness of breath.

Your daily fluid allowance depends on the amount of urine you pass and may change over time, as your urine output is likely to decrease in time.

In general, the more urine you produce, the more you can drink. Please ask your doctor or dietitian about your daily fluid allowance.

Fluids in foods like gravy, sauces, soups, jelly, and ice cream, in addition to all hot and cold drinks, all count.

Too much salt in the diet is linked to high blood pressure. It can make your body retain water and removing fluid on HD more difficult, causing blood pressure drops and body cramps. Salt will also make you thirsty and makes following a fluid restriction more difficult.

You can reduce salt in your diet gradually to still be able to enjoy your foods. Your taste buds will quickly adapt to using less salt and you will find that after about a month food will start to taste much better.

It is useful not to add salt automatically when cooking or about to eat. We often only use salt out of habit.

To reduce the amount you eat, try these suggestions:

• Marinating meat and fish in advance to give them more flavour e.g., use garlic, onions, lemon.
• Adding a small amount of red wine to stews and casseroles, and white wine to risottos and sauces for chicken.
• Try using a very low salt stock cubes, based on herbs and spices.
• Cut down on manufactured and processed foods: Try using fresh or frozen meat, fish, and vegetables rather than pre-prepared dishes or ready meals whenever possible.
• If buying tinned foods, choose those labelled ‘no added salt’ or ‘reduced salt’.
• Limit eating salty foods such as bacon, tinned meats, sausages, beef burgers, meat pies, smoked fish, olives, tinned and packet soups, salted peanuts and crisps.
• Try plain roasted meats/ poultry or fish with herbs and spices instead.

Warning: do not use salt substitutes e.g., Losalt, as they contain potassium.

Salt Label Reading Information

• High: more than 1.5g salt per 100g (or 0.6g sodium)
• Medium: between 0.3g and 1.5g per 100g (or 0.1g sodium)
• Low: 0.3g salt or less per 100g (or 0.1g sodium)

No more than one tablespoon of bottled sauces per day.