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American
Kidney Fund
reaching out
giving hope
improving lives
Healthy Eating for
People on Hemodialysis
reaching out
giving hope
improving lives
Healthy Eating
for People on
Hemodialysis
Y
ou need a “kidney-friendly” diet when you are on
dialysis. Watching what you eat and drink will help
you stay healthier. This brochure is for people who have
kidney failure and are on hemodialysis. It will describe a
kidney-friendly diet and why it is important.
This brochure will teach you about:
• The basics of a healthy diet
• What makes the kidney-friendly diet different
• Special steps for people with diabetes
• Where to find more information
Keep this in mind…
This guide gives only general information. Diet needs
vary from person to person depending on size, activity,
and other health concerns. Talk to a renal dietitian,
someone who specializes in the kidney-friendly diet, to
find a meal plan that meets your needs. Your dialysis
center will have a dietitian that you can meet with, and
Medicare will cover this service.
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Why is diet important?
Healthy Diet Basics
W
A
hat you eat affects your
health. Maintaining a healthy
weight and following a diet that is
low in salt can help you control
your blood pressure. If you have
diabetes, your diet is also
important in helping to control your
blood sugar. This can help you
prevent other health problems.
A kidney-friendly diet goes a step
further. It limits certain minerals in the foods you eat. This
helps keep waste from building up in your blood and may
help prevent some common problems caused by kidney
failure.
ll diets, including the kidney-friendly diet, need to take
into account some of the same things, like:
• Calories
• Carbohydrates
• Protein
• Fat
• Portions
In this section, we’ll review each of these. We’ll also take a
look at the nutrition facts label and explain how you can use
this tool to help you have a healthy diet.
We’ll start by reviewing the basics of a healthy diet. Then,
we’ll take a look at the kidney-friendly diet and some
helpful kidney-friendly diet resources.
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3
Calories
Carbohydrates
Y
Carbohydrates (“carbs”) are the easiest kind of energy for
your body to use. Healthy sources of carbohydrates
include whole grains, fruits and vegetables. Other
unhealthy sources of carbohydrates include sugar, honey,
hard candies, soft drinks and other sugary drinks.
our body gets energy from the calories you eat and
drink. Calories come from the carbohydrates, protein,
and fat in your diet. How many calories you need depends
on your age, sex, size and activity level. You may also
need to adjust how many calories you eat based on your
weight goals.
Some people will need to limit the calories they eat.
Others may need to have more calories. Your dietitian can
help you figure out how many calories you should have
each day. Work with your dietitian to make a meal plan
that helps you get the right amount of calories, and keep in
close contact for more advice and follow up.
4
Some carbohydrates are high in potassium and
phosphorus, which you may need to limit. We’ll talk about
this in more detail a little later. You may also need to watch
your carbohydrates carefully if you have diabetes. Your
dietitian can help you learn more about the carbohydrates
in your diet and how they affect your blood sugar.
5
Protein
Fat
Protein is one of the building
blocks of your body. Your body
needs protein to grow, heal and
stay healthy. Before you started
dialysis, your doctor or dietitian
may have told you to limit the
protein in your diet. Now that you are on dialysis, you may
need to eat more protein. This will help replace protein that
is lost during your treatments.
You need some fat in your diet to stay healthy. Fat gives
you energy, keeps you warm, and helps you use some of
the vitamins in your food. But too much fat can lead to
weight gain and heart disease. Try to limit fat in your diet,
and choose healthier fat when you can.
Talk to your dietitian to find out how much protein you should
have each day. Your dietitian can help you make a meal
plan that helps you get the protein you need.
Use the table below to learn which foods are low or high in
protein.
Lower-protein foods
Higher-protein foods
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Healthier fat or “good” fat is called unsaturated fat.
Examples of unsaturated fat include:
• Olive oil
• Vegetable oils
Unsaturated fat can help reduce cholesterol. If you need
to gain weight, try to eat more unsaturated fat. If you need
to lose weight, limit the unsaturated fat in your diet. As
always, moderation is the key. Too much “good” fat can
also cause problems.
Saturated fat, also known as “bad” fat can raise your
cholesterol and put you at risk for heart disease.
Examples of foods that have saturated fat include:
• Butter
• Lard
• Shortening
• Meat
Limit these in your diet. Choose healthier, unsaturated fat
instead. Trimming the fat from meat and removing the skin
from chicken or turkey can also help limit saturated fat.
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7
Sodium
Sodium (salt) is a mineral found in almost all foods. Too much
sodium can raise your blood pressure and make your heart
work harder. Too much sodium can also make you thirsty.
One of the best things that you can do to stay healthy is to
limit how much sodium you eat. A dialysis diet should have
less than 2,000 milligrams (mg) of sodium per day. To
limit sodium in your diet:
• Do not add salt to your food when cooking or at the
table. Try cooking with fresh herbs, lemon juice or other
salt-free spices.
• Choose fresh or frozen vegetables instead of canned
vegetables. If you do use canned vegetables, rinse
them to remove extra salt before cooking or eating them.
• Avoid processed meats like ham, bacon, sausage and
lunch meats.
• Munch on fresh fruits and vegetables rather than
crackers or other salty snacks.
• Avoid canned soups and frozen dinners that are high in
sodium.
• Avoid pickled foods, like olives and pickles.
• Limit high-sodium condiments like soy sauce, BBQ sauce
and ketchup.
8
Warning! Be careful with salt substitutes and “reduced
sodium” foods. Many salt substitutes are high in potassium.
Too much potassium can be dangerous for someone with
kidney failure. Work with your dietitian to find low-sodium
foods that are also low in potassium.
9
The Nutrition Facts Label
Serving Size
Use nutrition facts labels to learn more about what is in the
foods you eat. The nutrition facts label will tell you how much
carbohydrates, protein, fat and sodium are in each serving of a
food. This can help you pick foods that are high in the nutrients
you need and low in the nutrients you should limit.
Use the diagram on page 11 to find key areas of the
nutrition facts label that will give you the information you
need.
Note: People with kidney disease may also need to
watch the amount of potassium and phosphorus
they get. These do not have to be listed on the
nutrition facts label. Be careful! Even if they aren’t
listed, the food may be high in these. Check the
package ingredients list for other clues.
• Foods high in potassium might list the ingredient
potassium chloride or KCl.
• Foods high in phosphorus might have the words
phosphate or phosphoric somewhere in the
ingredients list.
See pages 14 and 15 to learn more. Your dietitian
can also help you learn which foods are high in
potassium and phosphorus.
10
This part of the label tells you how much of the food is equal to one
serving. Many packages contain more than one serving, but the
information on the label is for just one serving. Using the example
below, if you have one cup of this food, you will get 50 calories. If you
have two cups of this food, you will get 100 calories. If you have half a
cup of this food, you will get 25 calories. This same idea applies to all of
the other nutrients listed.
Calories
This part of the label tells you how
many calories are in each serving
of the food. An average adult will
need about 2,000 calories per day,
but this might vary based on age,
sex, size, activity level and health
concerns. Ask your doctor or
dietitian how many calories you
should have each day.
Nutrients
Look here to see how much fat,
sodium, carbohydrate and
protein are in each serving.
% Daily Value (%DV)
This part of the label tells you how much of your daily needs of a
nutrient are met with one serving of the food. This number is not exact,
as each person’s needs may be a little different. As a general rule,
when the %DV is less than 5%, the food is low in that nutrient. When
the %DV is more than 20%, the food is high in that nutrient.
11
Portions
How is a kidney-friendly diet different?
C
Dialysis helps to replace the work of your kidneys, but it
does not work as well as healthy kidneys. Some waste and
fluid still build up in your body. Over time, the waste and
extra fluid can cause heart, bone and other health
problems. A kidney-friendly diet limits how much of certain
minerals and fluid you take in. This can help keep the
waste and fluid from building up and causing problems.
hoosing healthy foods is a great start, but eating too
much of even healthy foods can be a problem. The
other part of a healthy diet is portion control, or watching
how much you eat.
To help control your portions:
• Eat slowly, and stop eating when you are not hungry
any more. It takes about 20 minutes for your
stomach to tell your brain that you are full. If you eat
too quickly, you may eat more than you need.
• Check the nutrition facts label to learn the true
serving size of a food. Many packages have more
than one serving. For example, a 20-ounce bottle of
soda is really two-and-a-half servings.
• Do not eat directly from the package the food came
in. Instead, take out one serving of food, and put the
bag or box away.
• Avoid eating when watching TV or driving. When you
are distracted you may not realize how much you
have eaten.
Exactly how strict your diet should be depends on your
treatment plan and other health concerns. Still, most people
on dialysis will need to limit:
• Potassium
• Phosphorus
• Fluids
Good portion control is an important part of any diet. It is
even more important in a kidney-friendly diet, because
you may need to limit how much of certain foods you eat.
Keep reading to learn more!
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13
Potassium
Phosphorus
Potassium is a mineral found in almost all foods. Your body
needs some potassium to make your muscles work, but too
much potassium can be dangerous. When you are on
dialysis, your potassium level may be too high or too low.
Having too much or too little potassium can cause muscle
cramps, irregular heartbeat and muscle weakness.
Most people on dialysis will need to limit potassium to
2,000 to 4,000 mg per day. Ask your dietitian how much
potassium you should have each day.
Phosphorus is a mineral found in many foods. It works with
calcium and vitamin D to keep your bones healthy. Healthy
kidneys help keep the right balance of phosphorous in your
body. When you are on dialysis, phosphorus can build up in
your blood. Too much phosphorus in your blood can lead to
weak bones that break easily.
Use the table below to learn which foods are low or high in
potassium. Your dietitian can also help you work in some
higher potassium foods in small amounts.
Eat this…
(lower-potassium foods)
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Rather than…
(higher-potassium foods)
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14
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Most people on dialysis will need to limit phosphorus to
about 1,000 mg per day. Ask your dietitian how much
phosphorus you should have each day.
Use the table below to learn which foods are low or high in
phosphorus.
Eat this…
(lower-phosphorus foods)
Rather than…
(higher-phosphorus foods)
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‡8QVDOWHGSRSFRUQ
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To help control your phosphorus, your doctor may also
prescribe a medicine called a phosphate binder. This helps to
keep phosphorus from building up in your blood. A phosphate
binder can be helpful, but you will still need to watch how much
phosphorus you eat. Ask your doctor if a phosphate binder is
right for you.
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Fluids
Other diet concerns
You need water to live, but when you are on dialysis, you
may not need as much. This is because fluid may build up
in your body between treatments. Too much fluid in your
body can be dangerous. It can cause high blood pressure,
swelling, heart failure and trouble breathing. Extra fluid
can also make your dialysis treatments more difficult.
Vitamins
Most people on dialysis will need to limit fluids. Ask your
dietitian how much fluid you should have each day.
If you need to limit fluids, you will need to cut back on how
much you drink. You may also need to cut back on some
foods that contain a lot of water. Soups or foods that melt,
like ice, ice cream and gelatin, have a lot of water. Many
fruits and vegetables are high in water, too.
When you limit your fluids, you may feel thirsty. To help
quench your thirst, you might try to:
• Chew gum
• Drink from small cups
• Rinse your mouth
• Suck on a piece of ice, mints or hard candy
(Remember to pick sugar-free candy if you have diabetes.)
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A kidney-friendly diet may make it hard to get all of the
vitamins and minerals you need. To help you get the right
balance of vitamins and minerals, your dietitian may
suggest a special supplement made for people with kidney
failure.
Your dietitian might also suggest a special kind of vitamin
D, folic acid or iron pill, to help avoid some common side
effects of kidney failure, like bone disease and anemia.
Regular multi-vitamins may not be healthy for you if you
have kidney failure. They may have too much of some
vitamins and not enough of others. Talk to your dietitian
to find vitamins that are right for you.
Important! Tell your
doctor and dietitian about
any vitamins, supplements
or over-the-counter
medicines you are taking.
Some may be harmless,
but others can cause
problems.
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Other diet concerns
What if I have diabetes?
Diabetes is the leading cause of kidney failure. Diabetes
can also damage other parts of your body, like your eyes
and heart. If you have diabetes, you will need to watch
your blood sugar and diet to stay healthy. Work with your
dietitian to make a kidney-friendly meal plan that helps you
keep your blood sugar in control.
A diabetes educator can also help you learn how to control
your blood sugar. Ask your doctor to refer you to a
diabetes educator in your area. You can also get a list of
diabetes educators from the American Association of
Diabetes Educators at www.diabeteseducator.org or
1.800.338.3633. Medicare and many insurance
companies may help pay for sessions with a diabetes
educator.
My Diet
Following the kidney-friendly diet can be difficult. Your dietitian
can help you learn how much of each nutrient you should have
each day. Next time you meet with your dietitian, take this
worksheet. Ask your dietitian to help you fill in the blanks.
Nutrient
Protein
Sodium
Potassium
Phosphorus
Fluid
Your dietitian can also help you learn what foods to limit
and other foods you might try instead. Work with your
dietitian to find a meal plan that works for you.
Summary
Foods To Limit
A well-balanced diet is important for good health. It is even
more important for people with on dialysis, because it may
help prevent other problems. Work with the dietitian at
your dialysis center to make a meal plan that helps you get
the right amount of calories, carbohydrates, protein, fat and
sodium. Your dietitian can also help you limit your
potassium, phosphorus and fluids.
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How Much I Should Have Each Day
Because They’re
High In…
What to Try
Instead
19
Kidney-Friendly Cookbooks
Brilliant Eats: Simple and Delicious Recipes for
Anyone Who Wants to be Kidney Wise
Kelly L. Welsh, RD, CD
www.brillianteats.com
1.866.524.6732
Creative Cooking for Renal Diabetic Diets
Creative Cooking for Renal Diets
Cleveland Clinic Foundation
www.patientsupport.net
1.800.247.6553
Calabash Cookbook for Kidney Health
National Kidney Foundation of Hawaii
www.kidneyhi.org
1.800.488.2277
The Gourmet Renal Cookbook
Sharon Stall, RD
212.434.3266
Carbohydrate & Sodium Controlled Recipes
CRN No. California/No. Nevada
www.crn-norcal.org
415.353.7725
Chinese Renal Kitchen
BC Chinese Nutrition Consultants
604.806.8141
Cooking for David: A Culinary Dialysis Cookbook
Sara Colman, RD, CDE and Dorothy Gordon, BS, RN
www.culinarykidneycooks.com
714.842.4684
The Kidney Helper Cookbook
Bob and Natalie Lufty with Mary Pinto, RD
www.consumermedhelp.com
1.877.248.2331
Kidney Kids’ Cookbook
Kay Anderson, Frances Buchanan, Linda Tyler
Edited by Betsy Watson
1.800.282.0190
Now You’re Cooking: A Resource for People with
Kidney Disease
Council on Renal Nutrition of New England
www.kidneyhealth.org
1.800.542.4001
Cooking the Renal Way
Oregon Council on Renal Nutrition
503.371.8047
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Renal Lifestyles Manual
Peggy Harum, RD, LD
Available in bookstores.
The Renal Patient’s
Guide to Good Eating
Judith Curtis
www.ccthomas.com
1.800.258.8980
Southern Comforts of Mississippi
National Kidney Foundation of Mississippi
www.kidneyms.org
1.800.232.1592
Online Recipes
DaVita
www.davita.com/recipes
Kidney Kitchen
National Kidney Foundation
www.kidney.org/patients/kidneykitchen
Kidney Times
Renal Support Network
www.kidneytimes.com
Northwest Kidney Centers
www.nwkidney.org
The Vegetarian Diet for Kidney Disease Treatment
Joan Brookhyser, RD, CSR, CD
Available in bookstores.
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Helpful Kidney Disease Resources
Notes:
American Kidney Fund
www.kidneyfund.org
1.800.638.8299
American Association of Kidney Patients
www.aakp.org
1.800.749.2257
American Dietetic Association
www.eatright.org
1.800.877.1600
National Institute of Diabetes and Digestive and
Kidney Diseases
www.niddk.nih.gov
1.800.891.5390
Acknowledgements
Our sincere thanks to Rebecca Brosch, RD, LD for her
continued support of the American Kidney Fund and for
her input on this brochure.
The American Kidney Fund is the leading national
voluntary health organization serving people with and at
risk for kidney disease through direct financial assistance,
comprehensive education, clinical research, and
community service programs.
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American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 301.881.3052
Fax: 301.881.0898
Toll-Free: 800.638.8299
HelpLine: 866.300.2900
[email protected]
http://www.kidneyfund.org
Se habla español.
Combined Federal Campaign #11404
© Copyright 2010 by American Kidney Fund, Inc. All rights reserved.