Dialysis

5
Apr
2017

Role of phosphorous and potassium in kidney disease diet

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ROLE OF PHOSPHOROUS IN KIDNEY DISEASE

Phosphorus is a mineral found mostly in dairy products and meats. Your body uses it to form strong bones and teeth. But starting in the earlier stages of chronic kidney disease (CKD), your kidneys begin to lose the ability to remove extra phosphorus from your body. Because too much phosphorus can harm your bones, it makes sense to eat less phosphorus. Some experts think 800 to 1,200 mg. of phosphorus per day is a good target.
If you are also on a lower protein diet, a low-phosphorus diet is easier because foods high in protein tend to be high in phosphorus, too. Your doctor may want you to limit dairy servings each day and take a calcium supplement. Taken with meals, calcium supplements act as phosphate binders, because they lock on to extra phosphorus and keep your body from absorbing it.

SOME LOW PHOSPHOROUS FOOD

  • Certain brands of nondairy creamers, rice milk (unenriched), soy milks
  • Cream cheese, sour cream
  • Soda-lemon-lime, grape, strawberry, cream soda, root beer, homemade iced tea, homemade lemonade, hot apple cider, cranberry juice
  • Gelatin, Popsicles, sherbet, Sorbet
  • Jellybeans, fondant, gumdrops, hard candy
  • Unsalted popcorn or pretzels
  • Sugar cookies, shortbread cookies, vanilla wafers, lemon cake, white or yellow cake, angel food cake
  • Jam, jelly, honey, cream cheese
  • Margarine, butter
  • Corn or rice cereals, refined wheat cereals
  • Cream of wheat, cream of rice, grits
  • French, Italian or white bread
  • White rice, pasta, couscous
  • Fresh or frozen meat, fish and poultry (compared to processed)
  • Fruits such as apples, berries, grapes, plums, pineapple, canned pears, peaches, fruit cocktail
  • Vegetables such as green beans, cabbage, carrots, cauliflower, eggplant, summer squash, bell pepper, cucumber, lettuce, onion, radish.


SOME HIGH PHOSPHOROUS FOODS

  • Milk
  • Cheese
  • Yogurt
  • Ice cream
  • Beer, cola, milk-based coffee, chocolate drinks
  • Chocolate
  • Bran
  • Brown rice, wild rice
  • Whole grain breads, cereals, crackers
  • Corn tortillas
  • Pancakes, waffles, biscuits
  • Pizza
  • Avocado
  • Nuts, seeds, nut butters
  • Dried beans and peas
  • Corn, peas
  • Processed meats such as hot dogs, sausage, turkey sausage, bologna
  • Organ meats
  • Sardines

LOW PHOSPHOROUS FOOD TIPS

  • Instead of milk,use substitutes like non-dairy creamers, rice milk (unenriched) or soy milk. Because some non-dairy creamers and soy milks are high in phosphorus, check with a renal dietitian for a list of acceptable brand name products.
  • Instead of cheese, use cream cheese or sour cream.
  • Instead of cola or Dr. Pepper® have cream soda, lemon-lime soda, grape soda, homemade lemonade, homemade iced tea or root beer.
  • Instead of ice cream have gelatin, Popsicles®, sherbet or sorbet (remember to count as fluid).
  • Instead of chocolate or nuts have jellybeans, fondant, gumdrops, hard candy, unsalted popcorn or unsalted pretzels.
  • Instead of chocolate cookies or cake have sugar cookies, shortbread cookies, vanilla wafers or vanilla, lemon or angel food cake.
  • Instead of hot chocolate or cocoa have hot apple cider or hot spiced cranberry juice.
  • Instead of bran, oat or whole wheat cereals use cereals made from corn, refined wheat or rice.
  • Instead of whole grain breads use French, Italian or white bread.
  • Instead of peanut butter use jam, jelly, honey, cream cheese margarine or butter.
  • Instead of dried beans or peas have green beans or wax beans.
  • Instead of brown rice or wild rice use white rice, pasta, macaroni, grits or couscous seasoned with margarine and herbs.
  • Instead of processed meats, fish and poultry use fresh or fresh frozen items.

ROLE OF POTASSIUM IN KIDNEY DISEASE

Having the right level of potassium in your body helps all your muscles work smoothly—including your heart. So, to stay as healthy as you can, you need to keep just the right level of potassium in your blood (not too much, not too little). Keeping potassium at the right level all the time is one of the jobs that healthy kidneys do for your body. When kidneys fail, they start to lose this ability.
Your potassium level should be checked regularly with a blood test. Many foods have potassium, but some such as avocados, dried fruits (including raisins, apricots and prunes), potatoes, oranges, bananas and salt substitutes are very high in potassium. 
REFERENCE
https://www.davita.com/kidney-disease/overview/the-basics/what-to-eat-when-you-have-kidney-disease/e/4665
https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/phosphorus-in-foods:-what-to-know-when-you’re-on-a-kidney-diet/e/10253



Apr
2017

Healthy foods for patients undergoing dialysis

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Red bell peppers
Red bell peppers are low in potassium and high in flavor, but that’s not the only reason they’re perfect for the kidney diet. These tasty vegetables are also an excellent source of vitamin C and vitamin A, as well as vitamin B6, folic acid and fiber. Red bell peppers are good for you because they contain lycopene, an antioxidant that protects against certain cancers.
Cabbage
High in vitamin K, vitamin C and fiber, cabbage is also a good source of vitamin B6 and folic acid. Low in potassium and low in cost, it’s an affordable addition to the kidney diet.
Cauliflower
Another cruciferous vegetable, cauliflower is high in vitamin C and a good source of folate and fiber. It’s also packed full of indoles, glucosinolates and thiocyanates—compounds that help the liver neutralize toxic substances that could damage cell membranes and DNA.
Garlic
Garlic helps prevent plaque from forming on your teeth, lowers cholesterol and reduces inflammation. Garlic provides a delicious flavor and garlic powder is a great substitute for garlic salt in the dialysis diet.
Onions
Onion contains sulfur compounds which give it its pungent smell. But in addition to making some people cry, onions are also rich in flavonoids, especially quercetin, a powerful antioxidant that works to reduce heart disease and protects against many cancers. Onions are low in potassium and a good source of chromium, a mineral that helps with carbohydrate, fat and protein metabolism.
Apples
Apples have been known to reduce cholesterol, prevent constipation, protect against heart disease and reduce the risk of cancer. It is high in fiber and anti-inflammatory compounds.
Cranberries
These tangy, tasty berries are known to protect against bladder infections by preventing bacteria from sticking to the bladder wall. In a similar way, cranberries also protect the stomach from ulcer-causing bacteria and protect the lining of the gastrointestinal (GI) tract, promoting GI health. Cranberries have also been shown to protect against cancer and heart disease.
Blueberries
Blueberries are high in antioxidant phytonutrients called anthocyanidins, which give them their blue color, and they are bursting with natural compounds that reduce inflammation. Blueberries are a good source of vitamin C; manganese, a compound that keeps your bones healthy; and fiber. They may also help protect the brain from some of the effects of aging. Antioxidants in blueberries and other berries have been shown to help slow bone breakdown in rats made to be low in estrogen.
Raspberries
Raspberries contain a phytonutrient called ellagic acid which helps neutralize free radicals in the body to prevent cell damage. They also contain flavonoids called anthocyanins, antioxidants which give them their red color. An excellent source of manganese, vitamin C, fiber and folate, a B vitamin, raspberries may have properties that inhibit cancer cell growth and tumor formation.
Strawberries
Strawberries are rich in two types of phenols: anthocyanins and ellagitannins. Anthocyananins are what give strawberries their red color and are powerful antioxidants that help protect body cell structures and prevent oxidative damage. Strawberries are an excellent source of vitamin C and manganese and a very good source of fiber. They are known to provide heart protection, as well as anti-cancer and anti-inflammatory components.
Cherries
Cherries have been shown to reduce inflammation when eaten daily. They are also packed with antioxidants and phytochemicals that protect the heart.
Red grapes
Red grapes contain several flavonoids that give them their reddish color. Flavonoids help protect against heart disease by preventing oxidation and reducing the formation of blood clots. Resveratrol, a flavonoid found in grapes, may also stimulate production of nitric oxide which helps relax muscle cells in the blood vessels to increase blood flow. These flavonoids also provide protection against cancer and prevent inflammation.
Egg whites
Egg whites are pure protein and provide the highest quality of protein with all the essential amino acids. For the kidney diet, egg whites provide protein with less phosphorus than other protein sources such as egg yolk or meats.
Fish
Fish provides high-quality protein and contains anti-inflammatory fats called omega-3s. The healthy fats in fish can help fight diseases such as heart disease and cancer. Omega-3s also help lower low-density lipoprotein or LDL cholesterol, which is bad cholesterol, and raise high-density lipoprotein or HDL cholesterol, which is good cholesterol.
Olive oil
Olive oil is a great source of oleic acid, an anti-inflammatory fatty acid. The monounsaturated fat in olive oil protects against oxidation. Olive oil is rich in polyphenols and antioxidant compounds that prevent inflammation and oxidation.
Studies show that populations that use large amounts of olive oil instead of other oils have lower rates of heart disease and cancer.
Buy virgin or extra virgin olive oil because they are higher in antioxidants. Use olive oil to make salad dressing, in cooking, for dipping bread or for marinating vegetables.


Reference:
https://www.davita.com/kidney-disease/diet-and-nutrition/lifestyle/top-15-healthy-foods-for-people-with-kidney-disease/e/5347



25
Feb
2016

Diet for CKD patients undergoing dialysis

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You may need to make changes to your diet when you have chronic kidney disease. These changes include limiting fluids, eating a low-protein diet, limiting salt, potassium, phosphorous, and other electrolytes, and getting enough calories if you are losing weight.You may need to alter your diet more if your kidney disease gets worse and when you are in dialysis.

CARBOHYDRATES
If you do not have a problem eating carbohydrates, these foods are a good source of energy. If your provider has recommended a low-protein diet, you may replace the calories from protein with:
  •  Fruits, breads, grains, and vegetables. These foods provide energy, as well as fiber, minerals, and vitamins.

  •  Hard candies, sugar, honey, and jelly. If needed, you can even eat high-calorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas.


FATS
Fats can be a good source of calories. Make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to protect your heart health. Talk to your provider or dietitian about fats and cholesterol that may increase your risk for heart problems.

PROTEIN
Low-protein diets may be helpful before you start dialysis. Your provider or dietitian may recommend a moderate-protein diet (1 gram of protein per kilogram of body weight per day).
Once you start dialysis, you will need to eat more protein. A high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended. This will help you replace muscles and other tissues that you lose.
People on dialysis should eat 8 to 10 ounces of high-protein foods each day. 
Your provider or dietitian may suggest adding egg whites, egg white powder, or protein powder.

CALCIUM AND PHOSPHOROUS
The minerals calcium and phosphorous will be checked often. Even in the early stages of chronic kidney disease, phosphorous levels in the blood can get too high. This can cause:
·         Low calcium. This causes the body to pull calcium from your bones, which can make your bones weaker and more likely to break.
You will need to limit the amount of dairy foods you eat, because they contain large amounts of phosphorous. This includes milk, yogurt, and cheese. Some dairy foods are lower in phosphorous, including tub margarine, butter, cream cheese, heavy cream, ricotta cheese, brie cheese, sherbet, and non dairy whipped toppings.
Fruits and vegetables contain only small amounts of phosphorous, but may contain large amounts of potassium.
You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body. Ask your provider or dietitian about how best to get these nutrients.
Your provider may recommend medicines called “phosphorous binders” if diet changes alone do not work to control the balance of this mineral in your body.

FLUIDS
In the early stages of kidney failure, you do not need to limit the fluid you drink. But, as your condition gets worse, or when you are on dialysis, you will need to watch the amount of liquid you take in.
In between dialysis sessions, fluid can build up in the body. Too much fluid will lead to shortness of breath, an emergency that needs immediate medical attention.
Your provider and dialysis nurse will let you know how much you should drink every day. 
DO NOT eat too much of foods that contain a lot of water, such as soups, Jelly, popsicles, ice cream, grapes, melons, lettuce, tomatoes, and celery.
Use smaller cups or glasses and turn over your cup after you have finished it.

Tips to keep from becoming thirsty include:

·         Avoid salty foods
·         Freeze some juice in an ice cube tray and eat it like a popsicle (you must count these ice cubes in your daily amount of fluids)
·         Stay cool on hot days
·         Low-sodium
·         No salt added
·         Sodium-free
·         Sodium-reduced
·         Unsalted
Check all labels to see how much salt or sodium foods contain per serving. Also, avoid foods that list salt near the beginning of the ingredients. Look for products with less than 100 mg of salt per serving.
DO NOTuse salt when cooking and take the salt shaker away from the table. Most other herbs are safe, and you can use them to flavor your food instead of salt.
DO NOTuse salt substitutes because they contain potassium. People with chronic kidney disease also need to limit their potassium.


POTASSIUM
Normal blood levels of potassium help keep your heart beating steadily. However, too much potassium can build up when the kidneys no longer function well. Dangerous heart rhythms may result, which can lead to death.
Potassium is found in many food groups, including fruits and vegetables. Choosing the right item from each food group can help control your potassium levels.
When eating fruits:
·         Choose peaches, grapes, pears, cherries, apples, berries, pineapple, plums, tangerines, and watermelon
·         Limit or avoid oranges and orange juice, nectarines, kiwis, raisins or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines
When eating vegetables:
·         Choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green and wax beans, lettuce, onion, peppers, watercress, zucchini, and yellow squash
·         Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, avocado, and cooked spinach


IRON
People with advanced kidney failure also have anemia and usually need extra iron.

Many foods contain extra iron (liver, beef, pork, chicken, lima and kidney beans, iron-fortified cereals). Talk to your provider or dietitian about which foods with iron you can eat because of your kidney disease.


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