1.
DIET IN DIALYSIS
DR VARUN MAMIDI
CONSULTANT NEPHROLOGIST
AINU HITECH CITY BRANCH,
HYDERABAD.

2.
Eating the balanced diet (right kind and amount of food)
Hemodialysis treatments
Taking medications

3.
INTRODUCTION
• Balanced diet is important part of treatment in dialysis patients
• Not one-size-fits all approach
• Factors that can effect the diet are:
⚬ Stage of CKD - Dialysis patients
⚬ Type of RRT - HD / PD
⚬ Laboratory results - Hb, P, Ca
⚬ Presence of medical conditions - uBP, Cardiac, VO

4.
DIET PLAN IN DIALYSIS PATIENTS
• Macronutrients
⚬ Carbohydrates
⚬ Proteins
⚬ Fats
• Micronutrients
⚬ Sodium
⚬ Phosphorus
⚬ Potassium
• Renal Dietician plays a major role

5.
CALORIES
• 1800 Kcal/day (30Kcal/kg) is the average total calorie intake
for dialysis patients
• Calories per day should be spread across the 5 - 6 meals and
should be derived from:
⚬ carbohydrates
⚬ proteins
⚬ fats

6.
CARBOHYDRATES
• Plant-based nutrients found in starchy foods like cereals and grains,
fruits and some starchy vegetables.
• Common foods include Chapatti, rice, beard, pasta and oats and
potatoes.
• Uses of carbohydrates:
⚬ Main source of energy to every cell of your body
⚬ Feeling of satiety

7.
CARBOHYDRATES
Simple carbohydrates
• Fruits
• Vegetables
• Milk and milk products
• Processed and refined
sugars
Complex carbohydrates
• Whole grain breads
• Cereals
• Starchy vegetables
• Legumes
Good source of fibre

8.
PROTEIN
• Protein is important for muscle maintanence and other bodily
functions.
• 75% of human body is made up of proteins. It allows the body
to counter:
⚬ Everyday's wear and tear
⚬ Heal from injury
⚬ Stop any bleeding
⚬ Fight infections

9.
PROTEIN
• During each HD session ~ 6-9 gms of protein is lost
• Hence, more protein than average person is needed in dialysis patients
*Nutritional secrets - Kidney warriors foundation

10.
PROTEIN
• Protein is made of a chain of 20 amino acids to keep the body healthy
(11AA - Liver, 9AA - Food)
• Complete proteins - consists of all the 9 amino acids that come from food
• Animal-based proteins are complete proteins: dairy(milk) and poultry,
cheese, eggs, fish, red meat and soybeans.
• Plant-based proteins are incomplete proteins: Grains, legumes, nuts and
seeds.

11.
PROTEIN
• Complete proteins + Incomplete protein = Will give the daily protein needs
• Vegetarinas: Protein requirement from plant and vegetarian sources - mostly incomplete proteins
⚬ Paneer
⚬ Kidney beans and soya beans

12.
PROTEIN SPARING EFFECT
*Nutritional secrets - Kidney warriors foundation

13.
FATS
• Extremely essential component balanced dialysis diet
• The RDA for patients on dialysis is 20 - 25% calories from fat
• Fats - Broken into: Unsaturated fats + Saturated fats

14.
Saturated fats cause:
⚬ Increases LDL cholesterol
⚬ Hypertension
⚬ Heart disease
⚬ Weight gain
Unsaturated fats :
⚬ Reduces LDL cholesterol
⚬ Skin and hair growth
⚬ Improves heart condition
⚬ Increases HDL
Saturated fats
• Meat, poultry, eggs
• Dairy products
(Cream, cheese, whole milk)
• Raise LDL cholesterol
Unsaturated fats
• Fish
• Nuts and Certain oils
(peanut oil and olive oil)
• Reduce LDL cholesterol

15.
Limit saturated fats
Limit fat containing protein
sources
More fibre rich foods
More Omega-3 FA foods
Avoid fry foods
Take skim milk
Avoid whole milk
Daily physical activity
TIPS TO REDUCE BAD
CHOLESTEROL

16.
FIBRE
• Advantages:
⚬ Cholesterol and blood sugar control,
⚬ Prevents constipation.
• In dialysis diet - tough to find fibre - Due to potassium and
phosphorus restriction foods
• High fibre and renal diet:
⚬ Eat all the quantity of fruits with peels allowed per day
⚬ Plain unsalted popcorn
⚬ Low potassium raw vegetables like cucumber and carrot.

17.
SODIUM
• Salt restriction - not NIL salt
• Excess sodium:
⚬ Increases thirst - drink more fluids.
⚬ Retain more water in the body.
⚬ Rise blood pressure
⚬ Breathing difficulty
⚬ Strain on heart and kidneys

18.
SODIUM
• All types of salt contain NACL
• 2 grams of sodium per day
• 2 grams of sodium is ~4g grams of salt.
• 3/4th teaspoon salt - 4gm of salt - 2gm sodium
• Techniques to restrict sodium intake:
⚬ Measured quantity of salt into a small box.
⚬ Look at sodium labels on packaged foods.

19.
HIGH SODIUM FOODS - AVOID
*Nutritional secrets - Kidney warriors foundation

20.
PHOSPHORUS
• Mineral that is excreted through urine. Builds up in dialysis
patients.
• Diet restriction to 1gm of phosphorus per day
• High phosphorus causes:
⚬ Muscle aches
⚬ Mineral bone disease
⚬ calcifications of heart, skin, joints and blood vessels
• Protein-rich foods contain more phosphorus like meat,
poultry, fish, nuts, beans and dairy products

21.
HIGH PHOSPHORUS FOODS -
LIMIT/AVOID
Avoid
Limit
*Nutritional secrets - Kidney warriors foundation

22.
LOW PHOSPHORUS FOODS
*Nutritional secrets - Kidney warriors foundation

23.
HIDDEN INORGANIC PHOSPHORUS
• Avoid foods with additives or preservatives, such as fast foods, ready to eat foods, canned and
bottled beverages and precessed meats and foods
*Nutritional secrets - Kidney warriors foundation

24.
PHOSPHATE BINDERS
• Don't forget phosphate binders with meals and snacks:
⚬ Should take phosphate binder with every meal and snack.
*https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf

25.
*Comprehensive Clinical Nephrology - John Feehally. 6th Edition

26.
POTASSIUM
• Safe zone: 3.5 - 5.0 mEq/L
• Healthy person: 3.5 - 4.5 gm/day (Avg diet: 8gm)
• Restricted potassium intake - 1.5 - 2 gm (40 mEq)
• High potassium levels cause:
⚬ Nausea
⚬ Weakness
⚬ Numbness
⚬ Cardiac arrhythmias
⚬ Cardiac arrest

27.
POTASSIUM
• Potassium is found in all foods:
⚬ Pulses and whole lentils - staple foods with high K
⚬ Dairy products - Has needed protein but with high K
• Proper choice of vegetables / fruits / grains / dairy and meat
in proper portions.
• Leeching of lentils and vegetables
• Moderation is the key

28.
POTASSIUM TABLES
• low potassium foods - consumed on daily basis without leeching
• Moderate potassium foods - Eaten in moderation
• High potassium foods - need to be avoided or leeched
• Do not depend on the internet values - as soil conditions change
so will potassium values - fruits grown in other parts of the world
may have different potassium values.

29.
*Nutritional secrets - Kidney warriors foundation

30.
*Nutritional secrets - Kidney warriors foundation

31.
*Nutritional secrets - Kidney warriors foundation
Papaya
Guava

32.
*Nutritional secrets - Kidney warriors foundation

33.
FLUIDS
• Fluid restriction is not only water - all food in liquid
state - water, tea, coffee, health drinks, soups, juices,
sambar, buttermilk, curd and ice creams
• Daily fluid intake: Urine output plus 500ml.
• Expected daily weight gain/meal: 0.4 - 0.5kgs/meal
⚬ The expected amount of fluid in a typical day's
food meal is at-least 500ml

34.
FLUIDS
• Fluid retention cause symptoms such as :
⚬ High blood pressure
⚬ Cardiac issues
⚬ Swelling of the legs
⚬ Pulmonary oedema
• Tips to limit fluid intake:
⚬ Drink in smaller size cups. Drink in SIPS.
⚬ Spray bottle, juice in ice cubes, mouth gargle with
ice cold water.
⚬ Medicines along with food
⚬ Low salt food - salt makes you thirsty.

35.
TAKE HOME POINTS
• Diet plan in dialysis patients should include all macronutrients and micronutrients
• Protein-rich foods contain more phosphorus and potassium and staple foods such
as pulses are high in potassium.
• Hence, a Balanced diet is important part of treatment in dialysis patients
• Moderation is the key
• Fluid restriction is not only water
• Renal Dietician plays a major role

36.
REFERENCES
• The Renal Diet - VCU Health System
• Nutritional Secrets - Kidney Warriors Foundation
• https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf
• Comprehensive Clinical Nephrology - John Feehally. 6th Edition