The document discusses diet and nutrition for patients undergoing dialysis. It outlines that a balanced diet is an important part of treatment, noting that factors like stage of kidney disease, type of renal replacement therapy, lab results, and medical conditions need to be considered. The diet plan should provide adequate calories, carbohydrates, proteins, fats, sodium, phosphorus, potassium, and fluids. Restricting intake of sodium, phosphorus, potassium and fluids is important to avoid health issues. A renal dietician plays a key role in developing an appropriate individualized diet plan.

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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

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

14. 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

15. 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

16. 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

17. 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.

18. 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

19. 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.

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

21. 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

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

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

24. 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

25. 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

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

27. 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

28. 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

29. 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.

30. *Nutritional secrets - Kidney warriors foundation

31. *Nutritional secrets - Kidney warriors foundation

32. *Nutritional secrets - Kidney warriors foundation
Papaya
Guava

33. *Nutritional secrets - Kidney warriors foundation

34. 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

35. 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.

36. 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

37. 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