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Gyles Lewis
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1 WELCOME to the University of Mississippi Medical Center Dialysis treatments are used to remove waste products and fluid from your body that your kidneys can no longer handle. Nutrition plays an important part of your dialysis treatment plan. Your renal dietitian can work with you to help with your diet. Dialysis patients should include protein in their diet as well as watch their sodium and fluid intake. Your labs will be drawn monthly, which will include your phosphorus and potassium that should be avoided/restricted as well. These handouts are designed to help you choose good dialysis friendly choices that are low in sodium, phosphorus, and potassium and high protein. If you have any questions about your diet, just ask your renal dietitian. The more you understand your diet, the easier it is to follow it. As you learn more about your diet, you will be able to eat a wider variety of foods. NAME DATE DIETITIAN PHONE REFERENCES National Kidney Foundation (NKF) American Association of Kidney Patients (AAKP) Academy of Nutrition and Dietetics (AND) United States Department of Agriculture (USDA)

2 PROTEIN It is important to include protein in your diet while on dialysis. Protein helps to build, repair, and maintain your body. It also helps fight against infection. Having too little protein can cause complications such as muscle breakdown, poor wound healing, and increased risk of infections and complications. Your albumin and other lab values will be checked monthly to give us an idea of your protein status. Most people on dialysis need 6 8 ounces of protein per day. A 3-ounce serving of protein is about the size of a deck of cards. Highly processed meats such as bacon, hotdogs, sausages and canned meats are high in phosphorus additives and sodium and need to be avoided. Good Sources of Protein Beef Veal Eggs/Egg Substitutes Wild Game Chicken & Turkey Pork & Fresh Pork Seafood (scallops, shrimp, oysters) Fish Beans* Cheese* Milk* Yogurt* *These foods are high in phosphorus. Check with your renal dietitian first before eating.

SODIUM Too much sodium in your diet can cause thirst, high

Avoid adding salt to your food because most foods already

Do not use salt substitutes unless your RD or MD approves it.

celery seed, thyme, marjoram, rosemary, chives CHICKEN:

marjoram, oregano, chives, parsley FISH: bay leaf, onion,

dill, chives EGGS: pepper, dry mustard, paprika, curry, green

onion, garlic, dill seed, celery seed, marjoram, lemon juice,

mint, tarragon, chives, sugar CORN: green pepper, onion,

pepper, hot chili peppers, basil, oregano POTATOES: chives,

such as pretzels, chips, nuts, crackers (choose low sodium or

Seasoned salt, garlic or onion salt, lemon pepper seasoning,

3 SODIUM Too much sodium in your diet can cause thirst, high blood pressure, and fluid gain. Avoid adding salt to your food because most foods already contain lots of sodium. Do not use salt substitutes unless your RD or MD approves it. Your renal dietitian can work with you to help you cook and flavor foods without salt. When buying foods, look at labels and choose products with less than 300 mg/serving. Seasoning Suggestions Salt is not the only seasoning that can make food taste good. With a few spices and a little creativity, a plain meal can turn into a special treat. BEEF/PORK: onion, garlic, pepper, sage, basil, caraway seed, celery seed, thyme, marjoram, rosemary, chives CHICKEN: paprika, onion, garlic, pepper, thyme, sage, rosemary, marjoram, oregano, chives, parsley FISH: bay leaf, onion, garlic, pepper, paprika, dry mustard, lemon juice, parsley, dill, chives EGGS: pepper, dry mustard, paprika, curry, green pepper, onion, fresh mushroom, jelly GREEN BEANS: pepper, onion, garlic, dill seed, celery seed, marjoram, lemon juice, sesame seeds CARROTS: parsley, onion, garlic, dill seed, mint, tarragon, chives, sugar CORN: green pepper, onion, pepper, hot chili peppers TOMATOES: bay leaf, onion, garlic, pepper, hot chili peppers, basil, oregano POTATOES: chives, onion, garlic, pepper, dill High Sodium Foods Snack Foods such as pretzels, chips, nuts, crackers (choose low sodium or sodium-free) Pancakes/Waffles Processed Foods (hotdogs) Seasoned salt, garlic or onion salt, lemon pepper seasoning, Tony Chachere s, etc. Ham, Sausage, Bacon Luncheon meats (salami and bologna) Instant/Boxed Meals Condiments (mustard, ketchup, barbeque sauce) Canned Products (choose fresh/ frozen vegetables) Pickles, Olives, Relish Soups (choose low/ reduced sodium and add more water) Canned Meats (potted meat, Vienna sausages)

4 FLUIDS What counts as fluid? Fluid is anything that is liquid at room temperature. You may need to limit your fluids while on dialysis. Most people on dialysis can have at least 4 cups of fluid plus the amount equal to their urine output. How do I determine my fluid restriction? How much fluid can you consume a day? KDOQI suggests 1000ml plus urine output. Water & Ice Soda 240 ml 1 cup 480 ml 2 cups 1000 ml 4 cups Coffee/tea Juice EXAMPLE: Let s say you are urinating 480 ml. Add 480 ml (2 cups) to 1000 ml (4 cups) to get 1480 ml (a total of 6 cups). This is a good number to start with. If you are gaining more than 3.0 kg (6.6 pounds) between treatments, you may want less than your calculation. How do I control my fluid? Controlling fluid can be challenging at times, especially during the summer. Here are some hints for controlling fluids. Chew sugar-free candy or gum. Lemons Eat chilled fruit such as frozen grapes. Know the amount of fluids your cups and glasses hold. Limit salty foods and seasonings. If diabetic, control your blood sugars. Alcohol Popsicle Ice Cream Syrup & Gravy Milk Jell-O Soup Supplement Nutritional Supplements

PHOSPHORUS Phosphorus is a mineral found in many foods.

High levels of blood phosphorus will cause calcium to be pulled from your bones, making

High phosphorus can also cause itching and hardening of blood vessels, tissues and

Your doctor may prescribe a medication to reduce the amount of phosphorus absorbed into

when you leave the house and go out to eat.

5 PHOSPHORUS Phosphorus is a mineral found in many foods. Having the right amount of phosphorus and calcium in the blood is needed for strong bones. When kidneys fail, excess phosphorus is not removed and will build up in the blood. High levels of blood phosphorus will cause calcium to be pulled from your bones, making your bones weak and brittle. High phosphorus can also cause itching and hardening of blood vessels, tissues and organs, which can increase your risk for heart attack and amputations. Your doctor may prescribe a medication to reduce the amount of phosphorus absorbed into your blood called a phosphorus binder (Renvela, Renvela Powder, Renagel, Phoslo, Fosrenol, or Tums). You must take this High Phosphorus Foods binder with meals and snacks because it absorbs the phosphorus from the foods you eat. Also, don t forget to bring your Beer Bran Cereal/Muffins Biscuits/Cornbread binders when you leave the house and go out to eat. Foods at restaurants can contain more phosphorus than foods prepared at home. Dark Colas (Coke, Peanut Butter Organ Meats Pepsi, Dr. Pepper, Many restaurants use Mr. Pibb ) phosphorus additives that are 100% absorbed. Restaurant foods do not have ingredient labels. Chocolate/Caramel Prepared/Processed Foods (macaroni & cheese, pizza, hotdogs) Milk ½ cup Yogurt ½ cup Cheese 1 oz. Ice Cream ½ cup Dairy products contain phosphorus. Limit to 1 serving per day. Eggnog

6 POTASSIUM (K+) Potassium is an electrolyte that helps with muscle function and regular heartbeat. The kidneys get rid of potassium. During kidney failure, potassium can build up in the blood or be lowered (Peritoneal Dialysis, vomiting, diarrhea, etc.). Both high and low potassium levels can cause muscle weakness, cramps, nausea, diarrhea, problems regulating blood pressure, heart attack and even death. Your monthly labs should tell you if you need to eat either more or less potassium in your diet. Almost all foods have some potassium. That is why serving size is very important. A large amount of a low potassium food can equal a high potassium food. TIPS FOR REDUCING POTASSIUM IN POTATOES, SWEET POTATOES, CARROTS, BEETS, AND RUTABAGAS 1. Peel and place the vegetables in cold water so they don t darken. 2. Slice vegetables 1/8 inch thick. 3. Rinse in warm water for a few seconds. 4. Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours. 5. Rinse under warm water again for a few seconds. 6. Cook vegetables with five times the amount of water to the amount of vegetable. What is a safe level of potassium in my blood? You are in the SAFE zone You are in the CAUTION zone HIGHER THAN 6.0 You are in the DANGER zone Legumes (Beans and Peas) Legumes are high in potassium and phosphorus (canned beans/peas should be rinsed well.) You may include (1/2 cup) servings of the following per week. Dried beans/peas Baked beans Black beans Black-eyed peas Chick peas (garbanzo) Field peas Lentils Lima beans (butter beans) Navy beans Northern beans Pinto beans Refried beans Soy beans Red (kidney) beans

7 High Potassium Foods No more than one 1/2 cup serving of high potassium food per day. Do not eat star fruit, otherwise known as carambola. Apricots Avocados Bananas Cantaloupe Honeydew Melon Dried Fruits (raisins, apricots, dates, figs, prunes) Kiwi Fruit Mangos Nectarines Oranges (fresh or juice) Papayas Pomegranate & Prune Juice Asparagus Artichokes Beets Brussels Sprouts Mushrooms (cooked) Potatoes (sweet, baked, or fried) Tomatoes Tomato/Vegetable Juice or Sauce Winter Squash & Pumpkin Greens & Spinach Granola Bran Cereal/Muffins Chocolate Coconut Nuts/Seeds/Peanut Butter Molasses Milk (limit to ½ cup/day) Ice Cream (limit to ½ cup/day) Salt Substitutes/ Light Salt Sports Drinks Snuff/Chewing Tobacco Legumes (see note on page 6)

8 Low Potassium Foods Apples Berries Grapes Peaches Plums Pineapple Cranberry Juice Apple Juice Grape Juice Eggplant Cucumbers Green Beans Raw Mushrooms Carrots Lettuce Cauliflower Non-Dairy Whipped Topping Non-Dairy Creamer Sherbet Sorbet Unenriched Rice Milk

9 Grocery List Suggestions for Dialysis Patients MEAT/PROTEIN FOODS c Beef (chuck, ground, roast, steak, stew) c Chicken c Eggs, Egg substitute (Egg Beaters, Scramblers ) c Fish (fresh or frozen) c Salmon (canned in water) c Tuna (canned in water) c Lamb c Pork (fresh) chops, loin, roast c Shellfish (clams, crab, crawfish, lobster, scallops, shrimp) c Tofu (soft) c Turkey c Veal c Wild Game (deer, duck, goose, pheasant, rabbit, squirrel) FRUITS (Serving size=l medium-size fruit or 1/2 cup canned) c Apple juice c Apples c Applesauce c Apricots (canned) c Blackberries c Blueberries c Cherries c Cranberries c Cranberry juice c Cranberry sauce c Figs (fresh) c Fruit cocktail c Grapefruit (1 half) c Grape juice c Grapes c Lemons c Lemon juice c Limes c Lime juice c Loganberries c Nectars (apricot, peach, pear) c Peaches (canned) c Pears (canned) c Pineapples c Plums c Raspberries c Strawberries c Tangerines VEGETABLES (Serving size=1/2 cup, no added salt) c Arugula c Asparagus c Beets (canned) c Broccoli c Cabbage (green, red) c Carrots c Cauliflower c Celery c Chili peppers c Chives c Coleslaw c Corn c Cucumbers c Eggplants c Endive c Garlic c Ginger root c Green beans c Greens (mustard, turnip) c Hominy c Jalapenos (fresh) c Kale c Leeks c Lettuce c Mixed vegetables c Mushrooms (raw) c Okra c Onions c Parsley c Peas (English) c Peppers (green, red, yellow) c Pimentos c Radicchio c Radishes c Seaweed kelp c Spaghetti squash c Sprouts (alfalfa, bean) c Summer squash (yellow, scallop, zucchini) c Tomatillos c Turnips c Water chestnuts c Watercress c Wax beans BREADS/CEREALS/GRAINS c Bagels (plain, blueberry, egg, raisin) c Bread (white, French, Italian, rye, soft wheat, sourdough) c Bread sticks (plain) c Cereals, dry, low salt (Chex [Rice, Corn], Cornflakes, Corn Pops, Cocoa Puffs, Fruity Pebbles, Product 19, Puffed Wheat, Puffed Rice, Rice Krispies, Special K, Sugar Smacks ) c Cereals, cooked (Cream of Rice, Cream of Wheat, Farina, Malto-Meal, Oatmeal c Couscous c Crackers (unsalted) c Dinner rolls or hard rolls c English muffins c Grits c Hamburger/hot dog buns c Noodles/Pasta (macaroni, spaghetti) c Melba toast c Oyster crackers c Pita bread c Popcorn, unsalted c Pretzels, unsalted c Rice (brown, white) c Rice cakes (unsalted) c Tortillas (flour) DAIRY/DAIRY SUBSTITUTES c Nondairy creamers c Nondairy frozen dessert topping (Cool Whip ) c Nondairy frozen desserts (Mocha Mix ) c Rice milk, unfortified BEVERAGES (Remember your fluid restriction) (Diabetics, watch your sugar intake) (Regular or diet) c 7-up, Sprite, lemonlime soda c Cherry 7-up c Cream soda c Ginger ale c Grape soda c Mello Yello c Mountain Dew c Orange soda c Root beer c Slice c Coffee c Fruit punch Hi-C (cherry, grape) c Horchata c Juices (apple, cranberry, grape, grapefruit, pineapple) c Kooi-Aid c Lemonade or limeade c Mineral water c Nectars (apricot, peach, pear, 1/2 c serving) c Nondairy creamers (Coffee Rich, Mocha Mix, etc.) c Tea c Water FATS c Butter c Cream cheese c Gravy c Margarine c Mayo c Miracle Whip c Nondairy creamers c Salad dressings c Sour cream c Vegetable oils (preferably canola or olive oil) SEASONINGS & SPICES c Allspice c Basil c Bay leaf c Caraway seed c Chives c Cilantro c Cinnamon c Cloves c Cumin c Curry c Dill

10 Remember just because a food is listed doesn t mean you can eat unlimited quantities. Your Registered Dietitian will help you determine the correct number of servings from each food group to help keep your weight and lab values within a healthy range. c Extracts (almond, lemon, lime, maple, orange, peppermint, vanilla, walnut) c Fennel c Garlic powder c Ginger c Horseradish (root) c Lemon juice c Lime juice c Mrs. Dash c Nutmeg c Onion powder or flakes c Oregano c Paprika c Parsley or parsley flakes c Pepper (black, red, white) c Pepper sauce c Pimentos c Poppy seed c Rosemary c Saccharin c Saffron c Sage c Savory c Sesame seeds c Tabasco c Tarragon c Thyme c Turmeric c Vinegar DESSERTS/SNACKS/ SWEETS (Diabetics, use caution) c Animal crackers c Cake (angel food, butter, lemon, pound, spice, sponge, strawberry, white, yellow) c Candy corn c Chewing gum c Chewy candy c Cinnamon drops c Cookies (ginger snaps, shortbread, sugar, vanilla wafers) c Corn cakes c Cotton candy c Doughnuts c Fruit ice c Graham crackers c Gumdrops c Gummy Bears c Hard candy c Hot Tamale candy c Italian Ice c JELL-O c Jelly beans c Jolly Ranchers c LifeSavers c Lollipops c Lorna Doones c Marshmallows c Melba toast c Newtons (fig, strawberry, apple, blueberry) c Pie (apple, berry, cherry, lemon, peach) c Popcorn (unsalted) c Pretzels (unsalted) c Rice cakes (unsalted) c Rice Krispie squares c Sorbet c Tortilla chips (unsalted) OTHER (Diabetics, use caution) c Apple butter c Corn syrup c Honey c Jams/jelly c Maple syrup c Marmalade c Powdered sugar c Sugar (brown or white) FROZEN MEALS Look for frozen meals which have less than: 600 mg sodium 600 mg potassium 300 mg phosphorus or less than 30% phosphorus *Phosphorus often is not on the food label, so in general avoid meals with dairy, nuts or beans. Here are some examples of meals that meet the above criteria. LEAN CUISINE (Nutrition info as of January 2010) Café Cuisine c Beef Chow Fun c Glazed Chicken c Grilled Chicken Caesar c Lemon Pepper Fish c Orange Chicken c Tortilla Crusted Fish c Steak Tips Portobello c Dinnertime Selects c Chicken Portobello Simple Favorites c Asian Style Pot Stickers c Chicken Chow Mein c Chicken Fried Rice c Chicken Teriyaki Stir Fry c Spaghetti with Meatballs Spa Cuisine c Apple Cranberry Chicken c Butternut Squash Ravioli c Ginger Garlic Stir Fry with Chicken c Grilled Chicken Primavera c Lemon Chicken c Roasted Honey Chicken c Rosemary Chicken c Sesame Stir Fry with Chicken c Salmon with Basil c Szechuan Style Stir Fry with Shrimp HEALTHY CHOICE (Nutrition info as of November 2009) Complete Meals c Mandarin Beef Lo Mein c Chicken Pesto Alfredo c Fire Roasted Tomato Chicken c Chicken Parmigiana c Country Breaded Chicken c Roasted Chicken Monterey c Chicken Balsamico c Roasted Sesame Chicken c Sweet & Sour Chicken c Spicy Shrimp Diavolo c Lemon Pepper Fish Café Steamers c Cajun Style Chicken & Shrimp c Chicken Margherita c Chicken Pesto Classico c Grilled Basil Chicken c Roasted Chicken Fresca c Roasted Chicken Marsala Asian Inspired Café Steamers c Chicken Pad Thai c Five-Spice Beef & Vegetables c General Tso s Spicy Chicken c Sweet & Spicy Orange Zest Chicken c Sweet Sesame Chicken All-Natural Entrees c Portobello Marsala Pasta c Mediterranean Pasta c Portobello Spinach Parmesan c Pumpkin Squash Ravioli c Sweet Asian Pot Stickers c Tomato Basil Penne Select Entrees c Chicken Alfredo Florentine c Bacon and Smokey Cheddar Chicken c Honey Ginger Chicken c Salisbury Steak c Slow Roasted Turkey Medallions NOTES

11 NUTRITION LABELS When you feel better and begin grocery shopping, check food labels: Simple rule of thumb: If salt is listed in the first five ingredients, the item is usually high in sodium. Ingredients are listed in order of the highest to the lowest amounts contained in the product. Next, look at the package label. Check the serving size. Nutrition values are listed per serving. If the sodium level is 300 mg or more per serving, or 600 mg per meal, the item is usually a higher sodium food. Compare labels of similar products. Select the lowest sodium level for the same serving size. SERVING SIZE: Serving size is now based on the amount most commonly eaten. LOOK FOR PROTEIN CONTENT: Larger meat portions provide higher protein. Eat at least 70 grams of protein per day. Nutrition Facts Serving Size 1 Hot Dog (45g) Servings Per Container 10 Amount Per Serving Calories 45 Calories from Fat 15 % Daily Value* Total Fat 1.5 g 2% Saturated Fat 1 g 5% Cholesterol 15 mg 5% Sodium 430 mg 18% Total Carbohydrate 2 g 1% Dietary Fiber 0 g 0% Sugars 2 g Protein 5 g Vitamin A 0% Vitamin C 8% Calcium 0% Iron 2% *Percentage daily values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs: Calories: 2,000 2,500 Total Fat Less than 65 g 80 g Sat Fat Less than 20 g 25 g Less than 300 mg 300 mg Less than 2,400 mg 2,400 mg Total Carbohydrate 300 g 375 g Dietary Fiber 25 g 30 g The above information was taken from an actual product label. SERVINGS PER CONTAINER: Refers to the number of servings included in the package. CALORIES AND CALORIES FROM FAT: Calories provide energy and protect protein. LOOK AT SODIUM CONTENT: If a food has more than 300 mg sodium per serving, it may make you more thirsty.

What Can I Eat? A Grocery List for People with Chronic Kidney Disease. General recommendations. Tips to lower the amount of sodium (salt) in your diet

What Can I Eat? A Grocery List for People with Chronic Kidney Disease General recommendations Eat a diet low in sodium, phosphorus, and potassium. Look at food labels or ask your healthcare provider for