Diabetes is the leading cause of chronic kidney diseases and kidney failure. Your kidneys work like filters to remove metabolic wastes, excess fluid and minerals from the blood. When the kidneys fail, these substances build up in the blood to toxic levels. Kidney dialysis helps to remove the wastes and slow down the progression of kidney diseases. However, no dialysis removes all wastes. People who are on kidney dialysis should follow a special diet to help them control the levels of wastes, fluids, and minerals in the blood.
Protein
Protein helps the body to repair tissues, fight infections, and build muscles. Diabetics are encouraged to include proteins in each meal for better glycemic control. However, when the kidneys fail, urea, a waste product from protein metabolism, can accumulate in the blood and affect the central nervous system. Diabetic patients with kidney disease may need a low-protein diet. But when kidney dialysis starts, protein intake will increase, especially with peritoneal dialysis. Eight to 10 oz of high-protein foods are recommended for most dialysis patients. It is best to choose lean animal proteins such as fish, lean meat, and eggs because they contain high-quality proteins, which produce less waste.
Sodium
Sodium is removed by the kidneys and blood levels of sodium increase when the kidneys are not working well. Too much sodium retains fluids and raises blood pressure. This increases the risk of cardiovascular disease and puts more strain on the kidneys. People on dialysis should pay close attention to sodium and salt intake to prevent fluid retention. Most processed foods are high in sodium. Always check the food label and choose products that contain less than 100 mg sodium per serving. Eat more fresh foods, which are usually lower in sodium.
Potassium and Phosphorous
Potassium and phosphorous are excreted by the kidneys. As kidney function declines, these minerals build up in the blood. Too much potassium leads to abnormal heart beats and can cause death. Excess phosphorous weakens the bones by withdrawing calcium from the bones. In general, diabetic patients on kidney dialysis should limit phosphorous and potassium intakes. But, people on peritoneal dialysis may need to take in more potassium.
Avoid foods such as dairy products, nuts, dark cola and dried beans that are high in phosphorus. Fruits and vegetables are the main dietary sources of potassium but they are healthy carbohydrate choices for diabetics. Choose those that are lower in potassium such as apple, pear, berries, broccoli, cabbage, and cauliflower. These fruits and vegetables also have a lower glycemic impact.
Calories
Diabetics may need to limit their calorie intake to prevent weight gain and the worsening of insulin resistance. However, some people on kidney dialysis may need to gain weight. This can be achieved by adding healthy fats such as olive oil, canola oil, and fish oil to the diet. Fats contribute more calories. Healthy fats decrease the risk of cardiovascular complications by lowering the bad lipids in the blood, including triglyceride and LDL cholesterol. People on peritoneal dialysis, however, may need to reduce calorie intake because the dialysis solution contains dextrose, a sugar that helps to draw wastes from the blood.
Fluids
Dialysis patients often produce little or no urine. Fluids build up quickly without urination, raising blood pressure and the burden on the heart. Therefore, patients on dialysis should restrict fluid intake. Fluid needs vary with residual kidney function. Check with your dietitian for your fluid allowance. All foods at room temperature contain fluids and should be included when totaling fluid intake. Avoid salty foods that increase thirst.
References
- MedlinePlus: Diet -- Chronic Kidney Disease
- National Kidney and Urological Diseases Information Clearinghouse: Eat Right to Feel Right on Hemodialysis
- National Kidney and Urological Diseases Information Clearinghouse: Kidney Failure: Choosing a Treatment That's Right for You
- National Kidney Foundation: Nutrition and Peritoneal Dialysis
- MayoClinic: Diabetes Diet
