Kidney failure, also known as end-stage renal disease (ESRD) or stage 5 chronic kidney disease, refers to the point in time when your kidneys are no longer functioning. Healthy kidneys filter wastes and excess minerals and fluids and remove them through urine. When your kidneys have failed, dialysis is the only way to rid your body of these components, so limiting what you are putting into your body is necessary, says the National Kidney Foundation. Minerals such as potassium and phosphorus that are taken in through diet build up in your blood between dialysis sessions and are harmful to your health and well-being. The renal dietitian at your dialysis clinic will help determine the appropriate diet to meet your needs and how to portion your foods to stay safely inside your diet guidelines.
Protein
Eating adequate protein on a daily basis is a major component of the renal diet. You need additional protein to maintain your nutritional status and prevent your body from breaking down proteins for energy as well as to keep your immune system strong, according to Registered Dietitian Stacey Adams, also a certified dietitian/nutritionist with a Masters in Public Health, of the Rogosin Institute. Protein needs are individualized and based on your weight and age, but are much higher than what you needed before you developed ESRD. Proteins recommended to consume include animal sources like lean beef, poultry, pork, fish and eggs. Meats that should be avoided include processed meats that are high in sodium, fat and preservatives like hot dogs; bologna; salami; deli meats; bacon and sausage.
Potassium
When your kidneys have failed they are no longer able to remove excess potassium from your blood. When potassium builds up in your blood it puts you at risk to have an irregular heartbeat or heart attack, advises the National Kidney Foundation. Potassium is found in most foods, so eating in moderation and avoiding high potassium sources will help you control your potassium level. Fruits and vegetables are rich in potassium, some more than others. A food is considered a high source if it contains 200 mg of potassium or more. The National Kidney Foundation provides an extensive list of high potassium foods and the serving size of each food. Some examples of fruits listed to avoid include bananas, oranges, orange juice, cantaloupe and honeydew melons, mango, kiwi, papaya, avocado, prunes and prune juice. Vegetables that should be avoided are white potatoes of any kind or form; sweet potatoes; tomatoes or tomato-based sauces and soups; spinach; dried beans and peas like pinto, black, garbanzo, northern and kidney beans; cooked mushrooms; and winter squash. Other high-potassium foods include dairy products, whole grains, nuts, seeds and chocolate.
Phosphorus
Phosphorus is another mineral found in most foods that is no longer removed by nonfunctioning kidneys. High phosphorus levels in the blood will cause calcium loss from your bones, leaving them brittle and easy to break, says the National Kidney Foundation. Dairy foods such as milk, cheese, yogurt and ice cream are high in phosphorus in addition to potassium. Rice milk or nondairy creamer are much lower in phosphorus and can be used to replace milk on cereal or in cooking. Be aware of foods that contain dairy products such as lasagna, pizza, cream-based soups or sauces and creamy casseroles. Whole-grain foods are high in phosphorus and should be substituted with refined grains such as white bread, pasta, cereal and rice. Chocolate, caramel and dark sodas should be avoided due to high phosphorus content. A doctor may order you a medication called a phosphorus binder to help you control your phosphorus level, according to the National Kidney Foundation. This medication is taken when you eat and will absorb some phosphorus from the foods in your stomach so you do not.
Sodium
Sodium is another mineral that needs to be restricted with kidney failure. Sodium causes elevated blood pressure, fluid retention and swelling in your tissues. The majority of your sodium intake comes from table salt. One teaspoon of table salt is equal to 2,300 mg of sodium and your doctor may have you on a 2,000 mg to 3,000 mg per day sodium restriction, says Maria Karalis, a registered dietitian and certified renal specialist with Fresenius Medical Center, a provider of dialysis. Processed foods and fast food are high in sodium, so try to cook more at home and use fresh ingredients. Avoid canned and frozen foods, although frozen vegetables are safe to eat. Salty snacks such as pretzels, chips, popcorn and crackers should be replaced with the unsalted or reduced-sodium versions. Use dried herbs or spices to season your food instead of salt-based seasonings or high-sodium sauces such as barbecue or teriyaki sauce.
Restricting Fluids
Most people in kidney failure need to restrict fluid intake. This is individualized and will be determined by your doctor and medical team at dialysis based on how much urine your body is still producing, advises Karalis. Some people still can urinate with kidney failure, while others may not be able to. When urine output decreases, fluids build up in your tissues, leading to swelling throughout your body. If you drink too much fluid and become overloaded, fluids can enter your lungs and surround your heart. Fluids include anything liquid at room temperature, so beverages of all kinds; soups; gelatin; and frozen desserts like ice cream, Italian ice and sherbet need to be counted into your fluid restriction for the day.
References
- American Association of Kidney Patients; Balancing Protein in the Renal Diet; Stacy Adams, MPH, RD, CDN; May 2004
- National Kidney Foundation: Phosphorus and Your CKD Diet
- National Kidney Foundation: Sodium and Your CKD Diet: How to Spice Up Your Cooking
- National Kidney Foundation: Potassium and Your CKD Diet
- American Association of Kidney Patients; Sodium, Fluids and Your Health; Maria Karalis, RD, LD, CSR; May 2003
