What Is the Relationship Between Hemodialysis and Nutrition?
Hemodialysis is an artificial way of filtering wastes, fluids, and salts from the blood in cases of kidney failure. This is the only way to manage renal failure. Besides this treatment, a special diet is required, which is an important part of the treatment plan. Since the kidneys cannot remove enough waste products and fluids from the blood, the body now has special needs. Hence, there is a need to restrict fluid intake and change the consumption of specific foods in the diet. The dietitian helps in planning the diet for this special circumstance.
What Nutrition Changes Should Be Made for Hemodialysis?
In hemodialysis patients, the following modifications need to be made:
Consume more high-protein foods.
Have less high-salt, high-potassium, and high-phosphorus foods.
Know from the dietician how much fluid one can safely consume, which includes coffee, tea, water, and any other food item that is liquid at room temperature.
Salt and Sodium Intake: Consume less salt and have less salty foods. This helps to control blood pressure. It also aids in reducing fluid weight gains between dialysis sessions since the salt causes thirst and leads the body to hold on to fluid. Instead of salt, other additives like herbs, spices, and low-salt flavor condiments can be used. Avoid salt substitutes comprising potassium.
Protein Consumption: Dialysis patients need to have more protein. Protein aids in keeping blood protein levels healthy and improving health. Protein also helps in keeping the muscles strong, heals wounds faster, strengthens the immune system, and enhances overall health. Consume a high-protein food item like meat, fish, poultry, eggs, etc., at every meal, or around 8 to 10 ounces of high-protein foods daily.
Other food products, such as peanut butter, nuts, seeds, dried beans, peas, and lentils, have increased protein content, too. Still, these items are generally restricted because of their high potassium and phosphorus components.
Grains, Cereals, or Bread: This group does not need changes unless the patient needs to restrict calorie consumption for weight loss and check carbohydrate intake for normal blood glucose levels. Grains, cereals, bread, and cornflakes are recommended as low-potassium sources that are high in calories. Usually, people need 6 to 11 portions of them daily. Whole grains and high-fiber foods should be avoided to limit the intake of phosphorus.
Dairy Products: Restrict the consumption of milk, yogurt, and cheese to half a cup of milk or yogurt and one ounce of cheese in a day. This is advised because the majority of dairy products have a high phosphorus content. By cutting the intake of dairy-based foods, bones and blood vessels get protected from increased phosphorus amounts.
Fruits or Their Juices: Fruits and fruit juices that are high in potassium content need to be avoided so that they are cardioprotective to the dialysis patient. Fruits with high potassium quantities are:
- Oranges and orange juice.
- Kiwi.
- Nectarines.
- Prunes and prune juice.
- Raisins and dried raisins.
- Bananas.
- Melons.
- Star fruit (completely avoid).
However, two to three servings of low-potassium fruits should be taken each day. One serving equals one small fruit or 4 ounces of fruit juice. Low-potassium fruits and drinks are listed as:
- Apple.
- Berries.
- Cherries.
- Drained fruit cocktail.
- Grapes.
- Peach.
- Pear.
- Pineapple.
- Plums.
- Tangerine.
- Watermelon.
- Drinks like apple cider, cranberry juice, cocktails, grape juice, and lemonade.
Vegetables and Salads: All vegetables comprise certain quantities of potassium, so those with high potassium percentages need to be avoided, which protects the heart.
Two to three servings of low-potassium vegetables should be eaten each day, where one serving equals half a cup. Some of the low-potassium vegetables are:
- Broccoli.
- Cabbage.
- Carrots.
- Cauliflower.
- Celery.
- Cucumber.
- Eggplant.
- Garlic.
- Lettuce.
- Onion.
- Peppers.
- Radish.
- Watercress.
- Zucchini and yellow squash.
- High-potassium vegetables are required to be avoided or limited. They are:
- Potatoes (including sweet potatoes).
- Tomatoes and tomato sauce.
- Winter squash.
- Pumpkin.
- Asparagus (cooked).
- Avocado.
- Beets.
- Cooked spinach.
According to the calorie needs, the dietitian may advise having high-calorie desserts, but they are high in potassium content, too. Dairy-based desserts and those consisting of chocolate, nuts, and bananas should be limited.
What Should Be Done in Cases of High Cholesterol Levels?
Modifying the diet helps in lowering the cholesterol levels in the blood. An increased intake of low-potassium fruits and vegetables and decreased consumption of fried foods, in conjunction with around 2.5 hours of physical activity every week aid in improving cholesterol levels.
What Changes Are Made for Diabetics?
The kidney and the diabetic diet are similar in many ways. Both diet plans recommend having three balanced meals, avoiding increased amounts of protein, and restricting sodium intake. A balanced meal is made up of at least three food groups: proteins, grains, vegetables, fruits, and dairy. Both meal plans advise having a half plate of vegetables, a quarter portion of carbohydrates, a quarter serving of high-protein food, and a piece of fruit. The biggest change between the two is that the kidney diet does not have a lot of variety in fruit and vegetable options. However, the diabetic diet recommends 1.61 to 2.68 ounces of carbohydrates with each meal and a gap of four to five hours between the meals. This advice is helpful for the kidney diet as well. Both the kidney and the diabetic diet support heart health.
Why Is It Important to Monitor the Liquid Intake?
Monitoring the liquid intake can help individuals feel better and prevent complications such as weight gain, swelling, and blood pressure changes between dialysis sessions. Excess fluid can strain the heart and lungs. Hemodialysis removes extra fluid, but excessive intake can cause discomfort. Limiting salt can help manage thirst and fluid intake.
Which Foods Are Considered Liquids and Why?
Count foods like soup, gelatin, ice cream, pudding, fruits, and vegetables; they contain water and contribute to the daily liquid intake.
What Should a Person Know about Potassium?
Limit potassium-rich foods like bananas, avocados, kiwis, and dried fruits to manage potassium levels. Opt for lower-potassium fruits and vegetables, and consume high-potassium foods in small portions, such as a few cherry tomatoes in a salad or a few raisins in oatmeal.
What Other Dietary Tips Can Be Followed in Hemodialysis Patients?
The following important tips can further be helpful with the special diet:
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Fresh or plain frozen vegetables possess no added salt. Draining all the cooking liquid before serving helps.
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Canned fruits are known to contain less potassium than fresh fruits. However, their liquid should be drained before consumption.
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Rice and almond milk are low in phosphorus and can replace dairy milk.
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Read labels on packaged foods, limit sodium-containing foods, and avoid phosphorus-containing foods.
Conclusion:
Hemodialysis treatment requires a special diet to be adopted as an adjunct. The diet plan requires strict recommendations from a registered dietician and a balance of potassium (not exceeding 2500 mg per day) and phosphorus levels, varying according to the individual's treatment needs.
