Processed cheese (1 ounce) Bouillon cubes (1/2 cup

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Dialysis Nutrition

• Information for awareness

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How much do we know about our clients nutrition?

• Information can be found from
• Posters and handouts in hallway
• Speaking with the dietician
• Speaking with the nurse
• www.kidney.org

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Nutritional Facts

• Normal levels of Potassium
• 3.5-5.5 mg/dL
• Normal levels of Sodium
• 2,000-3,000 mg per day
• Normal levels of Phosphorous
• 3.3-5.5 mg/dL
• Normal levels of Cholesterol
• At or below 200 mg/dL

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Where to start

• Common sense and moderation
• Avoid convenience foods, processed meats and
  cheeses, fast foods
• Protein is extremely important
• Distribute calories evenly throughout the day
• Limit pour liquids to 32 ounces per day

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Too much of a good thing

• Particular foods which contain phosphorous,
  potassium, and sodium need to be chosen from
  wisely
• This can be accomplished with commitment, new
  found skills (i.e.. label reading), and a support
  system from heath care staff, family and friends

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Phosphorous

• One dairy product per day
• Milk (1 cup)
• Cheese (2 ounces)
• Yogurt (1 cup)
• Pizza (1/4 of 12 in. pizza)
• Cottage Cheese (3/4 cup)
• Ice Cream (1 ½ cups)
• Custard (1 cup)

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Other Phosphorous Foods

• Nuts (1/2 cup)
• Waffle (2 squares)
• Pancakes (2 medium)
• Mac Cheese (1 cup)
• Bran Cereals (1/3 cup)
• Bran muffins (1 small)

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Phosphorous

• If Phosphorous is continually high, substitutions
  are possible to lower it
• Rice Dream or Soymilk vs. milk
• Sherbet vs. ice cream
• Popcorn unsalted vs. nuts
• Hamburger on a bun vs. pizza
• Binders are a must to keep Phosphorous low

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Too much phosphorus

• Can pull calcium from your bones, which will make
  your bones weak and likely to break.
• Also can cause skin ulcers and poor blood
  circulation
• Foods to avoid include milk, cheese, dried beans,
  peas, colas, nuts, and peanut butter

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High Potassium Foods

• May have 1 serving per day of
• Bananas
• Nectarines
• Oranges
• Kiwi
• Melon (6 x 1 slice)
• Melons cantaloupe, honeydew (1/4 of 5 diameter)
  
• OJ (1/2 cup)

• Beans-soy, navy, white (1/2 cup boiled)
• Potatoes (1/2 cup or 10 French fries
• Tomato
• Spinach-cooked (1/2 cup)
• Yams (1/2 cup)
• V8 juice salt free (1/2 cup)
• Tomato Juice (1/2 cup

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Medium Potassium Foods

• Mixed vegetables (1/2 cup)
• Nuts walnuts, almonds, and peanuts (1 ounce)
• Split peas (1/3 cup boiled)
• Peanut butter (2 tbsp)
• Mushrooms (1/2 cup)
• Okra (1/2 cup)
• Pineapple juice (1/2 cup)

• May have 2 servings per day
• Apple
• Peach
• Cherries (1/2 cup)
• Pear
• Plums (2)
• Fruit cocktail (1/2 cup)
• Apple juice (1/2 cup)
• Grape juice (1/2 cup)

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Low Potassium Foods

• Asparagus (4 spears)
• Green beans (1/2 cup)
• Bean sprouts (1/2 cup)
• Cabbage (1/2 cup)
• Lettuce (1 cup)
• Onions (1/2 cup)
• Soaked potatoes (1/2 cup)
• Cauliflower (1/2 cup)

• May have 3 servings per day
• Applesauce (1/2 cup)
• Blackberries (1/2 cup)
• Blueberries (1/2 cup)
• Grapes (1/2 cup)
• Strawberries (1/2 cup)
• Tangerines (1)
• Cranberry juice (1 cup)
• Lemonade (1 cup)

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Too much potassium

• High levels of K can cause weakness, numbness,
  an irregular heartbeat or a heart attack
• Foods to avoid include avocados, bananas, kiwis,
  and dried fruits

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Sodium

• Try to limit high sodium foods to one per day
• Processed cheese (1 ounce)
• Bouillon cubes (1/2 cup)
• Sauerkraut (1/4 cup)
• Bacon (2 slices)
• Hot dog (1)

• Ham (3 ounces)
• Tuna fish (1/4 cup)
• Gravy (1/4 cup)
• Chips potato, corn, pretzels (1 cup)
• Soy sauce (1-1/2 tsp)
• Salt (1/8 tsp)

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Friendly Sodium Substitutions

• Allspice
• Basil
• Chili Powder
• Coriander
• Dill
• Cumin
• Curry
• Garlic

• Mustard
• Onion
• Sage
• Tarragon
• Thyme
• Parsley
• Oregano
• Rosemary

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Too much sodium

• Causes thirst! Drinking too much fluid in
  response causes the heart to work harder to pump
  the fluid through the body, and over time can
  result in high BP and CHF.
• Also can cause headaches, puffiness, and
  shortness of breath.
• High Na foods to avoid cured foods, pizza, fast
  foods, processed foods, frozen dinners, luncheon
  meats

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Protein

• Protein is essential for building muscles,
  repairing tissue, fighting infections
• 8-10 ounces of high protein foods everyday (3
  ounces deck of cards, 1 ounce golf ball)
• Protein bars and Prostate help maintain that goal

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Not enough protein

• Dialysis filters out protein, and the body will
  begin to use protein in muscles for fuel (muscle
  wasting)
• Can cause fatigue, weight loss, increased risk of
  infections, and loss of mental awareness
• High quality protein foods include beef, pork,
  chicken, fish, soy

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Eating Out

• Plan ahead
• Be aware of portion size
• Ask for gravy, sauces on the side
• Request no salt
• Ask question to wait staff
• Share with family, friends

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Better choices vs. poor choices

• Eggs cooked to order
• Toast, bagel, English muffin, croissant, plain or
  blueberry muffin
• Margarine, jelly, honey, sugar and syrup
• Donuts, Danish pastry, coffee cake
• Pancakes, waffles, French toast

• Ham, sausage, or Canadian bacon
• Biscuits and bran muffins
• Real maple syrup or gravy
• Pastries with chocolate, nuts, coconut, or
  caramel
• Home fries or hash browns

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Better choices vs. poor choices

• Caesar salad with chicken or shrimp
• Meat filled tostadas
• Crab cakes, clams, most shrimp dishes
• Green salad
• Coleslaw
• Pasta salad

• Cottage cheese or other cheese dishes
• Quiche, cheese sticks
• Oysters
• Salted or smoked meat
• Potato salad
• Greek salad with olives

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Better choices vs. poor choices

• Beef
• Seafood or meat kabobs
• Sandwiches (no cheese)
• Fajitas
• Steamed rice
• Unsalted breadsticks

• Mixed dishes, liver and onions
• Gravy
• Sub sandwiches
• Bean dishes, chili beans
• Fried rice
• Baked or refried beans

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Better choices vs. poor choices

• Angel food, apple, lemon, pound, white or yellow
  cake with whipped cream
• Sugar cookies, butter cookies
• Strawberry shortcake
• Pies, tarts or cobblers made with apple,
  blueberry, cherry, lemon meringue or strawberry

• Chocolate, carrot, coconut, devils food, fruit
  or German chocolate cake
• Brownies, coconut macaroons
• Bananas, oranges or kiwi
• Pies like banana, chocolate, or coconut cream,
  pumpkin cheesecake

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Food labels
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Food labels

• Listing phosphorus potassium is not required,
  and if they arent listed, it does not mean they
  are not in that food item
• Understanding the terms
• Sodium Free - Only a trivial amount of sodium per
  serving.
• Very Low Sodium - 35 mg or less per serving.
• Low Sodium - 140 mg or less per serving.
• Reduced Sodium - Foods in which the level of
  sodium is reduced by 25.
• Light or Lite in Sodium - Foods in which the
  sodium is reduced by at least 50.

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Keep in mind

• Low sodium products have added potassium
• If sodium is listed among the top 5 ingredients,
  it means that product contains too much!
• Ingredients to Avoid Banana, cheese, chocolate,
  cocoa, coconut, cream, dried fruit, dried peas
  and beans, lentils, melon, milk, molasses, nuts,
  orange, peanut butter, potassium chloride,
  potato, raisins, dark rye flour, frozen
  vegetables packed with sauce, spinach, tomato,
  wheat or oat bran, whole wheat

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Excellent resources

• www.kidney.org (National Kidney Foundation)
• www.kidneyschool.org
• www.kidneyfund.org
• www.aakp.org
• www.niddk.nih.gov