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What are the diet restrictions of a Hemodialysis patient?

Nutritional needs of different patients depend on such factors as the size and nutritional status of the patient, urine output, nature of work, laboratory results, and other illnesses and medications.

Dietary recommendations

  • Energy : 35 kcal / kg ideal body weight
  • Protein : 1.0 - 1.2 g / kg ideal body weight
  • Carbohydrates : 50 - 55 % of total energy needs
  • Fat : 30 -35 % of total energy needs
  • Sodium : 2.0 - 2.5 g/day
  • Fluid : 500 ml + previous 24 hour urine output
  • Potassium : 40mg / kg ideal body weight ( 2 - 3 g/day)
  • Phosphorous : < 17mg/kg ideal body weight
  • Calcium : depends on serum levels.

(Source: handbook on hemodialysis, T.S. Singnam, PPN)

Protein and Energy

A dialysis patient who does not eat enough protein and carbohydrate will ultimately be undernourished because during dialysis they are removed along with the waste product (solute drag) and there will be depletion of amino acids which are needed for constant repair and maintenance of body tissues.

Foods that are high in protein are also high in phosphorous (>300 mg/100mg) like egg yolk, chocolate, organ meat eg. liver and kidney, dairy products, nuts, dried vegetables like mushroom and others.

Sodium

A patient increases thirst and blood pressure if there is a high sodium intake. Patients should be advised to eat more of low salt or salt free products eg. low salt biscuits and low salt margarine. The following should also be avoided like adding soya sauce, salt or tomato chili sauce, food enhancers such as MSG and baking soda, salty “tit bits” if experiencing nauseous feeling, drain the brine and soak the vegetables in fresh water when using canned vegetables.

Potassium

Potassium is found in almost all foods particularly fruits and vegetables. A cardiac arrest can be triggered if there is a high blood level of potassium.

Patient should avoid all dried vegetables and fruits, nuts, coconut milk, brown sugar, instant coffee, fruit juices, durian. Vegetables should be cut in small pieces and soaked in warn water for an hour prior to cooking. Use of curry powder and ground spices should be limited.

Fluid

Fluid intake is one of the most difficult aspects of nutrition that patients fail to comply. Patients must be aware to keep weight gain between dialysis treatments to less than 3-4% of their dry weight. To control high fluid intake, avoid high sodium food, drink “slightly hot” water to reduce intake, use small caps and glasses for drinking, rinse mouth with water but do not swallow, divide the day's fluid intake evenly over the whole day and strict mental discipline.

Saturated fat and cholesterol

Any reduction in saturated fat intake in the diet will result in drop in cholesterol levels (less than 300 mg/day). To reduce intake, full cream dairy products should be substituted with low fat milk, low fat cheese, and low fat yogurt etc., use of coconut milk. Trim all visible fat from meat and poultry, limit egg yolk to 2-3 times per week, avoid burgers, meat nuggets, sausages etc. Limit intake of prawns, squids, crab, cockles etc and don't forget to remove head from prawns and fish.