A good diet - Norfolk & Norwich Renal Unit

	Norfolk
Introduction to Renal Diet One of the main functions of the kidneys is to remove waste products from your body. When the kidneys are not working efficiently, these waste products are not removed and can build up to harmful levels. This can make you feel unwell. The level of waste products in your blood can be affected by the food you eat therefore diet is a very important part of the overall care of patients with kidney failure. If for health reasons you need to follow a special diet before starting dialysis, your doctor will refer you to a dietitian. On commencing dialysis, your diet will be individually assessed by the Dietitian and you will be advised according to: The type of dialysis you choose. Your blood results. Your urine output. The type of food you normally eat. Whether you are already following other special diets, e.g. a diabetic diet. It is recommended that your aim should be to achieve and maintain the best nutritional status possible. Diet before dialysis If you have been already advised by a dietitian it is recommended that you continue with that diet unless advised otherwise. If you have not yet been advised to follow a special diet here are some general guidelines to help keep you keep well: Fluid A high fluid intake will encourage your kidneys to work more efficiently at removing waste products from your blood. It is recommended that you try to drink at least 2 litres (3-4 pints) daily, i.e. 10 cups. The best fluids are: Water (tap/bottled) Fruit squashes Fizzy drinks Tea Salt A high salt intake can lead to high blood pressure. It is therefore important to cut down on your salt intake. Salt may be used sparingly in cooking, but NO salt should be added to food at the table. This includes table salt, sea salt, rock salt, celery salt and garlic salt (in other words any salt!). Salt substitutes should also be avoided as they contain potassium (another kind of salt) which can be harmful to people with kidney problems e.g. Lo-salt, Ruthmol and Selora. Avoid any food products which contain these items. Most of the salt we eat comes from foods itself, particularly processed convenience and snack foods. Avoid these foods as much as possible. Without salt, your food might taste bland, but over time your taste buds will adapt. There are lots of herbs and spices that can be used to add extra flavour. Please ask if you would like more advice on these. Salt reduction advice from the Norfolk renal dietitians - Click here UK guide to salt and health - Click here. General Achieve Good Nutrition: Eating a balanced diet is important for everybody, but particularly when you have kidney disease. It may also help to slow down the loss of kidney function, keeping you healthier for longer. Tips for eating well: Enjoy your food. Eat regular meals – do not skip breakfast! Eat to be a healthy weight. Eat fruit and vegetables every day. Base your meals around starchy foods (bread, cereals and potatoes). Eat less salt. Do not add salt to food at the table and do not eat too many processed foods. Too much salt will raise your blood pressure. A balanced diet: A balanced diet contains a variety of foods from the 5 different food groups. This is important to make sure you get enough energy (calories) and protein from food, as well as essential vitamins and minerals. The 5 food groups are: Bread, cereals and potatoes. Fruit and vegetables. Meat, fish and alternatives. Milk and dairy foods. Fatty and sugary foods. There is no such thing as a set diet for all renal patients. All renal patients on a renal diet will be on a diet specific to only them. Diets are individualised and just because so and so has been told not to eat bananas does not mean you can't. If you have kidney failure and a dietitian has not put you on a special individualised diet it means you don't have to be on one (yet!) The general advice above is for you. A dietitian will want to meet you if you need help: Losing weight. Maintaining adequate nutrition. Cutting back on certain foods because your blood results tell us you need to. Having renal disease can mean your appetite and taste of food are affected. If you feel you are not managing an adequate dietary intake, or are losing weight, please let the doctor, nurse or dietitian know so we can see you as soon as possible. Dietitians generally don't like giving out diet sheets without explaining them. Nevertheless, it can be useful to have some idea of what foods are low in potassium and phosphate before you get a chance to talk to a dietitian. The link below touches on salt, phosphate, potassium and protein in food. You of course can ring our renal dietitians for advice on these as well. Renal Diet from the Edinburgh Renal Unit. Low potassium and phosphate diets will not help you if you don't need to be on them. They might even leave you malnourished. If you need to be on these diets a dietitian will tell you. Eat to be a healthy weight. Two out of three methods of keeping people alive when their kidneys have stopped working are not available to obese people (because they would not work {though there might be exceptions at the lower end of obesity} ). The third method becomes more difficult to do. Follow this link to understand obesity, exercising to lose weight and what your BMI (body mass index) is. Weight loss Link Links from this site will also explain food groups and what healthy eating is. Dialysis Dialysis will help remove the waste products and fluid from the blood. However, this is not as efficient as having normal healthy kidneys; therefore usually some type of dietary modification is necessary. Haemodialysis: If you choose this type of dialysis, you will receive it two or three times each week. Your body will have a lot of the waste products and fluid removed then, however, they will gradually build up again during the days in between dialysis. The dietary modification for people on haemodialysis is therefore designed to stop the levels of waste product and fluid building up to a level that could be harmful. Peritoneal dialysis – C.A.P.D. This type of dialysis is carried out 7 days a week, 52 weeks a year. It allows a slow continuous removal of waste products and fluid from your body. However, it is still not as efficient as normal healthy kidneys so some care might still be needed with your diet and fluid intake. It is important that you have a high protein intake and eat healthily to avoid potential excessive weight gain whilst on CAPD. Diet on Dialysis
Nutrient ↓	Recommended intake on haemodialysis	Recommended intake on Peritoneal dialysis
Energy	Normal amount to keep you at a healthy weight.	As for haemodialysis, but you might find weight gain a problem due to absorption of glucose (calories) from the dialysis fluid (about 320 Kcal a day for an average 4 bags)
Protein (meat, fish, eggs, cheese, milk, pulses)	Normal	High, as protein is removed from the blood during dialysis.
Potassium (a mineral found naturally in most foods)	Depends on blood level, but intake often modified to some degree.	Depends of blood level, but intake less likely to be modified.
Phosphate (a mineral found naturally in protein foods, particularly in offal, shellfish, oily fish, game.)	Depends on blood level, but intake often modified to some degree. Might require phosphate binders to aid blood level control (see drug section).	Depends on blood level. Intake is likely to be modified. Might require phosphate binders to aid blood level control (see drug section).
Fluid	Depends on urine output, intake is usually restricted to 500 ml plus equivalent of your urine output.	Depends on urine output and amount of fluid removed daily by dialysis. Less strict restriction than on haemodialysis.
Salt	OK to use very small amounts in cooking. None to be added at the table. Reduce the amount of salty and processed foods.	As for haemodialysis.
Fibre (fruit, vegetable and wholemeal products)	Normal amount to keep your bowels healthy.	Normal / high intake to prevent constipation, as constipation reduces the effectiveness of the dialysis.
Vitamins	Supplements will be prescribed as necessary.	Supplements will be prescribed as necessary
How to contact a Dietitian There are several dietitians at the Norfolk and Norwich University Hospital that specialise in renal medicine. They work in outpatient clinics, on the wards and in the dialysis units at the hospital. They also look after the care of patients who dialyse at home. If you would like to see a dietitian to discuss your diet in more detail there are several ways you can contact us: Phone our department to speak with one of us. There is a dietitian available every Tuesday morning in the General Medical Outpatients East Department, working alongside the renal consultants. Leave a message with any member of the renal team. If you are under the care of one of the Renal Consultants you do not need a doctor to refer you to be able to see us. Renal Dietitians Department of Nutrition and Dietetics Norfolk & Norwich NHS Trust Colney Lane Norwich NR2 7UY Tel: (01603) 287011 Renal Dietitians April 2006