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Mastering a few basic concepts will help you redefine your new normal kidney safe diet. It is important to control how much sodium, potassium, phosphorus, excess fluids and sugar you eat for the reasons explained below.
Phosphorus is a mineral that is found in many of the foods you eat and the liquids you drink. When you have kidney disease, your kidneys cannot control the right amount of phosphorus in your body. Normally, phosphorus, calcium and vitamin D work together to help keep your bones strong and healthy, when they are in proper balance. When you have too much phosphorus in your blood, your body will pull calcium out of your bones. This can cause your bones to be soft, weak and brittle. Your bones will be more likely to break and you may have joint pain.
High levels of phosphorus or calcium in your blood will cause calcium deposits in your blood vessels and other organs, such as your heart, lungs and joints. Over time, calcium deposits in blood vessels can make them hard and lead to heart attacks, strokes and painful open skin sores. Calcium deposits can also cause itchy skin and red eyes.
Your dialysis treatments remove a significant amount of phosphorus so it is very important that you do not miss any treatments!
Learn more about controlling phosphorus levels in your diet from the American Kidney Fund's brochures on How to Prevent High Phosphorus with Kidney Disease, Phosphorus Food Guide, Sample Grocery Shopping List, and Dine Out with Confidence. Download all four brochures from the website.
Phosphate binders prevent the body from absorbing the phosphorus from the food you eat and eliminate it in the stool. This reduces the amount of phosphorus that gets into your blood. Phosphate binders should be taken 5 to 10 minutes before or immediately after your meals and snacks. Your doctor and dietitian will tell you when you should take your phosphate binders and discuss how many you need to take when you eat. The dose of phosphorus binders you take depends on the size of your meals and snacks.
Your goal is to keep your phosphorus blood levels in the normal range of approximately 3.0 to 5.5 mg/dL. Your doctor and dietitian will help you achieve this goal by helping you to adjust what you eat and the dose of your phosphate binders.
Watch our Wellness Bytes videos on phosphate binders on the Education page of the website.
Examples of Phosphate Binders
Be sure to check out our page describing Food Choices for a Healthy Lifestyle for kidney patients.
What is a dietitian and why do I need one? Since your kidneys are no longer working, your diet needs to evolve so that the foods that you eat decrease the 'food' burden on your body. A renal dietitian will help you create a new eating plan to keep you healthy.
How does what I eat affect my overall health? Everything that you eat can affect different organs in your body and how you feel from day-to-day. Mastering some key concepts will help you define your “new normal”. A dietitian will help design a nutrition plan that is best for you.
What is phosphorous and why do I need to limit it? Phosphorus is a mineral, and "electrolyte" that is found in most of the foods that we eat, including meat, fish, grains, and dairy products, and is normally eliminated by a working kidney. When it builds up in your body because your kidneys are not working to eliminate it, it can result in hardening your blood vessels and weaken your bones causing them to fracture easily.
What is potassium and why do I need to limit it? Potassium is a mineral, an "electrolyte", that is found in many foods including bananas, oranges, potatoes and tomatoes. It is normally eliminated by working kidneys and if they are too 'weak' to eliminate it, it builds up and can cause muscle weakness, occasional cramping, numbness and tingling (because it affects your nerves), nausea and vomiting, and an irregular heartbeat, even stopping your heart. You may even feel short of breath if high levels affect the muscles that help you breathe.
What is sodium and why do I need to limit it? Sodium is in the salt in a 'salt shaker'. It might be added to foods during a meal or during cooking. It is also found naturally in most food including celery, beets and milk. Prepared and packaged foods, including canned foods, lunch meats, frozen dinners and fast foods have sodium added during processing. High sodium intake can cause high blood pressure that is an important risk factor for heart disease and stroke.
What is protein? Why is it important to limit or increase? Protein in our diets is a nutrient commonly found in animal products, but also in plant sources including nuts and beans. It is a critical part of the process that gives you energy, builds cells and tissues, including muscles and helps make antibodies that fight infection and illnesses. The renal dietitian will encourage a patient to eat high-quality protein. High-quality protein comes from meat, poultry, fish, and eggs. It is a fine line between eating too much and too little protein when you’re on dialysis. Your dietitian will help you determine what the correct balance is for you.
Why is my fluid balance important? When you are on dialysis, your kidneys are no longer able to maintain the right balance between the fluid in your body and the fluid you drink and eat (anything from iced tea to ice cream, and even watermelon). When your kidneys are not working, fluid will build up in your body. This fluid accumulation can cause leg swelling, raise blood pressure that can cause heart damage, difficulty breathing, and may lead to a stroke. Trying to remove too much excess fluid during a dialysis treatment can damage your heart, cause cramping, low blood pressure and even fainting.
Why is my weight important? When thinking about weight, think about your weight at the start of a dialysis treatment and what your weight is at the end of a treatment. Your 'dry weight' is your weight without any excess fluid in your body.
Will I still be able to enjoy my cultural foods? Yes! You can still enjoy cultural foods with some adjustments and still eat a variety of healthy foods, including a plant-based diet. Your dietitian will help you adjust your diet to your cultural preferences and set goals to meet your body’s needs.
Will I still be able to eat fast food or at a restaurant? Fast food contains excess amounts of phosphorus, potassium, sodium and sugar and causes health problems for everyone. You cannot really modify fast food restaurant menus, including the way that the food is prepared. However, some restaurants may offer 'choices' including healthier options or be willing to accommodate special requests.
Can I still enjoy alcoholic beverages? Drinking alcohol may be allowable, however, it must be counted within your normal fluid allowance and diet. Alcohol may interact with your medications and effect their action. Speak to your doctor and dietitian before you drink any alcohol.
Can I drink coffee? Yes, you can have coffee in moderation. However, you must take into consideration your daily fluid intake and the effects caffeine can have on your blood pressure. Check with your healthcare team to determine optimal fluid intake for you.
Is soda allowed? Dark colas contain phosphorous which can be harmful to your heart and bones. You must also take into consideration that any fluids count towards your daily fluid intake.
What are phosphate binders and why do I need to take them? You will be prescribed a medicine called a phosphate binder (PhosLo, Velphoro, Auryxia, Renvela ) to reduce the amount of phosphate you absorb from your food. Phosphate binders work by binding (attaching) to some of the phosphate in food. This will reduce the amount of phosphate being absorbed into your blood stream. Taking your binders can help protect your bones and heart.
What are nutritional supplements and should I take them? Nutritional supplements are any dietary supplement that provides nutrients that may otherwise not be consumed in sufficient quantities; for example, vitamins, minerals, proteins, amino acids or other nutritional substances. Depending on how well you are eating and your monthly blood work, you may need a nutritional supplement. However, supplements or energy bars are nutrition dense, and can be high in phosphorus, potassium, sodium and calcium. There are some supplements that are appropriate for dialysis patients. Please consult with your dietitian to find which supplement is right for you.
I am taking a multivitamin or mineral supplement. Can I continue to take it? You may need to avoid some vitamins and minerals if you have kidney disease. Some of these include vitamins A, E and K. These vitamins are more likely to build up in your body and can cause harm if you have too much. Your doctor or dietitian will address whether to decrease, stop or continue this based on your progress and lab results.
Is it safe for me to use herbal supplements? Probably not and there are a few reasons for this. Many herbal supplements – such as pills, capsules, tinctures and teas – contain potassium and phosphorus which need to be limited in dialysis patients. Also, many of these supplements can build up in the blood stream due to the inability of your kidneys to filter waste products and this can lead to toxicity. Finally, herbal supplements can interfere with many medications and how they function. Speak with your doctor or dietitian if you have questions about specific products.
Is the diet on home dialysis more liberal than the diet on hemodialysis? The diet on home dialysis (peritoneal and home hemodialysis) can be less restrictive because you are doing your treatments more often. You may have a bit more flexibility with your limits and choices. Always check with your dietitian before changing your renal diet.