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Dialysis Nutrition “Information for awareness” How much do we know about our client’s nutrition? Information can be found from… Posters and handouts in hallway Speaking with the dietician Speaking with the nurse www.kidney.org Nutritional Facts Normal levels of Potassium 3.5-5.5 mg/dL

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dialysis nutrition

Dialysis Nutrition

“Information for awareness”

how much do we know about our client s nutrition
How much do we know about our client’s nutrition?
  • Information can be found from…
    • Posters and handouts in hallway
    • Speaking with the dietician
    • Speaking with the nurse
    • www.kidney.org
nutritional facts
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
where to start
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
too much of a good thing
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
phosphorous
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)
other phosphorous foods
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)
phosphorous9
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
too much phosphorus
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
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

High Potassium Foods
medium potassium foods
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)

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)

Medium Potassium Foods
low potassium foods
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)

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)

Low Potassium Foods
too much potassium
Too much potassium…
  • High levels of K+ can cause weakness, numbness, anirregular heartbeat or a heart attack
  • Foods to avoid include avocados, bananas, kiwis, and dried fruits
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)

Sodium
friendly sodium substitutions
Allspice

Basil

Chili Powder

Coriander

Dill

Cumin

Curry

Garlic

Mustard

Onion

Sage

Tarragon

Thyme

Parsley

Oregano

Rosemary

Friendly Sodium Substitutions
too much sodium
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
protein
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
not enough protein
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
eating out
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
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

Better choices vs. poor choices
better choices vs poor choices22
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

Better choices vs. poor choices
better choices vs poor choices23
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

Better choices vs. poor choices
better choices vs poor choices24
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, devil’s food, fruit or German chocolate cake

Brownies, coconut macaroons

Bananas, oranges or kiwi

Pies like banana, chocolate, or coconut cream, pumpkin cheesecake

Better choices vs. poor choices
food labels26
Food labels
  • Listing phosphorus & potassium is not required, and if they aren’t 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%.
keep in mind
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
excellent resources
Excellent resources
  • www.kidney.org (National Kidney Foundation)
  • www.kidneyschool.org
  • www.kidneyfund.org
  • www.aakp.org
  • www.niddk.nih.gov