Download Your information and what we use it for

Eating well on
peritoneal dialysis
Information for patients
This leaflet is for patients on peritoneal dialysis and their
friends and relatives. It explains the reasons why you should
eat well and gives dietary advice and tips.
Why you may need to alter your diet
When your kidneys are not working properly, your body’s waste
products build up in your blood. Many of these are harmful (e.g. urea,
potassium). Peritoneal dialysis (PD) removes waste products from
your blood, to stop the levels of waste products from getting too high.
Even when you are on PD there may still be some potential
complications, which are avoidable by combining your dialysis
treatment with an appropriate diet.
Changes to your diet can help to:
− Control blood pressure
− Maintain a healthy weight
− Keep your heart and blood vessels healthy
− Keep your bones healthy
− Prevent a build up of harmful waste products
Diet and fluid advice is individual to each person and depends on
many other things, such as other medical conditions, blood results and
eating patterns. Your dietitian will advise you on which parts of this
advice are most relevant to you.
1
Protein
Protein is an essential part of your diet to help build and repair body
tissue. During PD, some protein is lost from the body. To counteract
this loss, it is important to have plenty of protein in your diet.
Examples of high protein foods include:
− Animal proteins; red meat, poultry, white fish, tuna, salmon, cottage
cheese and eggs (see phosphate section).
− Vegetable proteins; pulses e.g. beans/lentils, soya products,
Quorn, tofu.
Try to include a good-sized portion of a food high in protein at two
meals every day. Your dietitian can advise you about the amounts of
these foods you require.
Potassium
You may have previously been advised to follow a low
potassium diet, as it is common for potassium levels
in the blood to rise when your kidneys are failing.
High levels of potassium in the blood can cause an
abnormal heart rhythm.
PD is very good at removing potassium from the blood, so once PD is
established, a low potassium diet is usually no longer needed.
Occasionally, the level of potassium in the blood can fall too low. This
can be corrected by increasing the potassium in your diet by eating
more of foods such as dried apricots, raisins, jacket potatoes, orange
juice and bananas.
Normal potassium level is around 3.6 - 5.3mmol/l.
2
Phosphate
Phosphate is found in a wide variety of foods and is normally removed
from the body by the kidneys. When kidney function is worsening,
phosphate levels in the blood can become too high. Ideally your
phosphate level should be kept between 1.1-1.7mmol/l.
If you have high phosphate levels in your blood, this may cause:
− Itchy skin and itchy eyes
− Weakened/ brittle bones and aching joints
− Life-threatening damage to your heart and blood vessels
If your phosphate level is high, you can reduce it by avoiding / limiting
foods high in phosphate, such as dairy foods.
Limit dairy foods to no more than:
Milk
1/3 -1/2 pint milk per day
Yoghurt
Include within milk allowance
Cheese
50g (2oz) hard cheese per week
Eggs
5 per week (no limit on egg whites)
Other foods to avoid include:
− Offal meats
− Chocolate
− Tinned fish with bones, e.g.
pilchards, sardines
− Prawns
− Malted milk drinks
− Cola drinks
− Nuts
− Foods containing lots of baking
powder e.g. scones.
3
Phosphate additives
Phosphates are often used as a preservative or as an ingredient in
processed foods and can contribute significantly to your total
phosphate intake. Check the labels of foods to look for any of the
following and try to avoid them:
−
−
−
−
−
−
−
Phosphoric acid
Dicalcium phosphate
Monocalcium phosphate
Pyrophosphates
Hexametaphosphate
Polyphosphates
Sodium phosphate.
Choosing fresh, unprocessed food will avoid this problem.
Phosphate binders
In addition to diet changes, you may also be prescribed some tablets
known as phosphate binders. These tablets should be taken when you
eat. They work by binding to phosphate in your food and reducing the
amount of phosphate your body can digest and absorb from it. The
most commonly prescribed phosphate binders are shown below:
− Calcichew (calcium carbonate) to be taken before food
− Phosex (calcium acetate) to be taken with food
− Renagel (sevelamer hydrochloride) to be taken with food
− Fosrenol (lanthanum carbonate) to be taken after food
If you need more advice about lowering your phosphate level, your
dietitian can give you more detailed advice.
Salt
We should all be trying to reduce our intake of salt and salty food, but
it is particularly important for those having dialysis treatment. A diet
high in salt can lead to fluid retention and high blood pressure. Salty
foods also make you thirsty so is unhelpful if you are trying to control
your fluid intake.
To avoid eating too much salt, follow these tips:
− Do not add salt at the table.
− Use only a very small amount of salt in cooking, or none at all. Try
to flavour your food with herbs and spices instead of salt.
− Cut down on salty processed foods e.g.:

Bacon, tinned meat like corned beef, ham, sausages & other
processed meat products

Smoked or salted fish

Anything tinned in brine, like tuna

Baked beans

Meat and vegetable extract (Bovril, Marmite)

Salted nuts, salted biscuits or crackers, crisps

Soups - tinned or packet

Stock cubes and gravy mixes

Pickle / chutney

Cheese

Many ready-prepared foods
If you need more advice about lowering your salt intake, your dietitian
can give you more advice about alternative flavourings and using food
labels.
5
Fluid (liquid)
The balance of fluid in your body depends upon your fluid intake
(drinks and “wet” foods) and your fluid output (any urine you pass and
additional fluid removed by dialysis).
It is important to try to keep to your “fluid allowance” to keep your body
in fluid balance. If you take in more fluid than is being removed, you
will become “overloaded” with fluid.
Excessive fluid intake causes a rapid increase in weight, shortness of
breath, ankle swelling and high blood pressure. This is harmful to your
heart as it then has to work much harder to deal with the extra fluid.
Your fluid balance may change over time depending on your urine
output and your dialysis regimen.
Try to keep your fluid intake to …………………..daily
When you drink too much, stronger dialysis bags are needed, to
remove more fluid from your body. Stronger bags contain more
glucose (sugar), causing additional weight gain and peritoneal
membrane damage. It is beneficial to be able to control your fluid
intake and stay on “weaker” bags for your dialysis.
Managing your fluid intake
If you are calculating your intake of fluids remember that many foods
have a high fluid content. For example, sauces and gravies, milk
puddings, jelly, ice cream and ice lollies may contribute significant
amounts of fluid to your overall intake so try to allow for these
'hidden fluids'.
6
Foods to choose
Foods in moderation
Foods to avoid
Protein foods
All fresh, unprocessed, lean meat, e.g. beef,
chicken, lamb, pork, turkey.
White fish (e.g. cod, haddock, plaice, skate,
sole), tuna – fresh or tinned in oil or spring
water, salmon.
Beans, lentils, pulses (if used in place of meat)
Dairy foods
Milk -1/3-1/2 pint daily,
Custard, ice cream, milk puddings, yoghurt
(include in milk allowance).
Hard cheese – limit to 50g (2oz) week
Eggs - up to five a week (but egg whites
unlimited).
Dairy foods
Cream *
Cottage cheese, cream cheese e.g.
Philadelphia,
Margarine*, low-fat spreads, butter*, oils*
Cereal foods
Corn Flakes, Rice Krispies.
Protein foods
Bacon, ham, tinned meats, sausages,
frankfurters, beefburgers, processed/’formed’
packet meat slices
Smoked fish, fish tinned in brine.
Veal, liver, kidney, heart, sweetbreads, paté
Tinned fish with bones, e.g. pilchards,
sardines. Fish roe, kippers, whitebait,
Seafood e.g. crab, prawns, scampi.
Cereal foods
Wholemeal/ white bread, chappatis, pitta
bread, cream crackers, crispbreads, pasta,
rice, noodles, Branflakes, porridge, Weetabix,
Shredded Wheat
Plain/ sweet biscuits, cakes*.
Fruit & vegetables
Chips*, fried or roast potatoes*.
Salt-free crisps* (e.g. Salt & Shake crisps with
no added salt).
Olives in brine.
Drinks
Beer, cider, lager, sherry, wine, gin, rum,
vodka, whisky.
Miscellaneous
Fruit & vegetables
Salt substitutes e.g. Losalt or Selora (contain
Boiled/home-made mashed potatoes, jacket
about 1/3 sodium of ordinary salt).
potatoes, sweet potatoes and yam.
Mayonnaise*/ salad cream *
Vegetables; fresh or frozen fruits.
Reduced salt gravy
Drinks
Sugar, boiled sweets, honey, syrup, jelly
Tea, coffee, herbal teas, squashes, fruit juices, babies, mints.
lemonade, mineral or tap water.
Miscellaneous
Artificial sweeteners, sugar-free boiled sweets,
chewing gum or mints, jams or marmalade.
All herbs and spices, garlic, pepper, vinegar
Low salt stock cubes e.g. Kallo very low salt.
* = foods high in fat
Dairy foods
Cheese spread e.g. Primula / Dairylea
Condensed or evaporated milk.
Cereal foods
All Bran, muesli, cereals containing nuts
Biscuits and cakes containing chocolate and
nuts.
Scones, bread and butter pudding.
Drinks
Malted milk drinks e.g. Ovaltine, Horlicks,
drinking chocolate, cocoa.
Coca Cola, milkshakes, Stout e.g. Guinness.
Miscellaneous
Tinned or packet soups, salt, including sea salt
and rock salt, gravy, meat and yeast extracts
(e.g. Marmite, Bovril), tomato ketchup, tinned
spaghetti & baked beans, Indian snacks (e.g.
chevda, gathia, sev), Twiglets, Bombay mix,
Salted crisps or other salty savoury snacks,
ordinary stock cubes, peanut butter, chocolate
spread, gram flour, pizza, quiche, baking
powder, nuts, chocolate.
It is recommended that all patients with renal
disease avoid star fruit as it contains a harmful
toxin.
Helpful hints
− Use a smaller cup.
− Take your tablets with your meals wherever possible to save on
water.
− Use an ice cube in place of a drink (try freezing a little lemon/lime
juice in with the ice cube).
− Try freezing small pieces of fruit (e.g. grapes, pineapple chunks or
berries).
− Help to stimulate saliva and stop your mouth feeling dry by sucking
a slice of lemon or lime, using sugar free gum/mints or boiled
sweets.
− Try to take drinks that quench your thirst. Very sweet or salty drinks
will not achieve this as effectively.
− Sip your drinks. Use a straw with cold drinks to slow you down.
− If you rinse your mouth out with cold water and spit it out rather
than swallowing, this can help take the edge off your thirst.
Track how much you drink through the day. Start the day with a
measuring jug of water equal to your fluid allowance. From this you
can make ice cubes and drinks. If you have hot drinks or other liquids
not made from water then remove an equal volume from the jug and
throw it away.
9
Useful measures to help you add up how much you are drinking:
Average Measure
Disposable
plastic cup
150ml
Tea cup
180ml
Can
330ml
Glass
200ml
Mug
200ml
Ice cube
20ml
Soup bowl
200ml
Your home measure
750mls = ¾ litre = about 1⅓ pints
1000mls = 1 litre = about 1¾ pints
1500mls= 1½ litre = about 2½ pints
Fibre
Constipation can be a common problem for people on PD. It can lead
to poor drainage of dialysis fluid. Where possible, try to eat fibre-rich
foods to help prevent constipation.
Good sources of fibre are:
− Wholemeal, granary or high fibre white bread
− Shredded Wheat, Weetabix, Branflakes, porridge
− Brown rice, wholewheat pasta
− Pulses, beans, lentils, dahl
− Dried fruit, fresh fruit and vegetables. Aim for 5 portions a day, as
long as your potassium level is well controlled.
10
Maintaining a healthy body weight
Many people notice that their appetite improves once
they start dialysis, and that their body weight starts
to rise. For some people, this may be a welcome
sign that they are eating better and regaining body
weight than had previously been lost. For others,
weight gain is unwanted.
One of the reasons you may gain flesh weight is the dialysis bags
contain glucose (sugar) and this is absorbed in to your body. This
provides you with extra calories (energy) that you haven’t had the
pleasure of eating!
The stronger, higher strength bags contain more glucose, so even
more calories are absorbed.
If you find you are gaining unwanted weight, you will need to make
some changes to your diet to tackle this problem and your dietitian can
help you with this.
Poor appetite
Some people on PD find their appetite is poor. A loss of appetite or
feeling of fullness is not uncommon. It is important that you eat
sufficient food, especially high protein foods. A poor appetite may lead
to a deficiency in important nutrients, resulting in a delay in recovering
from infections e.g. peritonitis.
If you are worried that you are not eating enough, contact the dietitian
for advice on increasing your calorie and protein intake.
Your dietitian can advise you about nutritional supplements that can
be prescribed by a doctor.
11
Diabetes
If you have diabetes, your blood glucose levels may increase when
you start dialysis, due to the glucose you will absorb from the bags.
You may need to do more regular monitoring for a while and your
diabetes treatment may need to alter. If you need help doing this,
speak to a member of staff.
Vitamins and minerals
Some vitamins are lost from the body during dialysis, so you may be
advised to take a vitamin supplement prescribed by your doctor.
Some vitamins can be harmful to dialysis patients. It is not advisable to
take other supplements unless you have checked with your doctor,
dietitian or pharmacist.
12
Binders
to take
Example meal plan
Breakfast
Fruit
Breakfast cereal and milk (from allowance)
Bread / toast with butter / margarine / low fat spread /
jam / marmalade
Egg (from allowance)
Tea
Mid-morning (if desired)
Tea or coffee
Main meal
_____oz / _____g meat/ poultry OR
_____oz / _____g white fish OR
_____ tablespoons pulses e.g. beans/lentils/chickpeas
Potatoes / rice / pasta
Vegetables / salad
Fresh / tinned fruit or yoghurt (from allowance)
Mid-afternoon (if desired)
Tea or soft drink
Snack meal
Bread
Butter / margarine / low fat spread
_____oz / _____g lean meat/poultry OR
_____oz / _____g tuna OR
_____tablespoons cottage cheese OR
_____ eggs (from allowance)
Salad
Fruit
13
Further information
National Kidney Federation
www.kidney.org.uk
The NKF is the National Kidney Patient charity in the United Kingdom.
The charity is run by Kidney Patients for Kidney Patients
Kidney Research UK
www.kidneyresearchuk.org
Kidney Research UK is the leading UK charity funding research that
focuses on the prevention, treatment and management of kidney
disease. The charity also dedicates its work to improving patient care
and raising awareness of kidney disease.
Kidney Patient Guide
www.kidneypatientguide.org.uk
This website provides information for renal patients, their partners and
families, health care professionals and anyone else who is interested
in kidney disease.
A variety of cookbooks are available. Ask your dietitian for more
details.
More information about the Trust can be found at
www.royalberkshire.nhs.uk
Useful contacts
Dietitian
Telephone
14
Royal Berkshire NHS Foundation Trust
London Road
Reading RG1 5AN
Telephone 0118 322 5111
www.royalberkshire.nhs.uk
This document can be made available in other
languages and formats upon request.
Department of Renal Medicine/Dietetics, March 2017
Review due: March 2019
15