When a person starts on dialysis, one of the diet contradictions is that all the sudden some foods that were forbidden are on the ‘ok to eat’ list and foods that were healthy to eat end up on the ‘limit or avoid’ list.

What’s going on? Read more…

Looking for a refreshing lunch for a warm summer day? 

Try one of these low sodium, low potassium, low phosphorus menus:

#1 

A scoop of chilled tuna salad (low sodium or reduced sodium tuna, mayonnaise, minced onion, celery and hard-boiled egg)
served in a lettuce leaf with 4 pieces Zwieback or Melba toast
Chilled, sliced red apple
8-ounces Iced tea with sweetener and lemon

#2 

Cold, diced chicken breast mixed with 1/4 diced apple, 1/2 celery rib and mayonnaise served on a French roll
1/2 cup chilled watermelon cubes
 4-ounces cold lemon-lime soda

#3 

A scoop of egg salad (eggs, mayonnaise, sweet pickle relish, pepper) served on 2 slices white bread
Sliced cucumbers and onions marinated in unseasoned rice vinegar,  pepper, and a teaspoon of sugar or sweetener
1/2 cup fresh berries with a spoonful of nondairy whipped topping
8-ounces chilled lemonade

#4 

6-8 pieces of chilled, boiled shrimp with a mixed green salad (salad mix, cucumbers, red pepper strips, baby carrots
1-2 tablespoons vinaigrette dressing
Bread sticks
1/2 cup strawberry sorbet
4-ounces ginger ale

Following a dialysis diet fluid restriction is easier if a person has a plan to keep up with the amount of liquids consumed each day. Keeping a running list of fluids consumed is the best way for kidney patients to track fluid intake. These helpful steps will increase awareness of fluids consumed: Read more…

Looking for another alternative to milk and cheese for your renal diet?

A company from New York, Delicious Milk Company, Inc., has engineered Dairy Delicious low phosphorus Milk Beverage and Cheddar Cheese sauce, products with significantly lower phosphorus and potassium content compared to regular milk and cheese. The products are available by phone at 877-432-4797 or online at www.dairydelicious.com. They are carried by grocery stores in some areas. Check the Diary Delicious website for a list of stores.

How do the Dairy Delicious products taste?
The milk beverage tastes more like milk to me than some other substitutes, perhaps because it is real milk instead of a formula. Read more…

Multivitamins or standard over-the-counter supplements are not suggested for dialysis patients as a replacement for renal vitamins for several reasons:

• Patients with kidney failure require more folic acid. Multivitamins and standard supplements do not supply enough folic acid to meet the requirements of those with end stage renal disease.
• All supplements that contain vitamin A are avoided in chronic kidney disease because the damaged kidneys are unable to remove it from the body. Excess vitamin A is very toxic.
• Vitamin D in a multivitamin or standard vitamin D supplement cannot be used by the body since the damaged kidney can no longer activate it. Special activated vitamin D formulas are prescribed if needed, along with careful monitoring of calcium, phosphorus and parathyroid hormone (PTH) levels.
• Vitamin C doses above the RDA are not recommended for kidney patients because it increases risk for oxalate deposits and kidney stones. Doubling up on a multivitamin or taking additional vitamin C can easily exceed the goal for dialysis patients.
• Cost may be higher if multiple supplements are purchased to replace renal vitamins. Many prescription plans cover the cost of renal vitamins. Some pharmacies offer generic over-the-counter brands at a lower price.
• Why add more pills than needed? Most kidney patients already take many pills.

Fluid intake for hemodialysis patients is limited between dialysis treatments since the kidneys lose the ability to make urine and remove excess fluid from the body. Excess fluid can increase blood pressure, causes the heart to work harder, and can cause shortness of breath.

For hemodialysis patients who no longer urinate due to complete kidney failure, liquids are usually limited to 32 ounces or 1000 ml each day. Some hemodialysis patients have a small amount of residual kidney function (residual renal function) so their kidneys are able to remove some fluid still. For them, the fluid restriction may be increased. How much liquid can dialysis patients with residual kidney function consume?

To find out, a 24-hour urine collection is measured. That volume is added to the initial 1000 ml (1 liter) fluid restriction. For example, if the 24-hour urine collection is 480 ml, which is the same as 16 ounces, the fluid restriction is increased from 32 ounces to 48 ounces or 1500 ml per day. Dialysis patients are advised to weigh themselves daily to help keep track of weight and fluid balance.

Vinegar is produced by bacteria that convert alcohol in fermented liquids into acetic acid, the ingredient responsible for the sour taste of vinegar.

Some vinegar sources include:

• Apple cider vinegar made from apple cider
• Balsamic vinegar made from white grape juice aged in wood barrels
• Distilled white vinegar made from a grain alcohol mixture
• Rice vinegar made from fermented rice
• Wine vinegar made from red or white wine

Vinegar is an excellent seasoning for a kidney diet because it is sodium free and very low in phosphorus. Potassium varies with the source, generally 5-30 mg per ounce.

Select unseasoned rice vinegar since seasoned rice vinegar contains 240 milligrams of sodium for only one tablespoon, plus contains added sugar. Try variations of vinegar flavored with herbs and fruit.

Use vinegar to make marinades and vinaigrette dressings. Add a splash during cooking for added flavor. Use as a table top seasoning on vegetables and fish.

Egg whites are an excellent source or high quality protein for the dialysis diet. Egg whites are very low in phosphorus (5 mg per egg white). Most of the phosphorus in an egg is in the yolk (60-90 mg per yolk).

 Pasteurized fresh egg whites are packaged in a carton, found in the egg/dairy section of the grocery store. Just Whites® are a powdered egg white product available at your local grocery store in the baking section.  Pasteurized egg products are safe to consume without cooking. People with kidney failure are at higher risk for illness if exposed to salmonella from raw eggs that are not pasteurized.

When extra protein is needed, add egg whites to egg dishes, ground meat dishes, smoothies or shakes to boost protein content.

Raw spinach is lower in potassium than cooked spinach. If you’ve ever cooked a bag of spinach, you can probably guess why. When heated, spinach leaves wilt, so it takes about 3 times more to produce an equal volume.

For comparison, 1/2 cup cooked fresh spinach weighs 3 ounces and contains 419 mg potassium. 1/2 cup raw fresh spinach weighs 1 ounce and contains 156 mg potassium.

If a low potassium diet is required due to kidney disease or dialysis, it’s best to stick with raw spinach in small amounts. Try mixing spinach leaves with lettuce for a salad or add to your favorite sandwich or wrap.

Add extra flavor to your next kidney diet dish by adding zest from lemon, lime, orange or grapefruit. Zest is the colored portion of the citrus skin. It contains aromatic oils and adds loads of flavor to cooked or raw foods.
To remove the zest, use a citrus zester, paring knife or vegetable peeler. Avoid the white pith between the zest and fruit–it is bitter.

What about potassium? One tablespoon of citrus zest contains less than 10 mg potassium.