Chronic kidney disease is associated with changes in nutritional status. When you start dialysis treatment you will often need to make some changes to your diet. This is due to loss of protein during dialysis and changes in the absorption and turnover of nutrients in your body as a consequence of the diminished kidney function. Some patients also experience symptoms like nausea, altered taste, fatigue and dry mouth which can affect the appetite. Some patients will experience higher blood levels of phosphate and/or potassium which will necessitate a need of some changes in the diet. 

Advice from the clinical dietician

Starting in dialysis can lead to many questions and uncertainty about restrictions in what to eat. It is important to keep a healthy weight. However, restrictions in the food choice can lead to malnutrition. The renal department offers you a consultation with a specialized clinical dietician when needed. Together we will find healthy and reasonable solutions regarding what to eat in your specific situation. 

Protein

When starting dialysis treatment you will need to eat and drink a larger amount of protein in order to stay healthy and strong. Protein helps to build muscles, repair tissue and strengthens the immune system. The need of protein is approx. 1,0-1,2 g/kg body weight/day. 

Sources of good protein are meat, fish, seafood, poultry, legumes, egg whites, cheese, milk and yoghurt. We advise you to include protein at every meal including snacks between meals as well. 

Protein supplements (e.g nutritional supplement drinks and protein powder) may be needed if it is not possible to eat sufficient protein in your meals. Your doctor or dietician can assess your need for supplement and offer advice on what to do. 

Sodium and fluid

Among other things the kidneys regulate fluid. Some people need to restrict the fluid intake. The doctor will advise you if you need to restrict the intake. If you need to restrict the amount of fluid, try to use small glasses for your drinks, ice cubes and/or frozen fruit in small pieces instead of fluid. Drops or lozenges from the pharmacy may help. 
Choose foods containing less salt e.g by looking after the ‘Nøglehulsmærket’ 
 

This is an official mark informing among other things about reduced salt content. The mark can be found on a variety of different food products. Too much sodium can make you feel thirsty and cause the body to retain water, which can cause fluid retention in the body, e.g. in face and feet. It can also lead to shortness of breath, high blood pressure and put more strain on your heart. Do not use salt substitutes containing potassium such as Seltin®. Minimize added salt on your food and use instead herbs like thyme, mint, basil and chili. 

Phosphate  

Phosphate is a mineral present in our food and beverages.  Your body needs phosphate to help form and strengthen your bones and teeth. It also helps your cells produce energy and build cell membranes. Chronic kidney disease can cause higher blood levels of phosphate. If your phosphate level is too high it may affects your bones and your heart. It can also cause calcification in your cells leading to cardiovascular disease.

When the phosphate level is too high you need to make some changes in your diet in order to minimize intake of phosphate. We recommend you to lower your intake of food containing high levels of phosphate such as dairy products (milk, cheese, yoghurt), egg yolks, milk powder, nuts, chocolate, cola soft drinks, Faxe Kondi soft drinks and Carlberg Sport drinks. Some foods may contain added artificial phosphate. These are labeled as: E338, E339, E340, E341, E343, E450, E451, E452. You can avoid these by buying organic food products or by looking at the nutrition declaration. We recommend you to eat a maximum of 25 g of cheese or 150 ml of milk/yogurt a day to keep your phosphate within levels. Soft cheese like cottage cheese and cream cheese contain less phosphate than hard cheese. Plant based milk products contain less phosphate than regular milk and yoghurt.

To help keep your phosphate levels under control you can use phosphate binders prescribed by your doctor. The phosphate binder tables have be taken with your meal. Your blood levels will be checked monthly. You will be informed by the doctor or nurse if you need to lower the amount of phosphate in your diet.   

Potassium

Potassium is another mineral in our food and beverages. Potassium helps your muscles work, including the muscles that control your heartbeat and breathing. Chronic kidney disease may cause high blood potassium which can affect the heart rhythm. Dialysis removes some of the potassium from the blood. However, some people also have to limit the intake of potassium in food and beverages in order to keep the blood potassium within range.

Food and beverages containing high levels of potassium include potato chips, milk, yoghurt, milk powder, concentrated tomato paste, sundried tomatoes, dried fruit, coffee, chocolate, juice, banana, potatoes, avocado, vegetables, nuts and seeds. We recommend you to lower the amount of foods with high content of potassium if your levels are too high. You can reduce the potassium levels in vegetables and potatoes significantly by peeling and cutting them into smaller pieces and boil them before further use in your meals.  Do not use the cooking water afterwards in the meal. Legumes always have to be boiled or taken from a can before added to the meal. 

Your blood levels will be checked monthly. You will be informed by the doctor or nurse if you need to lower the amount of potassium in your diet.   

Starfruit (Carambole)

Please be aware not to eat starfruit (carambole). Studies show that eating starfruit can have a harmful (toxic) effect for people who have kidney disease. The substances found in starfruit can affect the brain and cause neurological disorders. This toxic substance is called a neurotoxin. People with healthy, normal kidneys can process and pass this toxin out from their body.