EBPG nutritional guidelines ESPEN guideline for nutrition Calories (kcal/kg body weight/day) 30 – 40 (70 kg person: 2100 – 2800 kcal) 35 (70 kg person: 2450 kcal) Protein needed (g/kg body weight/day) A minimum of 1.1 (70 kg person: A minimum of  77 g) Haemodialysis 1.2 – 1.4 (70 kg person: 84 – 105 g) Phosphates (mg/day) 800 – 1000 800 – 1000 Potassium (mg/day) 1950 – 2730 (for patients with pre-dialysis potassium levels of > 6 mmol/l) 2000 – 2500 Sodium (mg/day) 2000 – 2300 (or 5 – 6 g of table salt / sodium chloride) 1800 – 2500 Fluids intake Interdialytic weight gain should not exceed 4 – 4.5 % of the dry weight Urine from previous day plus 1000 ml of fluids per day (Your physician will specify amount you may drink, is often less than 1 L)

Getting the right amount of protein

Before starting on hemodialysis treatment, you may have been prescribed a low-protein diet by your physician. After starting dialysis you need more protein. Getting the right amount of protein is important for your overall health and your wellbeing. Your body needs protein for:

 

•    Building muscles

•    Repairing tissue

•    Fighting infection

Ideally your protein intake will be half animal protein – good sources are eggs, dairy products, meat, poultry, and fish – and half vegetable protein: good sources are potatoes, pasta, legumes (soya beans, peas, lentils), and cereals.

 

Food rich in protein usually contains a certain amount of phosphate – dairy products, fish, and meat have high phosphate content. This is why almost all hemodialysis patients are prescribed phosphate binders to keep serum phosphate normal.

Our body takes up phosphate from food. If the kidneys are not functioning well enough, the excretion of phosphate is decreased and serum phosphate rises. If the amount of phosphate eliminated during the dialysis sessions is too low, you will be prescribed phosphate binders. Phosphate binders are drugs that inhibit your body from absorbing the phosphates contained in food.

 

You can limit your intake of phosphate by avoiding certain foods – such as nuts, cola drinks, or certain types of cheese. In general, processed food and soft drinks contain phosphate and potassium-rich additives. Whenever possible, use fresh food – meat and poultry – and avoid processed food containing phosphate additives. Read nutrition labels and look for phosphorus in the ingredients.

Be aware of potassium

If your food contains too much potassium, your blood potassium level will be too high. Normal potassium levels in your blood are needed to make your muscles and your heart work properly. Large amounts of potassium are contained in fruit juices, bananas, nuts, avocado, spinach, and potato products.

Eating too much salty food increases your thirst and causes you to drink. You should limit your daily salt intake to not more than six grams (equivalent to a teaspoonful). Usually you find high amounts of sodium in processed foods such as convenience food, ketchup, ham, and pizza. You may not notice it when you’re eating them, but a few hours later you could be thirsty. Instead of salt, use fresh or dried herbs, lemon, or spices.

As a rule, you can drink a volume equaling the amount of urine from the previous day plus one liter of fluids per day. This may differ individually and your doctor or dietician will help you to determine the right amount of fluid to drink each day. Please note that ‘fluid’ includes beverages and other foods that are liquid at room temperature such as soup, ice cream, and other frozen desserts.

The less you drink, the less water has to be removed during a dialysis session and the gentler your dialysis treatment will be. The lower the quantity of fluid that must be removed by ultrafiltration – the greater your long-term success with hemodialysis.

Changing your diet doesn’t necessarily mean less enjoyment. It is a fact that food and drink keep the body and soul together. But changing your consumption habits doesn’t have to be a burden. As a renal patient, you’re helping to keep your body functioning properly.

Physical exercise

Your exercise program doesn’t need to be about sporting excellence – which would put too much strain on your system – but should concentrate on lighter exercise. The most beneficial is resistance training, which you should do regularly. Resistance training gently activates muscles. It helps them grow at a slow, steady rate, supporting your bone structure. This sort of exercise reduces body fat, lowers blood pressure, and has beneficial effects on blood sugar and blood fat levels. It also fortifies the immune system over the long term.

 

Consult your dialysis team about what exercise you can do and with what intensity. Here are some ideas to get you started:

Gymnastics

Start each day with 10 minutes of gymnastics – arm circling, torso circling, simple leg lifts, or jogging on the spot. This will get your circulation going as soon as you get out of bed. It improves your coordination and mobility and you’ll feel fit for the rest of the day.

Cycling and walking are activities that you can do for as long and as far as you wish. Plus, they are great activities to do with other people.

Swimming and underwater gymnastics are particularly suitable for dialysis patients. Almost all the muscles in the body are strengthened – and joints and bones are supported.

 Out and about

Use your daily tasks as an opportunity to keep fit: take the stairs instead of the lift; walk or cycle to the shops – it’s good for the environment and it’s good for you. A short walk before bedtime clears your head and promotes more restful sleep.