Rakesh N, 35, recalls how his father’s meals were incomplete without banana and mango which were removed from his diet since he started dialysis. He says that although it’s been two years, he still finds it difficult to convince his father not to eat them, who has replaced the fruits with apple and papaya.
Rakesh, a resident of Bengaluru and a software engineer, tells Happiest Health that his father, Narayan (73), has chronic kidney disease along with cardiac issues and pulmonary edema. Due to food and fluid restrictions, he is not allowed to eat foods containing high potassium and phosphorus. As a result, they have cut down on fruits like banana, mango, avocado, dates, cashews, almonds, etc. “He has fluid restriction of 1 litre per day and we always have to monitor him. Whenever he drinks more than 1 litre of water, his legs swell up and he suffers from respiratory issues as the water gets collected in the lungs,” Rakesh said.
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Importance of diet and nutrition during dialysis
Diet is dependent on the severity of the individual’s condition and there is generally a recommended daily allowance of certain nutrients (including micronutrients and protein), says Dr Girish NS, consultant nephrologist and transplant physician, Manipal Hospital, Hebbal, Bengaluru.
“However, many times, we recommend a low-protein diet without taking the person’s dietetic history into account, which can significantly contribute towards malnutrition. Therefore, it is essential to ensure adequate protein intake. If an individual is consuming a higher quantity of protein, then he/she needs to reduce the protein intake based on the level of kidney function,” he said.
Dr Girish says that the necessity for dietary restriction is customised depending upon the stage and type of kidney disease. He says that a blanket diet should not be applied to people with kidney diseases, as it can be detrimental. “Certain types of restrictions may not be necessary in the early stages of kidney disease. Adequate protein intake is necessary as it often prevents malnutrition. In certain types of kidney diseases where potassium or phosphate levels are high, the appropriate restriction might be required,” he says.
Rakesh says that his father lost a lot of weight and became malnourished due to food restrictions. “Doctors explained to us the nutrients he needed and gave us a customised diet chart. We had to make him understand the importance of the diet and fluid restriction and now he is following it religiously,” Rakesh said.
What to eat and avoid?
Dr Kunal Gandhi, consultant nephrologist, Amrita Hospital, Faridabad, says that adults as well as children undergoing dialysis are asked to follow a normal diet and consume food with more nutrients. However, children are suggested to consume more protein (and other nutrients) compared to adults as they are in the growing phase, says Dr Gandhi.
Talking about restricting fluid intake based on urine output, he says that up to one and half litres of water is allowed per day which includes tea, coffee and other fluids. He adds, “One should not have direct table salt and can only consume two grams or a pinch of salt which is cooked. For some people, potassium becomes a problem despite undergoing dialysis. In such cases, potassium intake is restricted and we ask them to avoid potassium rich fruits and vegetables.”
According to Dr Gandhi, when a person is on regular dialysis, he/she is allowed to eat anything and there’s very less restrictions as dialysis removes the excess minerals. “For example, most green leafy vegetables and protein foods contain phosphorus. We allow people to eat them if they are on dialysis three times a week, as it removes the excess phosphorus. If an individual is having high phosphorous levels despite dialysis, we put them on phosphorous binder medications so that we don’t restrict more food items and they can get enough protein,” he said.
Dr Gandhi explains that when an individual consumes more salt, they feel thirsty and end up drinking more water, which gets accumulated in the body resulting in swelling of the feet, water in lungs, breathlessness and high blood pressure.
Extra protein for peritoneal dialysis
Dr Gandhi says that people undergoing peritoneal dialysis (PD) can consume more protein as there is more protein loss in PD compared to hemodialysis. “We suggest them to eat more protein as their body would have lost a lot of it during PD. The other restrictions and diet are the same as for hemodialysis,” he said.
Takeaways
- Dietary restrictions for an individual undergoing dialysis are customised depending upon the stage and type of kidney disease.
- Adequate protein intake is necessary as it often prevents malnutrition.
- Common items that are restricted include water intake, sodium, potassium and phosphorous.
- People undergoing peritoneal dialysis are suggested to consume more protein.
