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Dietary management post renal (kidney) transplantation

Renal (kidney) transplant refers to surgical process of removal of a kidney from healthy donor and placing the same in body of patient dealing with kidney failure. Diet principles change at several stages of kidney disease and likewise also after transplantation. To know about kidney transplant diet, click here

With the advent of new kidney, several lost functions are restored and hence, the dietary restrictions are few. Herewith outlined are a few dietary restrictions post renal (kidney) transplantation:

• For the first 6 weeks post-kidney transplant; you will need a high protein diet to counter the effect of surgery as well as the medications needed post- transplantation and to promote wound healing.
  • In order to increase the protein intake, you may prefer proteins with high biological value like egg whites, milk and milk products like curd, paneer, fish, chicken, etc.
  • A combination of cereal and pulse recipes like idli/ dosa/ khichdi, etc, too can form a good quality protein and should be preferred.
  • In order to minimize any chances of food infection post-transplant, you may be advised to prefer only well-cooked foods and avoid any raw food items like fruits, salads, chutneys, etc for first 6-8 months. Instead of raw forms, you may be asked to opt for fruits and salads in steamed form, for example – steamed apple/ pineapple/ carrots/ beetroot, etc.
  • Regarding your fluid and salt intake, it would be decided by your doctor depending on your parameters like urine output, BP, swelling, etc. If these parameters are well under control you may be asked to drink plenty of fluids (upto 4-5 liters initially) and salt intake would be liberalized.
  • Avoid sugar if you are a diabetic and if not, cut it down to a minimal requirement throughout the day. Replace table sugar from your routine diet with natural sweeteners like dates (check with your Renal Dietitian before making any changes in your sugar management).
• After 6 weeks post-kidney transplant; you may be advised to switch to your regular dietary routine; however, after your doctors recommendation.
  • In case you put on weight or your blood sugar rises after first 6 months, you may be asked to consult your dietitian
  • To gain access to some quick, easy and healthy kidney transplant recipes including lunch & dinner menus with sugar free desserts.

By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD

Dietary management in peritoneal dialysis (PD)

Calories and proteins

Peritoneal dialysis (PD) is another form of dialysis that utilizes the abdomen to filter out waste products. In this type of dialysis, the membrane of the peritoneal cavity (situated in the abdomen) acts as a filter (i.e dialyser). Hence, here the filter is natural as compared to artificial filter in hemodialysis (HD).

Patients on PD need to modify their diet in order to suit the PD therapy. They need to include a high calorie and as well as high protein diet. As PD is usually performed daily as against HD which is performed only thrice a week; the cumulative loss of proteins is higher in PD. To know more about protein complimenting recipes, click here

Hence, patients are recommended a high protein diet and in absence of high amount of calories, proteins may be used up for gaining energy; hence to avoid this, sufficient calories are needed.

While a trained Renal Dietitian can design a diet chart for PD patients according to their parameters and food choices; it is important to note that PD diet is more liberal as compared to HD diet due to higher frequency at which metabolic wastes are flushed off from the body as compared to HD. To gain access to high protein recipes for individuals on peritoneal dialysis, click here

Fluid and salt

Restriction of fluid and salt depends upon the urinary output of patient, blood pressure and cardiac status. If the patient has a good urine output, strict fluid and salt restriction may not be required. If the patient has poor urine output, it may lead of fluid overload which may further lead to breathlessness, swelling and raised blood pressure; hence in such cases, fluid and salt intake may need to be restricted. One must always check with the respective Nephrologist about the amount of fluid and salt that is allowed for daily routine.

Potassium

Generally strict potassium restriction may not be required as PD is performed on daily basis and hence the waste products, including potassium do not pile up in the blood. However, potassium intake should be individualized based on patients lab parameters. Potassium rich sources like coconut, avla, soups, instant gravies/ packaged items. etc should be consumed with caution. Patients should avoid low sodium salts in order to avoid raised potassium level in the blood.

Phosphorus

Similar to dietary potassium, dietary phosphorus too may not require strict restriction unless its level exceeds beyond its normal range. As most of foods containing high amount of phosphorus contain high amount of proteins too, they cannot be excluded from diet of PD patients.

Vitamins and minerals

Vitamins, minerals and trace elements are micronutrients required by the body to help with normal metabolism, energy production, cell function and growth. Supplementation of both may be needed in order to overcome oxidative stress, inflammation, etc and also to meet its demands in case of poor dietary intake.

By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD

Tips for managing potassium intake

Potassium is an electrolyte (a kind of a mineral in the body) that helps to move nutrients into the cell and drive waste products out of the cell. Its most vital function is regulating the heart beat and if this function gets altered, it may give rise to complications.

In patients with advanced kidney diseases, especially the ones on dialysis; the balance of potassium gets altered as kidneys are not able to flush it efficiently from the body. If left unattended, it may lead to emergencies which can be fatal. Hence, it is important to maintain potassium level under control through dietary restrictions. Herewith are a few practical tips for lowering dietary potassium intake:

• AVOID SALT SUBSTITUTES. In order to lower the blood pressure, some varieties of salt labelled as low sodium salt; contain potassium as their main ingredient. These are harmful for patients with kidney disease and should be completely avoided.
• Avoid coconut-based items like coconut water, coconut chutney, coconut laddos, etc
• Avoid nuts, dry fruits and fruits containing excessive amount of potassium like berries, cherries, peaches, plums, kiwis, etc. To know more about fruits that are safe for individuals with diabetes as well as kidney disease, click here
• Avoid vegetables containing high amounts of potassium like potato, sweet potato, arbi (colocasia), etc or consume them after leaching
• Leaching is a method that can reduce some amount of potassium from the food ingredient. To leach vegetables, chop them and either soak them in water for 2-3 hours and then discard water or chop them and boil them in plenty of water till they soften and then discard the water. Once water is discarded, vegetables are lower in potassium and can be used for preparing it. Remember leaching only removes some potassium, not all. To get access to some kidney friendly, easy, quick and healthy recipes including desserts, click here
• Similarly, to reduce the amount of potassium in dals and pulses, they can be soaked in plenty of water and then can be used after discarding the water. Dals and pulses both contain too much potassium and hence, portion control may be needed in order to limit potassium intake. A trained Renal Dietitian can help you achieve this.
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By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD

Diet for high uric acid

High amount of uric acid in blood may be seen when your diet is high in a compound known as purine. High amount of purine comes from diet rich in animal foods like beef, pork, poultry, fish and mainly organ meats such as liver, brain, etc. High uric acid levels may give rise to uric acid stones which may get deposited into the kidneys. Furthermore, it can also lead to deposition of uric acid crystals in joints, leading to a painful condition known as gout. Hence, it is important to keep uric acid in control.

Herewith are a few dietary instructions to maintain uric acid under control:

1. Prefer drinking enough water in order to maintain good hydration. Your urine should appear light yellow or clear, if it is dark yellow and concentrated; it signifies less hydration. This may trigger chances of stone formation. Hence, one should drink enough fluids to form at least 2 liters urine daily.
2. Limit intake of alcohol as it can increase uric acid levels in the blood.
3. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup. If you are a diabetic and looking for a sweetener, click here to understand which sweetener you may prefer
4. Avoid crash diets because they can make the urine more acidic, which makes it harder for uric acid to dissolve
5. Maintain a heathy weight. Obesity is one of the risk factors for developing high uric acid
6. Amongst vegetables and pulses with beans as they contain high level of purines; for example, spinach, french beans, broad beans, soyabean, kidney bean (rajmah), black eyed bean (lobia), fish, etc

1. Prefer whole grains and fibrous fruits and vegetables
2. Avoid excessive fat intake. Avoid double fried foods.

As uric acid is flushed off by the kidneys, high uric acid level may be seen if you have long standing kidney disease, i.e. chronic kidney disease (CKD). Hence, it is important to speak to your Nephrologist about lowering your uric acid level through medications as well as speak to your Dietician regarding diet for same. As patients with kidney disease may need fluid restriction, it is important to get individualized guidance. 

By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD

Tips for managing fluid and salt intake

Fluid management:

As kidneys are the ones who regulate the fluid status of the body, when under compromised state due to several conditions; they fail to do so. This leads to fluid accumulation in the body which manifests as symptoms like swelling on the feet, breathlessness, elevated BP, etc.

Hence, patients with advanced kidney disease and/ or the ones on dialysis are advised to lower their fluid intake. If the above symptoms persist, it is recommended that strict fluid input- output be maintained. In such cases the fluid allowance should be determined by measuring previous days urine output and adding 500 ml to it (this 500 ml extra is for insensible fluid losses that may occur through skin or respiration). To get answers to some frequently asked questions about kidney diet, click here

Herewith are a few practical tips to lower fluid intake for patients with advanced kidney disease and/ or on dialysis:

• Do not forget to include all liquids such as milk, tea, dals, etc. into fluids. Fluid does not refer to ONLY WATER
• Consult your Nephrologist about the total amount of fluids that can be consumed in a day and store that amount in a measured bottle
• Avoid drinking water from sources other than the measured bottle as it may increase fluid intake
• Avoid fluids such as soups, sherbats, cold drinks, canned beverages, fruit juices, coconut water, etc
• You may prefer sucking ice cubes (limit to 4-6 cubes a day) to overcome mouth dryness and excessive thirst
• Alternatively, you may simply rinse mouth with water at regular intervals as this method too can moisten the mouth
• Chewing gums (sugar-free if you are a diabetic) can help to control thirst; else you may prefer thirst quenching lozenges
• Avoid spicy, salty and fried food items as they attract water
• Avoid exercising in too hot weather

To know some Do’s and donts about dialysis diet, click here

Salt management:

Kidneys help in balancing electrolytes such as sodium and potassium. When they are unable to do so, the levels of these electrolytes may get disturbed in the blood. Excessive salt intake is associated with serious outcomes like elevated blood pressure/ stroke/ heart failure, etc. Hence, dietary sodium restriction is essential and herewith are few practical approaches to reduce daily salt intake:

• Avoid adding salt to the food while cooking. Portion out your food first and then add salt from the prescribed amount suggested by your doctor
• Avoid adding salt to food ingredients that can be eaten in saltless form like chapatis, rice, salad, curds, etc
• In foods that require salt like vegetables, dals, gravies, etc add minimal salt and adjust taste with ingredients like lemon juice, vinegar, amchur, salt free tamarind pulp, raw mango pulp, green chillies, mixed herbs, oregano, olives, etc
• Avoid papads, pickles, jam, jellies, sauces, etc
• Avoid items containing excessive salt like salted nuts, biscuits, dry fruits, chips, etc
• Avoid food items containing baking soda/ baking powder like cakes, pastries, pasta, pizzas, donuts, etc
• Avoid the use of salted butter, instead prefer homemade butter (makhan)
• AVOID SALT SUBSTITUTES as they contain high amount of potassium. Prefer salts containing iodized sodium chloride only.

By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD