Category: Blogs

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

Diet for Chronic Kidney Disease

Diagnosed with Chronic Kidney Disease (CKD), need not worry about your diet!

Let not the thought of a restrictive diet haunt you!!

Yes, it does need changes but slowly and gradually, you can adapt to it.

We can walk you through some tips that can help you select your food items wisely and then we shall look into some kidney friendly recipes too!

Few tips for diet in CKD:

1. Salt restriction: It is of prime importance in CKD. Salt and fluid restriction are needed to avoid complications of CKD like raised blood pressure, swelling on feet/ face, breathlessness, etc. To get answers to some frequently asked questions about kidney diet, click here

Myth: Kidney patients should prefer low sodium salt.

Fact: Kidney patients should not prefer low sodium salt, they should rather prefer normal sodium and iodised salt but in less quantity. Also, they should not prefer a NO SALT diet, but a LOW SALT diet.

Practical tips: Avoid adding salt to chapatti, rice, salads, curd. Add salt only to vegetables/ dals and breakfast/ snacks. Avoid foods with extra salt like baking soda/ baking powder; namely breads, biscuits, khari, butter, toasts, etc.

2. Fluid restriction: As kidneys are responsible for flushing out extra fluid from body, so when kidneys cannot perform this function; fluid can begin to accumulate in the body. This can give rise to symptoms like raised blood pressure, swelling on feet/face, breathlessness, etc. Hence, always talk to your Nephrologist about your fluid intake.

Myth: Drinking more water can help in flushing out toxins like creatinine from body.

Fact: When kidneys are not able to do their work efficiently, it leads to accumulation of fluids and hence, fluid intake should be restricted.

Practical tips: Use a bottle with measurement marks on it, to track your fluid intake. Remember to count all liquids (at room temperature) like tea/ milk/ dal/ kadi/ kadha/ buttermilk/ ice cream, etc as fluids.

3. Potassium restriction: Potassium restriction is required in case your potassium level rises in blood. It is a dangerous element as it can lead to harmful consequences like cardiac arrest (stops the functioning of heart).

Myth: Potassium is not as dangerous as creatinine for kidney patients.

Facts: Potassium is much more dangerous than creatinine as it can lead to cardiac arrest (sudden stoppage of heart) while creatinine does not do so.

Practical tips: For lowering the potassium intake, avoid coconut water and coconut based items like chutneys, etc, fruit juices, soups, sherbats, alcoholic beverages and neera.

4. Protein restriction: CKD diet requires restriction of proteins; however, they should not be completely eliminated from diet. Protein intake for normal individuals should be 1 gram per kg body weight. In CKD, this needs to be lowered down to 0.6-0.8 gram per kg body weight.

Myth: Proteins should be completely stopped from diet if you have CKD.

Fact: This does not serve the purpose, on the other hand; it can cause reverse outcome which is malnutrition. Protein intake should be reduced only if the intake is high and this should be done under the supervision of a Renal Dietician. Talk to your Dietician to know whether you need protein restriction. On a practical note, a Jain patient may already be eating low protein as compared to a Christian patient. So, a Renal Dietician can help you with this.

Practical tips: Avoid eating too many proteins in a single meal. Spread out proteins in every meal in limited quantity, for example – one can prefer milk or curd in breakfast, dal or pulse or egg white in lunch and dinner.

At times kidney patients have to struggle with their meals as they may not be tasty due to low salt intake, so if you are looking forward for some LOW SALT but highly tasty kidney friendly side dishes, click here

By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD

Diet for hemodialysis

Initiated on dialysis and worried about what to eat and what not?

Relax, we can help you stay healthy and eat healthy while on dialysis.

We can walk you through some tips that can help you select your food items wisely and then we shall look into some dialysis friendly recipes too! To get access to low salt, low potassium, high protein dips for dialysis patients, click here

Few tips for diet in dialysis:

• Salt restriction: Eating excessive salt can make you feel thirsty. Drinking excessive water can lead to fluid burden in your body which can result into accumulation of fluids in body. Hence, salt restriction is essential while on hemodialysis.

Myth: Salt substitutes are healthy for dialysis patients.

Fact: Salt substitutes like low sodium salts contain potassium which is a dangerous element as excessive potassium can cause changes in normal rhythm of the heart and can be fatal.

Practical tips: Avoid salted nuts, snacks, biscuits, dry fruits, etc. Avoid adding salt to chapatti, rice, salads, curd. Add salt only to vegetables/ dals and breakfast/ snacks. Instead of salt, you may use other flavouring agents like lime, vinegar, amchur powder.

• Fluid restriction: Yes, fluid restriction is carried further from CKD to dialysis as well. This is because kidneys are no longer able to flush out extra fluids from the body. Dialysis begins at the last stage of kidney disease and it helps in flushing off extra fluids; along with toxins, hence fluid restriction is essential. Talk to your Nephrologist about the amount of fluid that you can drink.

Myth: Water drunk during dialysis session can get flushed from the machine at the same time.

Fact: Water drunk cannot get flushed out from the body at the same time.

Practical tips: You may opt to drink luke warm water instead of cold water as warm water is difficult to be had in a large quantity while cold water can be had easily. To reduce the fluids intake, warm water can prove to be beneficial.

• Potassium restriction: Potassium restriction is required in case your potassium level rises in blood. It is a dangerous element as it can lead to harmful consequences like cardiac arrest (stops the functioning of heart).

Myth: Potassium is not a dangerous parameter.

Facts: Potassium is a SILENT KILLER! Especially for patients with heart problems, it can lead to sudden cardiac arrest (sudden stoppage of heart) without warning sings.

Practical tips: For lowering the potassium intake, prefer rice chapatis or bhakhris over wheat chapatis. Prefer kadi over curd. Prefer leaching vegetables and dals/ pulses. Avoid coconut water and coconut based items like chutneys, etc, fruit juices, soups, sherbats, alcoholic beverages and neera. To view low potassium vegetable recipe, click here

NOTE: Leaching is process which involves chopping and either soaking vegetables (or dals/ pulses) in large quantity of water or boiling vegetables in large quantity of water and then discarding water. This helps in reducing the potassium content from vegetables or dals/ pulses.

• Protein supplementation: Once on dialysis, you need to eat extra proteins to compensate for the loss of proteins during dialysis procedure. If you are on hemodialysis, you need to eat 1.2 grams proteins per kg body weight per day (i.e. 20% more than the protein intake for normal individuals). To incorporate this extra proteins intake, you may need artificial supplements like high protein powders or high protein biscuits. You may talk to your Nephrologist/ Renal Dietician for same. To gain access to high protein dialysis friendly recipes, click here

Myth: Over the counter protein supplement can be preferred by dialysis patients.

Fact: Dialysis patients need special supplements which are low in electrolytes, phosphorus and high in calories as well as proteins. They are specially designed keeping the needs of dialysis patients in mind. Hence, any over the counter protein supplement should not be preferred.

Practical tips: To increase your protein intake, you may opt:

• 4-6 egg whites a day or
• 80-100 grams paneer (chenna/cottage cheese) a day or
• 25 grams of defatted soya chunks

In addition, it is advisable to have cereal – pulse combination based items as they are good sources of protein too, for example – khichdi/ idli/ dosa/ uttapam/ etc.

By-

Dr Rachana Jasani,

Renal Nutritionist,

PhD, RD