Fact sheetDiet specifications

Published on 1 Nov 2011


Renal diet - haemodialysis

This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.

Aim

To provide a diet with the following nutrient content:

  • energy: at least 9500kJ per day
  • protein: at least 90g per day
  • sodium: <100mmol (2300mg) per day
  • potassium: <70 mmol per day
  • phosphate: <1200mg per day

Characteristics

  • protein choices from foods of high biological value (such as meat, fish, poultry, eggs and limited dairy)
  • limits foods high in sodium
  • limits foods high in potassium (milk, yoghurt, legumes, nuts, and some fruit and vegetables)
  • limits foods high in phosphate (eg dairy and legumes)

Indications

Patients on haemodialysis.

Nutritional adequacy

This diet may not meet individual nutrient requirements due to the individual needs and treatment of this patient group. Supplementation may be required.

Precautions

  • Not all patients on haemodialysis require this diet specification. For example, a low-potassium diet may not be required; nor will it be needed if a patient is eating poorly.
  • Monitoring by a dietitian is required if this diet specification is to be removed, combined with other diet specifications, or used long term.

Paediatrics

Not suitable for use in paediatrics.

Suggested Meal Plan

MealSodiumPotassiumPhosphate
Breakfast<500mg <15mmol (585mg) <250mg
Morning tea<250mg <5mmol (195mg) <100mg
Lunch<600mg <20mmol (780mg) <350mg
Afternoon tea<250mg <5mmol (195mg) <100mg
Dinner<600mg <20mmol (780mg) <350mg
Supper<100mg <5mmol (195mg) <50mg
  • Encourage use of high-energy items such as plain sweet biscuits, cream biscuits, croissants, marshmallows, small bags of sweets (e.g. boiled lollies, jellybeans, glucose lollies, jubes, Minties™, pavlova, cream, margarine) to help increase energy intake.
  • Consult a dietitian for advice about whether high-energy items are suitable for use with patients with diabetes on haemodialysis.

Specific menu planning guidelines

Allowed Not allowed
Hot main dishes

Plain roasted and grilled meat, fish and poultry

At least 20g protein per serve

<15mmol (345mg) sodium per serve

<10mmol (390mg) potassium per serve

<300mg phosphate per serve (e.g. plain roasted meats, poultry, steamed fish, eggs)

Legumes and lentils(unless vegetarian)

≥15mmol (345mg) sodium per serve

≥10mmol (390mg) potassium per serve

≥300mg phosphate per serve

Sauces, gravies

Salt-reduced gravies and sauces

Apple, mint and cranberry sauces

Tomato sauce (one portion per day)

Cheese sauces and white sauces (only one tablespoon per day)

Soy sauce
Starchy vegetables / pasta / rice

Plain rice and pasta

<2mmol (46mg) sodium per serve

Potato: limit to one serve per day, <7mmol (273mg) potassium per serve

Note: To reduce potassium content, boil in large volume of water, rather than steaming or roasting

Brown rice, wholemeal pasta

≥2mmol (46mg) sodium per serve

≥7mmol (273mg) potassium per serve,
e.g. baked potato with skin and potato chips

Vegetables

<5mmol (195mg) potassium per serve

Four serves per day

Note: To reduce potassium content, boil in large volume of water, rather than steaming or roasting

≥5mmol (195mg) potassium per serve

Any vegetables served with cheese sauce or white sauce

Mixed legumes, e.g. three-bean mix

SoupsNoneAll
Sandwiches

White, wholegrain and wholemeal bread

At least 10g protein per serve

<20mmol (460mg) sodium per serve

<300mg phosphate per sandwich (e.g. unsalted meat, chicken, egg, reduced-salt canned fish)

≥20mmol (460mg) sodium per serve
Salads, dressings

<20mmol (460mg) sodium for full salad

<15mmol (585mg) potassium for full salad

<5mmol (390mg) potassium for side salad

<350mg phosphate for full salad

≥20mmol (460mg) sodium per serve

≥15mmol (585mg) potassium for full salad

≥5mmol (195mg) potassium for side salad

≥350mg phosphate for full salad

Breads, cereals

White, wholegrain and wholemeal bread

Limit bread to six slices per day

Most plain breakfast cereals, with the following allowances per serve:

<13mmol (300mg) sodium

<8mmol (310mg) potassium

<150mg phosphate
e.g. rolled oats made with water, Weet-bix™, Light n Tasty™, Special K™, Sustain™, Guardian®, Just Right® (tropical or apple), Mini-Wheats® (whole wheat or strawberry); many other cereals not listed may meet these allowances and could be used

White rice and pasta

Unsalted unflavoured rice cakes

Breakfast cereals with the following allowances per serve:

≥13mmol (300mg) sodium

≥8mmol (310mg) potassium

≥150mg phosphate

e.g. All Bran®, Sultana Bran®, muesli, rolled oats made with milk

SpreadsSalt-free butter and margarine, jam, honey

Regular butter and margarine

Peanut butter, Vegemite™, Marmite™

Hot breakfast choices

Plain boiled, poached or scrambled eggs and omelettes, prepared with no added salt

Reduced-salt baked beans (90g or 1/3 cup)

Reduced-salt canned spaghetti

Baked beans

Bacon, sausages, canned spaghetti

Egg dishes prepared with salt

Fruit

<5mmol (195mg) potassium per serve, e.g. fresh apples, grapes, pears, oranges, watermelon, mandarins

All canned fruit (preferably drained)

≥5mmol (195mg) potassium per serve, e.g. apricots, bananas

Dried fruits

Yoghurt100g yoghurt per day-
Desserts

<5mmol (195mg) potassium per serve

<8mmol (184mg) sodium per serve.

<70mg phosphate per serve

At least one choice with <2.5mmol (97mg) potassium per serve must be offered per day
e.g. pavlova, ice-cream, jelly, apple sponge, apple danish, apple pie, mousse, jam roll

≥5mmol (195mg) potassium per serve

≥8mmol (184mg) sodium per serve

≥70mg phosphate per serve
e.g. rich chocolate, fruit or banana cake

Milk and cheese

Milk for cereal, tea and coffee (<250ml per day)

Any plain milk (cow, soy, goat)

One slice cheese per day

Hard cheese as allowed in hot main and sauces, salad or sandwich limits

Ricotta and cottage cheese allowed

All milk (including soy milk), other than for cereal, tea and coffee

Hard cheese if above meal limits

Portion-control cheese at mid-meals

BeveragesTea, cordial, non-cola-based soft drinks
Limit coffee to three cups per day

Milk and milk-based drinks, Sustagen™

Fruit and vegetable juices

Milo®, Aktavite®, Ovaltine®, cocoa

Bonox®

BiscuitsPlain refined-flour crackers and biscuits
(e.g. Sao™, Milk Arrowroot™, Morning Coffee™, Ryvita®, rice cakes)

>1.5mmol (58mg) potassium per serve of two biscuits, e.g. some chocolate, wholemeal or fruit biscuits

>3mmol (69mg) sodium per serve of two biscuits or portion-control pack (e.g. Jatz™)

Miscellaneous

Herbs, spices, vinegar, lemon wedge, pepper

Chutney and pickles (small amounts only)

Sugar, cream

Nuts, olives

Monosodium glutamate (MSG), salt sachets, coconut, dried fruit, chocolate

References

  1. Ash S, Campbell K, MacLaughlin H, McCoy E, Chan M, Anderson K et al. Evidence based practice guidelines for nutritional management of chronic kidney disease. Nutr Diet 2006;63 Suppl 2:S33-45.
  2. Dietitians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
  3. American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. [accessed 17 March 2010].
  4. National Kidney Foundation. Potassium and your CKD diet. [accessed 17 March 2010].
  5. Voss, D. Potassium in pre-dialysis patients. Nephrology 2005;10 Suppl 5:S188-90.
  6. Caring for Australians with Renal Impairment. CARI guidelines: potassium in pre-dialysis patients. 2004.
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