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
| Meal | Sodium | Potassium | Phosphate |
|---|---|---|---|
| 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 ≥7mmol (273mg) potassium per serve, |
| 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 |
| Soups | None | All |
| 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 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 |
| Spreads | Salt-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 |
| Yoghurt | 100g 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 | ≥5mmol (195mg) potassium per serve ≥8mmol (184mg) sodium per serve ≥70mg phosphate per serve |
| 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 |
| Beverages | Tea, 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® |
| Biscuits | Plain 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
- 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.
- Dietitians Association of Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
- American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. [accessed 17 March 2010].
- National Kidney Foundation. Potassium and your CKD diet. [accessed 17 March 2010].
- Voss, D. Potassium in pre-dialysis patients. Nephrology 2005;10 Suppl 5:S188-90.
- Caring for Australians with Renal Impairment. CARI guidelines: potassium in pre-dialysis patients. 2004.