Renal diet - peritoneal dialysis
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
- 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 phosphate (e.g. dairy and legumes)
Indications
Patients on peritoneal dialysis.
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 peritoneal dialysis require this diet specification.
- Consultation with a dietitian is required if this diet specification is to be removed, or used long term.
- Other diet specifications commonly used with peritoneal dialysis include fluid restriction and diabetic diet.
Paediatrics
Not suitable for use in paediatrics.
Suggested Meal Plan
| Meal | Sodium | Phosphate |
|---|---|---|
| Breakfast | <500mg Maximum two serves breads / cereals (e.g. one cereal + one bread) One serve milk | <250mg |
| Morning tea | <250mg | <100mg |
| Lunch | <600mg Maximum one main meal or salad or sandwich One serve dessert | <350mg |
| Afternoon tea | <250mg | <100mg |
| Dinner | <600mg Maximum one main meal or salad or sandwich One serve dessert | <350mg |
| Supper | <100mg | <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 dialysis.
- No salt sachets are provided on meal trays.
- Limit bread to six slices per day.
- Milk as a drink to be avoided. Milk should be provided for cereal and tea / coffee only, up to 250mL per day.
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 <300mg phosphate per serve (e.g. plain roasted meats, poultry, steamed fish, eggs) | Legumes and lentils(unless vegetarian) ≥15mmol (345mg) sodium per serve ≥300mg phosphate per serve |
| Sauces, gravies | Salt-reduced gravies and sauces Apple, mint and cranberry sauces Cheese sauce and white sauces (one tablespoon per day) Tomato sauce (one portion per day) | Soy sauce |
| Starchy vegetables / pasta / rice | White rice and pasta <2mmol (46mg) sodium per serve | Brown rice, wholemeal pasta ≥2mmol (46mg) sodium per serve |
| Vegetables | All others | Mixed legumes, e.g. three-bean mix |
| Soups | <6mmol (138mg) sodium per serve | ≥6mmol sodium per serve, e.g. tomato soup Cream soups made with milk Soups with added legumes (e.g. lentil soup, minestrone) |
| 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 <350mg phosphate for full salad | ≥20mmol (460mg) sodium per serve ≥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 <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 ≥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 | All fresh fruit and canned fruit | |
| Yoghurt | 100g yoghurt per day | - |
| Desserts | <8mmol (184mg) sodium per serve <70mg phosphate per serve e.g. pavlova, ice-cream, jelly, apple sponge, apple Danish, apple pie, mousse, jam roll | ≥8mmol (184mg) sodium per serve ≥70mg phosphate per serve Milk desserts, except ice-cream |
| 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) | > 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, 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.