If you are undergoing haemodialysis (HD), your protein requirements will be increased due to dialysis related protein losses, elevated energy expenditure and persistent inflammation. Based on KDOQI (Kidney Disease Outcomes Quality Initiative) Clinical Practice Guideline for Nutrition, the protein needs are up to 1.0 - 1.2g protein per kilogram body weight per day.

For instance, for a 65kg person who is undergoing haemodialysis, the daily protein requirements are 65 – 78g protein per day. Hence, your daily protein intake varies depending on your body weight. If you are unsure of the exact amount or portion of protein you should be consuming, it is recommended that you consult your dietitian to get a diet plan.

References

If you are undergoing haemodialysis (HD), one of your goals would be to maintain your blood potassium level within the normal range on non-dialysis days. As haemodialysis is not done daily, there may be a build-up of potassium in your body. Hence, it is crucial to ensure your blood potassium level stays within the normal range by managing your food intake. If your blood potassium level increases progressively or remains persistently high, your doctor or dietitian may advice you to follow a low-potassium diet. This is in general defined as not more than 2,000 – 3,000mg potassium per day, or per your health professional’s advice.

While following a low-potassium diet, it is still important to eat well and avoid the risk of excessively low blood potassium level (hypokalaemia). If you are unsure which foods may be lower in, or higher in potassium, refer to these tables.

Haemodialysis (HD) will help to remove some but not all of the excess phosphorus from your blood. While undergoing haemodialysis, you may also need to consume more protein foods, which are usually high in phosphorus.

Your doctor may prescribe you with phosphate binders, which are medications that help to reduce the amount of phosphorus absorbed by your body from the foods you eat. This is to prevent a build-up of phosphorus in your blood which may lead to weak and brittle bones, increasing the risk of breakage. Take them as suggested by your doctor or dietitian.

If your blood phosphorus level remains within the recommended range, no restriction is needed but you are encouraged to adjust your daily food intake to maintain your phosphorus level within the recommended range. However, if your blood phosphorus level increases progressively or is persistently high even after treatment and medication, phosphorus restriction may be needed. When following a low phosphorus diet, aim to keep your phosphorus intake to 800 – 1,000 mg per day. Some tips to help you achieve this include limiting your intake of processed foods with phosphorus-based additives, and preparing home-cooked meals by using fresh ingredients.

Although haemodialysis (HD) helps to remove waste products, excess sodium and fluids from your blood, it is still important to limit your sodium intake to prevent:

• Increased blood pressure

• Thirst

• Weight gain due to fluid retention

• Discomfort during dialysis

There is consistent evidence that blood pressure and volume control can be improved when sodium intake is limited to less than 2,300mg/day.

Sodium is found in a variety of foods other than table salt. Other sources of sodium include:

• Commercial condiments and seasonings such as sauces, gravy mix/granules, bouillon cubes or liquid stock, ready-made pastes, ketchup, flavoured salts (i.e garlic, onion salt)

• Processed foods such as cold-cuts, sausages, cheese, canned foods, preserved foods (i.e salted fish, anchovies), smoked/cured foods, instant noodles, canned/instant soups, savoury snacks and pastries, microwaveable or ready-to-eat meals, fast-food

• Sports or isotonic drinks, packaged vegetable juice

References

Haemodialysis (HD) helps to remove waste products, excess sodium and fluids from your blood. However, it is still important to control your fluid intake to prevent fluid retention and minimize weight gain otherwise your HD treatments will need to be adjusted (i.e removal of more fluids).

With fluid retention, you may notice symptoms such as:

• Swelling in your face, arms and legs

• Increased blood pressure

• Shortness of breath (due to fluid build-up in the lungs) and consequent lung infections

• Heart failure (due to weakened heart muscles and/or enlarged heart)

How much fluid you need to restrict depends on factors such as weight gain between dialysis sessions and if any and signs of fluid retention. It is advisable to speak with your physician or dietitian to understand your body’s fluid balance and how much you should be taking each day.

References