and phosphate in kidney failure

Transcription

1 10916 MAIN DIET BROCHURE 14/05/02 16:38 Side 1 DIET and phosphate in kidney failure

2 10916 MAIN DIET BROCHURE 14/05/02 16:38 Side 2 CONTENTS This booklet The aim of this booklet is to help you to learn which foods you can eat safely and which you should eat less of if you have kidney problems. This should help you to understand the reasons why you are asked not to eat certain things. Each person is different with a different set of symptoms. You can adapt your diet to meet your own needs and requirements. Your doctor or dietician should be able to answer any specific questions that you have. Together, you should be able to create a unique, well-balanced and healthy diet that meets all your needs. Special diets don t have to be boring: there are plenty of delicious foods that are healthy. The booklet will help to guide you through the nutrients that are found in foods, focusing on phosphates, as it is of particular importance for patients with kidney failure who may have problems keeping their bones healthy. The booklet will then discuss the phosphate content of some selected foodstuffs and the value of other nutrients. Some foods low in phosphate are listed to help you to choose healthy and tasty combinations. If phosphate in your diet is not controlled, this can alter the calcium and phosphate balance in your body, and cause renal bone disease. Remember This booklet is only a guide. Consult your doctor or dietician if you have any questions! FOOTNOTE The words phosphate and phosphorus are often used interchangeably. Foods contain phosphorus and, where appropriate, it is phosphorus levels in foods that are depicted in this booklet. However, your doctor and dietician are likely to refer to it as phosphate. What do your kidneys do? 4 Diet for renal patients 5 Diet for patients with renal transplants 6 A balanced diet 7 The importance of phosphate and calcium 8 Renal bone disease 8 How does kidney failure affect calcium and phosphate? 8 Calcium + phosphate 9 Keeping your phosphate and calcium levels normal 10 What are phosphate binders? 11 Meat, fish, poultry and phosphate 12 Cereals, bread, nuts and phosphate 14 Cheese, milk products, eggs and phosphate 16 Fruit and phosphate 18 Vegetables and phosphate 20 Condiments and phosphate 22 Other essential nutrients 23 Protein 24 Energy (calories) 25 Fats 26 Fluid 27 Sodium (salt) 28 Potassium 29 Summary 30 3

3 10916 MAIN DIET BROCHURE 14/05/02 16:38 Side 4 WHAT DO YOUR KIDNEYS DO? DIET FOR RENAL PATIENTS Your kidneys have various functions. Amongst other things, they: Clear waste products from your blood (what is left when your body has used up all the useful nutrients). Remove excess water from your body and mix this with the waste products to make urine. Help to keep your bones healthy, by controlling the calcium and phosphate balance in your body. Control your blood pressure and red blood cell production. If you have kidney failure, your kidneys become unable to do their work and waste products and fluids build up in your blood, making you feel unwell. Your kidneys may eventually stop working completely. This is called end-stage renal failure and the kidneys work needs to be taken over by dialysis or a kidney transplant. There are two types of dialysis: peritoneal dialysis (PD) and haemodialysis (HD) and these are discussed in the other brochures in this series (see back page). In some cases, a kidney transplant may be performed so that a new kidney can take over the work of the failing kidney. It is important for you to remember that dialysis and transplantation may not return your kidney function to normal, but they can help to control your symptoms and improve your health. Dialysis gets rid of toxins and maintains fluid balance, relieving kidney failure symptoms and allowing patients to lead a relatively normal life. In haemodialysis, a machine takes over the role of the kidneys, clearing waste products and excess water from the blood. With peritoneal dialysis, waste products are filtered through the body s own peritoneum (a membrane in the abdomen). Creatinine levels: your doctor will use measurements of creatinine in your blood as a marker of the amount of work your kidneys can do and to decide which treatment you need. High blood creatinine levels may mean that your kidneys are not working well. Kidney Kidney If you have kidney failure, your kidney function will be seriously impaired. Your body will have problems getting rid of waste food substances and fluid. Another problem is that it can not get rid of excess amounts of useful fluids, such as potassium, sodium and phosphate. The build-up of waste can cause symptoms that you recognise such as itching, joint pain, tiredness and loss of appetite. If the waste builds up over a longer period of time it may cause more serious problems, e.g. renal bone disease caused by the build-up of phosphate (see page 8). This takes the strength out of your bones and increases the risk of them fracturing and breaking. When your kidneys stop working properly, you will need to change the way you eat. The changes you need to make to your diet will depend on: The sort of kidney disease that you have. The stage of kidney failure - your nutritional needs will change as your kidney failure progresses. The kind of dialysis you are on. Whether or not you have diabetes. Your height, weight and level of activity. How much you urinate. The dietary advice that you receive will also change at different stages of your disease. 4 5

4 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 6 DIET FOR PATIENTS WITH RENAL TRANSPLANTS A BALANCED DIET Healthy eating guidelines Reduce the amount of fat you eat (stick to polyor monounsaturated fat). Eat some high-fibre foods (wholemeal bread and cereals). Don t add extra salt to your foods and don t eat salty snacks and foods (especially if you have high blood pressure). After a kidney transplant, there is no reason why you should have to follow a restrictive diet, unless the transplant begins to fail. In theory, you have a new kidney and should be able to eat as you did before you developed problems. Simply follow the usual healthy eating guidelines: cut down on fat (especially saturated fat), sugar and salt, and eat more fibre! The drugs you are given following the transplant may cause changes in your appetite and an increase in weight. Your cholesterol levels may also increase; this can play a part in the development of heart disease. For these reasons it is even more important for you to follow healthy eating guidelines. Good nutrition is essential for good health. Nutrition is even more critical for people with problems such as kidney disease. There are certain healthy eating guidelines that all people, including patients with kidney failure, should follow. These are the same whether you are on dialysis or not or have had a transplant (see page 6). There are essential nutrients that become more important when you develop kidney failure. Their importance depends on whether you are a HD or PD patient (though there are usually less restrictions if you are on PD). For more information about diet at different stages of renal failure, see the other booklets in this series listed on the back cover. One of the most important nutrients to consider is phosphate: the amount of phosphate in your body can have a huge effect on your bone health. Eat with caution Eat moderately Eat freely 6 7

5 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 8 THE IMPORTANCE OF PHOSPHATE AND CALCIUM Healthy bone Early bone disease Renal bone disease Healthy bones depend on a fine balance between calcium, phosphate and vitamin D in the body. The kidneys control this balance and, if you have kidney failure, the balance will slowly tip over time and affect the health of your bones. Essential nutrients are lost from the bones making them weak and susceptible to breakage. Keeping calcium and phosphate balanced is important for strong bones and to avoid renal bone disease. How does kidney failure affect calcium and phosphate? If you have kidney failure: Your blood calcium levels may be too low. Your blood phosphate levels may be too high. Your blood vitamin D levels may be too low. Calcium + phosphate Phosphate is found in many foods and most people eat more than their bodies need. Too much phosphate in your blood upsets the balance of nutrients. Phosphate builds up, and calcium is pulled from bones over time, making your bones weak. Because of this phosphate build-up and its effect on bone health, you need to limit phosphate in your diet to avoid future problems. The imbalance of calcium and phosphate usually happens long before dialysis is required, but you may not notice any symptoms until after you have begun dialysis. Treatment should start early to avoid the long-term detrimental effects on your bones. Phosphate Calcium Advanced bone disease The sooner you start to think about your phosphate levels, the more your bones will benefit. The stronger your bones are before dialysis and transplantation, the better. 8 9

6 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 10 KEEPING YOUR PHOSPHATE AND CALCIUM LEVELS NORMAL WHAT ARE PHOSPHATE BINDERS? To minimise your risk of developing renal bone disease, your doctor may suggest you: Increase your calcium and vitamin D levels. Some phosphate binders contain calcium and you can get extra calcium from these (see next page). A vitamin D capsule or injection may also be given to provide what you are lacking and to help increase your blood calcium levels. Decrease your phosphate levels. Dialysis will get rid of some of the excess phosphate from your blood. Phosphate binders will also remove excess phosphate from your digestive system. But you will also need to reduce the amount of phosphate in your diet. Unfortunately, most foods contain phosphate, so if you cut out these foods altogether, your diet would lack in other essential nutrients. Your doctor or dietician will help you create a balanced diet. without reducing the amount of protein that you eat because they are contained in the same foods. But it is possible to cut down on phosphate just choose your foods carefully. Phosphate is found in foods like dairy products, chocolate, eggs, offal, shellfish and fish bones. The phosphate content of certain foodstuffs is discussed on pages Your doctor may give you a phosphate binder to help keep your phosphate levels low. These could be calcium carbonate or calcium acetate tablets that you take just before your meals and snacks. While in your digestive system, they latch-on to some of the phosphate that you eat and carry it out into your stools so that you do not absorb it. They may also contain calcium to help boost your blood calcium levels and strengthen your bones. However, there are phosphate binders available that do not contain calcium. Phosphate binders only work if you take them just before your meal! If you eat higher phosphate foods or eat bigger meals, you may need to take more phosphate binders. Your doctor will prescribe the tablets and work with you to decide what dose you should take. If you do not stick to your diet and you do not take your phosphate binders with every meal, your blood phosphate levels will increase. This sets off the chain reaction that causes the calcium levels in your blood to decrease so that calcium is pulled out of your bones to compensate. Do not take iron tablets and phosphate binders at the same time as they interact and the iron will not be absorbed properly! Food P phosphate P phosphate + binder P S T R E B L O O D As the name suggests, phosphate binders bind to phosphate in the stomach, preventing it from being absorbed into the bloodstream. This keeps blood phosphate levels low. A M Learning about the phosphate content of different foods can help you to keep your phosphate levels under control. It can be difficult to cut down phosphate intake 10 11

7 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 12 MEAT, FISH, POULTRY AND PHOSPHATE Meat, fish and poultry Avoid eating Prawns Fish with edible bones Fish roe Beef liver Chicken liver Offal Meat, fish and poultry are rich in protein AND phosphate. This can present problems in deciding which foods to eat. Protein is essential for every bodily function and for your overall health, but you may have to avoid foods with too much phosphate in them. Your challenge is to eat enough meat, fish and poultry to provide your body with the protein that it needs, but to choose those that contain relatively low levels of phosphate. These include poultry, lean meat and some fish without bones all of which are extremely healthy. Avoid very large helpings of meat if possible, unless your doctor or dietician tells you otherwise. Oily or fatty fish contain omega fatty acids. You may have heard of these: they are useful in protecting your blood vessels against blood clotting and heart disease and are especially important if you have heart problems. The body cannot make them itself and needs to obtain them from the diet. You can try to eat more oily fish (e.g., mackerel, salmon, trout, herring, sardines without bones) to boost your omega fatty acid levels. Bacon Pork chop Low phosphate content (1-99 mg/average portion) Bacon (lean and grilled) Beef, lean Frankfurter sausage Lamb Shrimp (canned and drained) Salmon Turkey Roast beef Shrimp Phosphate content per portion (approx 100g) of some meat, fish and poultry* *In food, phosphate is measured as phosphorus and it is phosphorus values that are represented in this table Moderate phosphate content ( mg/average portion) Beef (roast) Duck (roast) Lamb (lean) Pork chop (lean) Rabbit (stewed) Turkey (roast) Crab (boiled) Mussels (boiled) Squid Duck Leg of lamb High phosphate content (220+ mg/average portion) Chicken (roast, light meat) Beef kidney Pheasant Pigeon Pork liver Veal (escalope) Cod (baked fillets) Cod roe (hard and fried) Haddock (steamed) Halibut (steamed) Plaice (steamed) Prawns (boiled) Salmon (steamed) Sardines (canned in oil) Skate in batter (without bones) Trout (brown and steamed) Whiting (steamed) 12 13

8 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 14 CEREALS, BREAD, NUTS AND PHOSPHATE Cereals, bread and nuts Avoid eating Nuts Seeds Lentils Bran cereals Cereals and bread are a very good source of energy. It is unlikely that your cereals and bread intake will be restricted on account of their phosphate content, so you should be able to eat them quite freely. Rusk Baguette Focaccia Pasta Pitta Wholemeal bread Croissant It is always recommended, as part of a healthy balanced diet, that you eat wholemeal bread because this contains fibre, which helps to keep your digestive system healthy. Wholemeal bread does contain some phosphate, but it is important that you eat fibre and this is a very good source. You should avoid eating nuts and seeds as these contain high levels of phosphate. If you are a vegetarian you may need to get your protein from nuts and pulses, so you should speak to your dietician. Bagel Low phosphate content (1-99 mg/average portion) Cornflakes Crispbread, wheat Crispbread, rye Croissants Digestive biscuits, plain Foccacia Graham bread Macaroni, boiled Pitta bread, white Rusks Rye bread White bread Hazelnuts Pecan nuts Pistacio nuts (with shells) Bagel Rice Wheat crispbread Phosphate content per portion of some cereals, bread and nuts* (225g pasta or rice; 2 slices bread; approx 35g (handful) nuts) Moderate phosphate content ( mg/average portion) Baguette Muesli, with no added sugar Oatmeal Rice, white and boiled Wholemeal bread Almonds Brazil nuts Peanuts, dry roasted Walnuts Cornflakes High phosphate content (220+ mg/average portion) Bran, wheat Rice, brown and boiled Spaghetti, wholemeal *In food, phosphate is measured as phosphorus and it is phosphorus values that are represented in this table 14 15

9 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 16 CHEESE, MILK PRODUCTS, EGGS AND PHOSPHATE Cheese, milk products and eggs Eat less Milk Cheese Yoghurt Soups made with milk or cream Chocolate drinks Dairy products are an essential part of the diet. But because they are high in phosphate, you will be advised to limit your intake of these. Cheese is a good source of protein, but unfortunately it also has a high phosphate content. If you need to eat more protein, you should eat snacks that consist of bread and meat or fish rather than cheese. Cottage cheese Blue cheese Yoghurt Milk Cream cheese Brie You should try only to eat a small amount of the cheeses with moderate phosphate content from the table opposite. Phosphate content per portion of some cheese, milk products and eggs* (Approx 40g/wedge cheese; Milk products: approx 230ml/one glass milk; one 150g yoghurt; 2 medium eggs.) Low phosphate content (1-99 mg/average portion) Cottage cheese Cream cheese Sour cream Double cream Butter Margarine Moderate phosphate content ( mg/average portion) Blue cheese Brie Feta cheese Cheddar cheese (hard cheese) Edam High phosphate content (220+ mg/average portion) Cheese spread Parmesan Eggs, whole Chocolate milk/hot chocolate Skimmed milk Semi-skimmed milk Full fat milk Yoghurt, low fat Milk is a good source of calcium, but also contains a lot of phosphate, so you will need to drink only a small amount (1-2 small glasses) daily. Remember also that dairy products contain a lot of saturated fat, so as part of your healthy diet you should avoid eating too many of these. Saturated fat can increase your blood cholesterol and put you at greater risk of developing heart disease. These are very high in (saturated) fat so should only be eaten in small amounts *In food, phosphate is measured as phosphorus and it is phosphorus values that are represented in this table 16 17

10 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 18 FRUIT AND PHOSPHATE Fruit There is generally no need to worry about phosphate in fruit. Most fruits like apples, pears and oranges can be eaten without restriction. Pear Orange Mango Grapes Lemon However, some fruits contain a lot of potassium and you will need to watch out for this if your potassium levels are high (see page 29). Pineapple Melon Grapefruit Cherries Apple Phosphate content per portion of some fruits* (1 piece of fruit; handful of grapes, cherries, apricots; 120g slice mango, melon, grapefruit) Low phosphate content (0-99 mg/average portion) Apple, raw Apricots, dried^ Avocado^ Cherries, raw Figs, dried^ Grapefruit Grapes Lemon Mango, flesh only Melon, Honeydew Orange Pear Pineapple ^These items are particularly high in potassium *In food, phosphate is measured as phosphorus and it is phosphorus values that are represented in this table 18 19

11 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 20 VEGETABLES AND PHOSPHATE Vegetables Most vegetables can be eaten in unlimited quantities in terms of phosphate. Some vegetables do, however, contain a lot of potassium and you will need to watch out for this if your potassium levels are high (see page 29). If you are a vegetarian, you need to pay special attention to which vegetables you can eat. You also need to make sure you get enough protein (from beans, peas and pulses) as your intake of dairy products may be restricted because of its phosphate content. Brussels sprouts Leek Cauliflower Tomatoes Spinach White cabbage Carrots Broccoli Green beans Capsicum peppers Raw potatoes contain more potassium than boiled potatoes. It is therefore recommended to boil potatoes twice and throw away the water. In this way as much as half of the potassium is removed. Savoy cabbage Cucumber Beetroot Lettuce Red cabbage Aubergine (eggplant) Phosphate content per portion (approx 80g) of some vegetables.* Low phosphate content (0-99 mg/average portion) Aubergine (eggplant) Beetroot, boiled Broccoli, boiled Brussels sprouts, boiled^ Cabbage, boiled^ Carrots, old and boiled Cauliflower, boiled Cucumber Green beans, raw Green peas, boiled Lettuce Mushrooms, fried Okra, boiled Pepper/capsicum, green and raw Potatoes, new and boiled Spinach, boiled Sweetcorn, kernels canned and drained Tomatoes, raw Moderate phosphate content (100+ mg/average portion) Broad beans^ Potatoes, baked with flesh and skin^ ^These items are particularly high in potassium *In food, phosphate is measured as phosphorus and it is phosphorus values that are represented in this table 20 21

12 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 22 CONDIMENTS AND PHOSPHATE OTHER ESSENTIAL NUTRIENTS Garlic Salt Honey Chilli pepper Mustard Olives Olive oil Jam Sugar Condiments can help to make your food tasty and interesting. Some condiments and flavourings, such as mustard and garlic, are relatively high in phosphate. However, as they are eaten in such small amounts, they can generally be eaten quite freely. Things to watch out for are salt and olives. Table salt (sodium) should not usually be added to your food and olives should be avoided in large quantities if you have a problem with your potassium levels. In both cases it would help if you talk to your doctor or dietician. So far we have mainly focussed on phosphate as a nutrient. There are also many other important nutrients found in foods. They are all essential for a healthy balanced diet, but if you have renal disease you may have to adjust the amount of each nutrient that you eat by choosing your foods carefully. In this section you will become familiar with the functions of food constituents such as: protein, energy, fats, fluid, sodium and potassium As well as these nutrients, you also need to make sure you get enough vitamins and iron. Phosphate content per portion (approx 15 g) of some condiments and miscellaneous foods* Low phosphate content (1-99 mg/average portion) Chilli pepper Garlic Honey Jam Mango chutney Mustard, smooth Olives, in brine Sugar, white Tomato ketchup Mayonnaise Olive oil *In food, phosphate is measured as phosphorus and it is phosphorus values that are represented in this table Salmon 22 23

13 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 24 Foods rich in protein include: Meat, nuts*, fish*, beans* and pulses (lentils)*, dairy products (milk, cheese)*, eggs* *Fish with edible bones, dairy products, eggs and nuts have a high phosphate content Salmon Protein Protein from the diet is essential for building muscles, allowing the body to repair itself, fighting infection and replacing the protein lost in dialysis. Meat, fish, dairy products and beans are all good sources of protein. Everybody needs protein in their diet to prevent nutritional problems especially patients with kidney failure. If you are well nourished you are likely to do better on dialysis and be more able to fight infection. Protein is essential for life and is contained in all of the body s cells. When protein is digested it produces waste products such as urea, and patients with kidney failure have difficulty getting rid of such products. But people with kidney problems should not stop eating protein. Restricting protein intake may delay the need for dialysis because less urea and other waste products build up in the blood. But restricting your protein intake could cause loss of weight and malnutrition. In fact, malnutrition is a big problem for patients on dialysis and a healthy protein intake is recommended once you start renal replacement therapy. Patients on dialysis may be advised to eat more protein depending on the type of dialysis they re receiving. If you are on dialysis, you may find that you lose your appetite and you might not feel like eating certain foods. If this is the case, then your doctor or dietician may recommend that you take some special supplements to keep up your protein (and energy) levels. You may also lose protein into your dialysis fluid (especially on PD), which means that eating enough protein becomes even more important. Energy (calories) Calories are needed to provide energy and maintain weight. If you do not get enough energy in your diet, your body starts to break down your muscles to provide energy and this can worsen your disease. You can increase your energy intake by eating more carbohydrates (such as bread and pasta) and other energy-giving foods (sugar, jam, honey, oils, fat). If you have kidney problems, it is important to maintain your calorie intake so that you don t lose weight. Your doctor or dietician can advise you on which high-energy foods to eat, or you may be given special high-energy supplements to keep your levels up. This is especially true if you are on HD as, unlike with PD, HD fluid doesn t contain any extra energy. If you have diabetes, you should consult your doctor or dietician about your carbohydrate intake. Foods rich in energy include: Pasta, bread, rice, sugar, jam & honey, potatoes* *Potatoes are high in potassium Bagel 24 25

14 10916 MAIN DIET BROCHURE 14/05/02 16:39 Side 26 Foods rich in saturated fat include: Lard, butter and other animal fats Foods rich in polyunsaturated fat include: Sunflower oil, other plant oils Foods rich in monounsaturated fat include: Olive oil, olive oil margarine, rapeseed oil Fats Fats are a very concentrated source of energy and are stored by the body. They can be saturated, polyunsaturated or monounsaturated. Saturated fats, found mainly in animal products, have been found to increase bad (low-density lipoprotein [LDL] cholesterol, and can contribute to heart disease if too many are eaten. Polyunsaturated, and especially monounsaturated, fats are less likely to increase LDL cholesterol and are healthier (although they do contain as many calories). Olive oil Usually you would be advised to eat a diet that is low in fat. However, since loss of weight is an issue for kidney failure patients, your doctor or dietician may advise you to eat more fat to boost your calorie intake. You can compromise by eating monounsaturated or polyunsaturated fats, which have the same calories as saturated fat but are better for your heart. Fats can be visible such as butter and oil, but also invisible such as those found in cheese, biscuits and nuts. Fluid In healthy people body fluid is very carefully balanced. Healthy kidneys get rid of excess fluid from the body to control the body s water content. This extra fluid comes from water and liquids that you drink and from high-liquid foods such as soup and ice cream. If you have fluid overload you may have swollen ankles or a high blood pressure. If this happens suddenly, tell your doctor immediately because it can be dangerous. If you have kidney failure you cannot control the amount of water in your body and your kidneys make much less urine than normal or no urine at all. If you drink too much you may retain water (fluid overload; this can be dangerous) and if you drink too little you may become dehydrated. It can be difficult to find a healthy balance. If you are worried about the amount of fluid you should be drinking, talk to your doctor. Dehydration is the opposite of fluid overload. It can happen if you do not drink enough or if you are sweating or vomiting. If you are dehydrated you will also have low blood pressure, which will make you feel dizzy when you stand up. If this happens you should contact your doctor. If you are dehydrated you may need to drink more or your doctor may wish to stop your diuretics (water tablets). If you are on dialysis this will need to be adjusted to remove less water from your blood. Your doctor can advise you on fluid intake and you should not restrict your intake unless told to do so. Foods that contain a lot of fluid: Soup, ice cream, sauces, jelly, custard, yoghurt 26 27

15 10916 MAIN DIET BROCHURE 14/05/02 16:40 Side 28 Foods that contain a lot of sodium (salt) include: Crisps and snacks, salted nuts, convenience foods, table salt Sodium (salt) Sodium keeps water in the body and helps to control blood pressure. It is extremely important in helping to control your body s fluid balance. Table salt contains sodium, as do foods like crisps and convenience or processed foods and meats (bacon, sausages). You may be asked to eat fewer salty foods if you have kidney failure because they make you thirsty and drinking too much may cause fluid overload. Sodium is replaced by potassium in salt substitutes. Avoid these! If you are on HD, your fluid intake is likely to be more restricted than if you are on PD, so you may need to be extra careful about your salt intake. Salt Potassium Potassium is an extremely important mineral and helps the heart to function properly. It is present in many fruits and vegetables as well as in meat and dairy products. In healthy individuals, the kidneys regulate potassium but if you have kidney failure, this does not happen and potassium levels in your body can build up. If blood potassium levels are too high or too low, your heart can be affected. Your potassium levels will be monitored regularly. If they are high, your doctor or dietician will try to work out why and whether you may be eating too many foods that contain a lot of potassium. These include potatoes, chocolate, fruit and mushrooms and you may have to eat less of these. an intermittent therapy, your blood potassium levels may start to rise between treatments and you may need dietary advice to reduce your potassium intake. Foods rich in potassium include: Bananas, Brussels sprouts, mushrooms, chocolate, spinach, potatoes Potatoes Assume that, unless you are told otherwise, there is no need to restrict your potassium intake. PD patients rarely need to restrict their potassium intake because it is cleared from the blood every day. If you are on HD, which is You can chop potatoes into small portions, boil them and throw the water away to remove some of the potassium

16 10916 MAIN DIET BROCHURE 14/05/02 16:40 Side 30 SUMMARY This booklet is intended as a guide. Your diet will depend upon many factors. These include the stage of kidney failure you are at and the treatment you are on, e.g. peritoneal dialysis (PD), haemodialysis (HD) or if you have had a transplant. Your diet will also depend on: Your individual circumstances. Your age and weight. Foods you like. Your overall health. The facilities available at your renal unit. To help you understand how your diet will change in relation to which treatment you are on, there are a number of other brochures in this series. These are listed on the back cover. There should be a doctor or dietician available to discuss your dietary requirements and guide you on the combination of foods that is best for you. Please ask to see them to make sure that you are advised to eat a diet that is appropriate for you! Most importantly, you need to follow healthy eating guidelines and enjoy your food - diets do not have to be boring! 30

17 10916 MAIN DIET BROCHURE 14/05/02 16:40 Side 32 Booklets in this series include: Diet and phosphate in kidney failure Diet and limited kidney function (non-dialysis) Diet and peritoneal dialysis Diet and haemodialysis LEO Pharma GROUP DESIGN LEO Pharma CVR.NO