Kidney Dialysis Foundation

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1) LOW POTASSIUM DIET
Potassium
Potassium is a mineral found naturally in foods. It plays an important role in normal muscle and nerve activity, especially in the heart.

The kidneys remove excess potassium. People with kidney failure have reduced ability to remove excess potassium, thus causing accumulation of potassium in the blood.It is dangerous when blood potassium level is too high or too low.

Too high a level of potassium can cause muscle weakness, affect the heart rhythm and may even cause death. Too much potassium in the blood can be caused by eating too much high potassium food, fever, surgery, gastrointestinal bleeding and breakdown of body tissue.

Too low a level of potassium can happen when there is not enough potassium in the diet, vomiting, diarrhea, medications such as using potassium binding resins and diuretics preparation that increase the loss of potassium. Eating too little potassium can be dangerous to the heart too. Haemodialysis patients tend to have high levels of potassium while peritoneal dialysis patients tend to have low levels. As Haemodialysis is performed only three times a week while peritoneal dialysis is done on a daily basis and washes out more potassium.

Kidney failure patient should maintain the potassium level at a normal range of 3.5 - 5.0 mmol/L.

Many fruits and vegetables contain potassium. Limit to 2 servings of fruits and 2 servings of vegetables a day. Choose low potassium varieties.


Medium potassium foods (Limit intake)
Fruits:
Lychees	Melon	Plums
Strawberries	Pineapple

Vegetables:
Boiled broad beans	Peas	Baked beans
Pumpkin	Raw beetroot	Lady's fingers
Carrots	Sweetcorn	Cauliflower
Sweet potato	Boiled brussels sprouts	Radish
Raw cabbage	Boiled broccoli	Leeks
Celery	Lettuce	Green beans


High potassium foods (best to avoid)
Fruits:
Avocados	Peach	Apricot
Pomegranate	Cherries	Prunes
Figs	Raisins	Grapes
Dates	Nectarines	Banana
Orange	Sultanas

Vegetables:
Ginger root	Bamboo shoots	Mushrooms
All kinds of nuts	Tomato	Potato (jacket chips, roast chips)
Spinach	Lentils (boiled)	Yam
Green leafy vegetables	Lotus root


Other foods/drinks high in potassium to avoid
Coffee	Potato chips	Milo
Bottle sauces e.g. tomato ketchup	Ovaltine	Marmite
Alcohol	Stock cubes	Horlicks
Salt substitutes	Chocolate	Molassess
Chocolate products	Bran	Toffee
Coffeemate


	Remember:
	1. 2. 3. 4. 5. 6.	Always remember to cut vegetables into smaller pieces and soak in water for one hour before cooking. Boil and then discard the water. Do not make soup or gravy with it. Do not steam or use a pressure cooker or microwave oven or to stir fry your vegetables, always boil them in plenty of water so as to remove potassium. Potato is high in potassium, so potatoes for roasting or chips must be parboiled for 10 minutes first. Tinned fruit is lower in potassium than fresh fruit but always drain the juice before eating. Salt substitutes contain potassium and it is advisable to always read labels carefully. When in doubt about the food products, check with your doctor or dietician whether the products are suitable for you.

2) LOW PHOSPHATE DIET
Phosphorus is a mineral needed by the body for healthy bones. When kidneys do not function properly, they cannot remove excess phosphorus. Therefore, phosphorus builds up in the blood, which lowers the level of calcium which is also an important substance for building bones. Most of the body calcium is found in the bones. High blood phosphorus level causes the bone to release calcium into the blood. This will make the bones weak and cause them to break easily. Itching, bone pain and red eyes may occur too.

The normal blood phosphorus level is 0.85 - 1.45mmol/L. A blood test for phosphorus is the way to tell if the phosphorus is too high.


	How can you control phosphorus level in the blood?
	1.	Avoid high phosphorus products in your diet.
	2.	Take phosphate binders. Phosphate binders such as calcium carbonate and aluminium hydroxide preparations such as Alutab combine with the phosphorus in foods and is eliminated in the stool, preventing it from getting into the blood stream. This medication should be taken WITH meals, otherwise it will not be effective.

High Phosphorus Foods
Phosphorus is found mainly in dairy products and other high protein foods.


Drinks
Cocoa	Malted drinks eg. Horlicks, Ovaltine

Dairy Products
Milk	Cheese	Yogurt
Ice Cream

Cereal Products
All bran	Muesli	Oatmeal
Wheat germ	Raisin bran	Waffles
Shredded wheat	Yeast extracts e.g. marmite, bovril	Chocolate cake
Wholemeal breads	Foods containing a lot of baking powder e.g. rock buns, scones

Vegetables*
Beans, peas	Lentils	Soyabeans
Pumpkin seeds	Sunflower seeds	All kinds of nuts
* Beans, peas and soyabeans may be included in the diet if eaten as a substitute for fish or meat.

Meat, Fish and Poultry
Liver	Seafood e.g. prawn, crab, lobster	Egg yolk
Kidney	Fish with edible bones e.g. sardine, ikan bilis


	IMPORTANT
	1.	Restrict to a minimal amount or avoid food that contains high phosphorus.
	2.	Some of the food may also contain a high amount of potassium, so be careful when selecting them.
	3.	Remember to take phosphate binders WITH food. Do not stop taking them on your own. If you have a problem with taking such phosphate binders, discuss with your doctor in-charge, dietician or nurse.
	4.	When in doubt about the food products, check with your doctor or dietician whether the products are suitable for you.
	5.	Taking phosphate binding medication regularly and avoiding high phosphorus food can help you control phosphorus levels.

3) FLUID MANAGEMENT IN DIALYSIS
Healthy kidneys eliminate excess water as urine. People with renal failure usually make little or no urine, so they depend on dialysis to remove excess water. Therefore, in renal failure it is essential to control the volume of fluid intake to prevent the body from fluid overload, which causes complications.


	Fluid overload can cause:
	1.	An increase in blood pressure This increase of blood pressure causes damage to the blood vessels, headache, blurred vision and stroke. Excessive fluid overload causes strain and stress on the heart which will cause it to develop into "big" heart. As a result, the heart becomes weak, which makes a patient unable to tolerate ultrafiltration and has continual heart problems.
	2.	Shortness of breath Excessive fluid can lead to water filling the air sacs in the lungs. This will reduce the air space in the air sacs where gaseous exchange takes place, causing renal patient to complain of difficulty in breathing even when lying down.
	3.	Swollen eyelids and ankles or feet
	4.	Distended abdomen

To prevent these complications from happening, it is essential to follow the fluid allowance as ordered by the renal physician.


	TIPS IN FLUID CONTROL
	1.	Count all fluids (even those sips taken with medications), all ice cubes, gravies, soups, oats, porridge, puddings, etc in your fluid allowance.
	2.	It is important to measure all the fluids in the diet accurately. You may like to measure a jug of water every morning containing your restricted amount you can take for the day. As the day goes by, pour from the jug for drinking or even cooking or making ice cubes.
	3.	Reduce salt intake as this will help to decrease thirst.
	4.	Avoid adding salt, soya sauce, tomato ketchup and any other sauces to meals at the table.
	5.	Avoid salty food e.g. bacon, ham, salted fish, smoked fish, salted vegetables, salted eggs, salted chips, salted nuts, cheese, etc.
	6.	Add garlic, onions, herbs or spices to food for extra flavour in order to reduce salt used in cooking.
	7.	Avoid canned food as they contain high salt content.
	8.	Instead of a few large drinks, divide daily fluid into smaller but more frequent drinks. It may also help if you use a smaller cup each time.
	9.	Ice cubes are more thirst quenching than water. But remember to count them in the daily fluid allowance. It may be helpful to take 100 mls of the fluid allowance each day and make that into ice cubes.
	10.	Take medicine with food. Some medications need little or no fluid to swallow if taken with food. If this is not possible, remember to count the fluid used in taking the medications into the fluid allowance.
	11.	When your mouth feels very dry, rinse with water, gargle if necessary, but do not swallow it. Alternatively, you can suck a slice of fresh lemon as this helps to stimulate salivation.
	12.	Some people find sucking sweets can also help to quench thirst. Choose sugar-free sweets if you are diabetic.
	13.	Save your fluid allowance if you are going out.
	14.	Try to sip drinks or use a straw, as they will last much longer. You can try to squeeze some lemon juice into your water.
	15.	Try to keep yourself busy. You will find it much easier to keep to your fluid allowance if you are busy and not always thinking about your next drink.
	16.	Clean your teeth regularly. Use mouthwash to freshen your mouth and throat.
	17.	Weigh yourself daily and check your weight gain. If you are on haemodialysis, you should not put on more than 1.5 - 2 kg between dialysis.
	18.	Be sure to measure your favourite cup or mug, so that you will not under or over estimate the amount of fluids each time you drink. 1 full tea cup = 200mls 1 scoop ice-cream = 60mls 1 full coffee mug = 300 mls 1 packet drink = 250mls 1 full glass = 200 mls 1 standard ice cube = 30mls 1 tablespoon fluid = 15mls When in doubt about your fluid requirements, always discuss with your doctor, dietician or dialysis nurses.

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