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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Nutrition

Kidney Health: Eat Right on Hemodialysis (Fill in the Blank) (192)

Kidney Health: Eat Right on Hemodialysis (Fill in the Blank) (192) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition

192

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Eat Right on Hemodialysis (Fill in the Blank)

What can I eat?
Healthy kidneys help clear waste out of your body through your urine. Waste comes from the
body processing foods we eat and drink. Sick kidneys cannot keep up. As a result, waste and
fluid can build in your blood. This can make you feel sick. Hemodialysis can clear most waste
and fluid. Eating right can help make less waste build up in your blood. The less waste build up
in your blood, the better you will feel.

What does protein do?
Protein is needed to build and repair muscle. Protein also helps you fight off infections. Eating
enough protein can help you live longer on HD. People on HD need to eat more protein because
some protein is lost during the dialysis process.

How much protein can I eat?
Your dietitian will decide the amount of protein that you should have each day to meet your
body’s needs. A larger amount of protein can be found in meat, eggs and fish. Bread, cereal and
vegetables have small amounts of protein. Below is the number of protein choices you should eat
each day.

Your daily protein prescription is _______________________ grams.

Meat/Meat Substitute_____________ choices daily

ξ Each choice has 7 grams of protein. Each of these is equal to one
choice:
1 ounce beef, chicken, lamb, pork, fish
¼ cup salmon, tuna, crab, lobster clams
¼ cup cottage cheese
1 ounce or 5 medium shrimp
1 egg
¼ cup egg substitute
4 ounces tofu
*2 tablespoons peanut butter
*½ cup cooked beans, peas, or lentils
*1 ounce natural cheese (Swiss, Cheddar, etc)

*Choices higher in phosphorus and/or potassium

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Milk ____________ choices daily (Milk is limited in your diet
because it is high in potassium and phosphorus.)

ξ Each choice has 8 grams of protein. Each of these is equal to one
choice:

1 cup milk
1 cup yogurt or ½ C of Greek yogurt
¾ cup custard
1 cup (milk based) soup
½ cup ice cream
1 cup milk-based pudding
*2½ cups non-dairy substitute

* Make sure a non-dairy substitute does not contain phosphorus
additives.



Starches
Starches help provide energy and have fiber to help with constipation. You may need to limit
starches if you are diabetic or are trying to lose weight. Starches do not provide a large amount
of protein to your diet.

Starch ________________choices daily

ξ Each choice has 2 grams of protein. Each of these is equal to one
choice:
1 slice of bread, muffin, 2 inch biscuit, or dinner roll
½ cup double-cooked potatoes*
½ cup cooked rice or pasta
½ cup cooked cereal
½ hamburger bun, English muffin, bagel
¾ cup dry cereal
¼ cup Grapenuts®
2-4 inch pancakes
3 graham crackers (2 1/2 inch square)
6 saltines
2 ½ tablespoons flour
3 cups popcorn
½ of a 6 inch pita
1-7 inch flour tortilla
2-4 by ½ inch breadsticks

* See potassium section for how to double-cook potatoes






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Fat
Fat can help add calories if you are trying to gain weight. Some fat is needed in your diet for
your overall health.


What does sodium or salt do?
Salt is a mix of sodium and chloride. Sodium, a mineral, helps the body balance fluids. It exits
the body through the urine. When your kidneys are sick, sodium can build in your blood. This
can make you thirsty. The more fluid you drink, the more your heart works to pump the fluid
through your body. Over time, this can cause high blood pressure and congestive heart failure.

How much sodium can I eat?
ξ Do not use salt at the table.
ξ Use only half the amount of salt (or less) called for in recipes and in cooking.
ξ Limit sodium to less than 2000 mg per day.

Avoid foods high in sodium as listed below.

All salted or smoked meat/fish
ξ Bacon and Canadian bacon
ξ Bratwurst
ξ Canned tuna and meat entrees
ξ Corned beef
ξ Frankfurters, hot dogs
ξ Herring, sardines, and smoked fish
ξ Ham
ξ Luncheon meats
ξ Smoked sausage

Breads and rolls with salt toppings

Cheeses
ξ Camembert
ξ Cheese spreads, party dips, and processed cheese such as Velveeta® or American®
ξ Gorgonzola
ξ Roquefort

Fat _________ choices per day (45 calories per serving)

1 teaspoon margarine, butter, shortening 2 tablespoons sour cream or liquid creamer
1 teaspoon mayonnaise 2 tablespoons cream cheese
1 teaspoon cooking oil 3 tablespoons non-dairy milk substitute
1 tablespoon salad dressing ¼ cup whipped topping
1 tablespoon powder creamer

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Avoid foods high in sodium as listed below.

Convenience and processed foods
ξ Asian foods
ξ Bouillon cubes
ξ Frozen dinners
ξ Gravy and sauce mixes
ξ Packaged entrees, rice, potato, and noodle mixes
ξ Pickles, olives, relish
ξ Potato chips
ξ Pot pies
ξ Pretzels
ξ Salted nuts, popcorn, and snack crackers
ξ Sauerkraut
ξ Spaghetti (store brand)
ξ Soups: canned, frozen, or dehydrated.
ξ Tomato juice, canned tomatoes, sauce, and paste

Seasonings
ξ Lemon pepper
ξ Horseradish
ξ Meat tenderizers
ξ Monosodium glutamate (MSG)
ξ Salts: celery, garlic, onion, seasoned
ξ Sauces: Barbeque, chili, meat, soy, Worcestershire

DO NOT USE Salt substitutes that have large amounts of potassium such as: Morton’s Salt
Substitute®, No Salt®, Diamond Crystal®, Lite Salt



What can I use?
Try these spices and herbs to cut the salt but not the flavor.

Durkee Smart Seasons®
Dried horseradish
Flavored pan sprays
Fresh garlic
Fresh dried herbs
Herbal Bouquet®
Lawry’s Seasoned Pepper®
Mrs. Dash® (all types)

Pepper: black, red, or white
Powder: onion or garlic
Scallions, onions, shallots
Spike® salt-free
Tabasco®sauce
Veg-it®
Pleasoning® Mini-Mini Salt








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What about fluid?
Most people on hemodialysis need to limit their fluid intake. The amount of fluid you can drink
safely is based on the amount of urine output. If you drink too much fluid between hemodialysis
sessions, you may feel:
ξ Short of breath
ξ Weight gain
ξ Your heart works harder
ξ Swelling or edema
ξ Increased blood pressure

What are fluids?
Any food that you drink or food you eat that becomes liquid at room temperature.

Food Amount Ounces
Jell-O® (plain) ½ cup 4
Jell-O® (with fruit or veggies) ½ cup 2
Popsicle® 1 twin bar 2
Yogurt 4 ounces 3
Ice Cream or sherbet ½ cup 3

Many fruits and vegetables also have a lot of water in them.
ξ Melons, apples, oranges, grapes, tomatoes, lettuce, and celery
ξ Ice is a fluid

How much fluid can I have?
ξ You want to limit yourself to ____cups per day or ____ounces per day.
ξ You will want to avoid gaining more than 1-2 pounds per day.

How can I control my thirst?
ξ Drink from smaller cups, glasses, or cans
ξ Freeze juice and eat it like a popsicle
ξ Limit sodium intake

What does potassium do?
Potassium is found in your muscles. Your biggest muscle is your heart. Too much or too little
potassium in your blood can cause muscle cramps or stop your heartbeat.

How much potassium can I eat?
Hemodialysis helps to clear potassium out of your blood. Potassium can build in your blood
between hemodialysis sessions.







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Below is a listing of fruits and vegetables that contain low, medium and high amounts of
potassium. Your dietitian will let you know how many choices from each group you may have.

Low Potassium Group _______________ choices per day

ξ Each food is ½ cup or medium in size.
ξ Each choice has less than 150 milligrams potassium or 4 milliequivalents.

Fruit
ξ Apple juice, applesauce, or apple without skin
ξ Blackberries, blueberries, boysenberries, raspberries, or gooseberries
ξ Canned apricots, figs, fruit cocktail, grapes, Mandarin oranges, peaches, pears,
pineapple, or plums
ξ Cranberries, cranberry sauce, or cranberry juice
ξ Fresh grapes, lemon, limes, pears, pineapple, raspberries, rhubarb, strawberries, or
tangerines
ξ Nectars: peach, pear, or apricot

Vegetables
ξ Bamboo shoots, canned
ξ Beans - green or wax beans
ξ Broccoli and cauliflower, fresh or boiled
ξ Cabbage, 1 stalk of celery, or cucumber
ξ Eggplant
ξ Greens (raw or cooked): collards, dandelion, mustard, raw kale or turnip
ξ Hominy
ξ Leeks or onion: green, red, yellow, or white
ξ Lettuce: cos, romaine, iceberg, leaf, endive, or watercress
ξ Mushrooms
ξ Peppers: sweet or hot
ξ Double-cooked* potatoes
ξ Radishes, turnips, and water chestnuts
* See page 8 for how to double-cook potatoes


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Medium Potassium Group _____________ choices per day

ξ Each food is ½ cup or medium in size.
ξ Each serving has 150-250 milligrams of potassium or 4-6.5 milliequivalents.

Fruit
ξ Apple, with skin
ξ Canned cherries
ξ Fresh apricots, cubed casaba, 15 cherries, 2 figs, ½ of a grapefruit, orange, peach, 2
plums, or 1 cup cubed watermelon
ξ Juice: grape, grapefruit, orange, or pineapple juice

Vegetables
ξ Asparagus, frozen, cooked
ξ Artichoke heart, boiled
ξ Brussels sprouts
ξ Carrots
ξ Corn, canned or 1 small ear
ξ Garbanzo beans


ξ Greens, frozen, cooked: kale or turnip
ξ Mixed vegetables
ξ Okra, frozen or cooked
ξ Peas, green
ξ Summer squash: yellow, zucchini,
spaghetti, crookneck, or white scallop


High Potassium Group ________________ choices per day

ξ Each food is ½ cup or medium in size.
ξ Each serving has more than 250 milligrams potassium or 6.5 milliequivalents.

Fruit
ξ ½ of an avocado, banana, 1 cup cubed cantaloupe or honeydew
ξ Dried fruits: apricots, dates, figs, prunes, or raisins
ξ Kiwi fruit
ξ Mango
ξ Nectarine
ξ Prune Juice
ξ Tangelo

Vegetables
ξ Artichoke, 1 medium
ξ Beets and beet greens
ξ Dried beans and peas: kidney,
lima, navy, pinto, black-eyed
peas, or split peas
ξ Kohlrabi
ξ Potato: baked, boiled, fried, not
double-cooked


ξ Pumpkin
ξ Rutabaga, cooked
ξ Spinach
ξ Sweet potato or yams
ξ Tomato, fresh or canned
ξ Unsalted tomato or vegetable juice
ξ Winter squash: acorn, butternut, or
hubbard



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How to double-cook potatoes (to lower the potassium)
*This does not make potatoes a low-potassium food, but it can decrease the potassium
content by about half.

1. Wash and peel the potato.
2. Slice into thin slices.
3. Place the sliced potato in room temperature water. Use two times the amount of water to
the amount of potato.
4. Bring to a boil.
5. Drain the water and add two times the amount of water to the amount of vegetable of
fresh room temperature water.
6. Boil again and cook until soft and tender.

**Avoid Yukon gold potatoes as they will still be high in potassium after double-
cooking.


What does phosphorus do?
Phosphorus, a mineral, is important for your bones and teeth. When your kidneys are sick,
phosphorus builds up in your blood. This pulls calcium from your bones. Your bones can
become weak and prone to break. Calcium and phosphorus can settle in your soft tissues, your
blood vessels and your heart, causing damage to them also.

How much phosphorus can I eat?
To keep your bones healthy, limit your phosphorus intake. But because protein foods contain
phosphorus and you do need plenty of protein, your doctor may also ask you to take a medicine
with meals to bind phosphorus from the food you eat. When the phosphorus is bound with the
binder medicine, it will be excreted in the stool.

Examples of binder medicines include: Renagel®, Renvela®, Phoslo®, Tums®, or Fosrenol®.

What can I eat: Most of your phosphorus should come from good protein sources. But what else
can you eat? Your dietitian will let you know.

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Foods with a large amount of phosphorus:

Dairy products
ξ Milk
ξ Cheese
ξ Yogurt
ξ Custard and pudding
ξ Ice cream and ice milk
ξ Casseroles with cheese
Protein foods
ξ Meat
ξ Poultry and fish
ξ Eggs
ξ Organ meats
ξ Dried beans and peas
ξ Nuts, seeds, and peanut butter
ξ Soybeans and tofu
ξ Lentils
ξ Salmon and sardines

Grain Products*
ξ Bran products
ξ Oatmeal
ξ Brown rice
ξ Whole grain breads and
cornbread
ξ Wheat germ
ξ Boxed cake/bread mixes
*Ok to use to help with constipation
Other Foods
ξ Chocolate, cocoa
ξ Caramel
ξ Beer
ξ Carbonated colas
ξ Dried fruit
ξ Molasses
ξ Pizza


Phosphorus content of soft drinks:

High phosphorus
ξ Cola
ξ Diet cola
ξ Dr. Pepper®
ξ Cherry cola
ξ Some bottled iced teas*

Low phosphorus
ξ Ginger ale
ξ Grape soda
ξ Root beer
ξ Club soda
ξ Sprite®, 7-Up®, Slice®
ξ Orange soda (except Nehi®)
*Many bottled drinks, processed meats, and boxed baking items contain phosphorus additives,
which binders will not help much with. Examples are phosphoric acid, hexametaphosphate, or
tricalcium phosphate. Always read the ingredients list of packaged foods for “phos” foods.








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Resources
There are several cookbooks designed especially for people with kidney failure. These may help
add variety to your diet

The Gourmet Renal Nutrition Cookbook by Sharon Stau, RD, MPH, Sol Goldman Renal Therapy
Center, Lenox Hill Hospital Dialysis Unit, 100 E. 77th St., New York, NY 10021

Cooking the Renal Way by Council on Renal Nutrition of Oregon; (revised 1993), Oregon CRN,
P.O. Box 29133, Portland, OR 97210-9133

The Renal Gourmet by Mardy Peters, a kidney patient; Emenar Inc., 320 Charmille Lane,
Woodale, IL 60191

Living Well on Dialysis A Cookbook for Patients and Their Families; National Kidney
Foundation, New York, NY, Council of Renal Nutrition


Websites (ask your kidney dietitian for a handout with more websites)
www.kidneyschool.com
www.Davita.com
www.ikidney.com
www.culinarykidneycooks.com Recipes
www.kidney.org The National Kidney Foundation
www.kidneydirections.com


Teach Back
What is the most important thing you learned from this handout?


What changes will you make in your diet/lifestyle, based on what you learned today?


If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at:
(608) 287-2770

Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 2/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department
of Nursing. HF#192