By Maria Karalis, RD, LD, CSR The optimal renal diet is one that is customized to fit your needs. Such a diet will be specific based on your individual chemistries, medical history, lifestyle, likes and dislikes. It should generally be expected that most dialysis patients will require some type of restriction in sodium and fluid. This article will focus on tips for controlling your thirst and maintaining your weight gains between hemodialysis treatments. Sodium Sodium is a mineral that is found in many foods and in salt. Did you know that one teaspoon of salt has approximately 2300 mg of sodium? Using less salt is a good way of cutting down on sodium. However a cautionary note: many salt substitutes contain potassium chloride in place of sodium and must not be used while following the renal diet. Sodium is an important mineral that helps to control blood pressure. When your kidneys are not working properly, too much sodium makes your body hold fluid and this could be detrimental to your health. This can result in high blood pressure, edema and rapid weight gain. Sodium also makes you thirsty, making it difficult to adhere to your fluid allowance. The amount of sodium one is allowed on hemodialysis varies from two to three grams per day depending on your urine output. The more you urinate the more sodium is removed in the urine and the more sodium that is allowed in your diet. Your renal dietitian will teach you about the amount of sodium allowed in your diet. The foods listed in Table 1 are high in sodium and should be limited in your diet. However, all foods can fit and your dietitian can show you how to include some of these high sodium foods. Fluids When kidney function slows down, you make less urine. The less urine your body makes, the less fluid you can drink. Your fluid allowance is determined by the amount of urine produced in a 24-hour period. Most patients are restricted to 700 to 1000 ml of fluid per day plus urine output. For example, if you urinate 500 cc, your total daily fluid allowance would be 1200 cc (500 + 700). Excessive weight gain between treatments, increased thirst and edema are signs that you need to cut back on your sodium and fluid intake. Excess fluid in your body can result in edema, especially in your ankles and feet; fluid buildup around your lungs, leading to shortness of breath; congestive heart failure and high blood pressure. Dialysis nurses and technicians assess for signs and symptoms of fluid overload every time you come to dialysis. Low blood pressure and little or no weight gain between treatments are signs that you may increase sodium and fluid intake. But always check with your renal dietitian or nephrologist before doing this. Generally speaking, the goal is to maintain your weight gains to one to two pounds a day between treatments. Foods that are liquid at room temperature should be counted as part of your total daily fluid allowance. Examples of fluids are: Water and ice Sodas (colas, 7up) Koolaid or lemonade Popsicles Juices Jell-O Milk Ice cream, sherbet Coffee, decaf or tea Sauces, gravies Iced tea Soups
Additionally, use standard measuring cups for measuring fluids. 1 measuring cup of fluid = 8 ounces = 240cc 1 quart of fluid = 32 ounces = 960cc Two cups of fluid = Approximately 1 pound of weight
Tips on fluid and thirst control include: Ice lasts longer in your mouth than liquid. Try ice made from lemonade. (Keep in mind that ice needs to be counted as part of your fluid allowance.) Gum, hard candy (sour balls), or mints can help reduce thirst. Follow your low sodium diet. Remember, salty foods make you thirsty. Rinse your mouth with mouthwash or water without swallowing to help quench thirst. Lemon wedges can help alleviate thirst. Dry mouth can be relieved by eating something such as bread and jelly or bread with applesauce. If you are diabetic, good blood sugar control can help reduce thirst. Try very cold, low potassium fruit. Try frozen grapes. Use small cups or glasses instead of large ones. Know how much fluid your favorite glass or cup holds. The closer you follow your diet, the easier and less cramping you will have on dialysis.
Sometimes you may have to stay longer or come back for an extra treatment if you have gained too much water weight. Maria Karalis is a Registered Dietitian and Staff Developer in Staff Development with Fresenius Medical Care. She is a Board Certified Specialist in Renal Nutrition (CSR) and has been working in the renal industry for over 11 years. The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care. This article originally appeared in the May 2003 issue of aakpRENALIFE, Vol. 18, No. 6.
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