Living Well on Dialysis Cookbook

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Introduction

Good nutrition is the key to good health for everyone. It is especially important for people with chronic kidney disease. Even with the help of artificial kidney treatments (dialysis), you cannot get rid of all the wastes and fluids that build up in your body from what you eat and drink.

You can work closely with your renal dietitian to decide on a meal plan that is best for you and includes some of your favorite foods. Your individual meal plan will be based on your age, your weight, foods you like, your dialysis treatments and other medical conditions such as diabetes, heart disease and high blood pressure. It will be tailored to your needs but may not meet the specific needs of other patients. Most people with kidney disease must modify their intake of certain nutrients such as protein, potassium, sodium, phosphorus and fluid. Each person has different needs. Following the meal plan suggested by your renal dietitian will help you feel your best.

Calories are needed to provide your body with energy to allow it to function properly. Your renal dietitian can help you plan a meal plan containing the right balance of calories from different sources to keep your body healthy.

Protein is used to build and repair tissue. Many of the foods you eat contain protein. The best sources of protein are dairy products, eggs, meat, poultry (chicken, turkey, etc.) and seafood. Breads, cereals and vegetables are mostly carbohydrates but also contain a small amount of protein.

Carbohydrates provide fuel or energy for your body in the form of starches and sugars. The major sources are breads, cereals, fruits, grains and vegetables. If you have diabetes you may be watching your carbohydrate intake to help control your blood sugar.

Fat is a concentrated energy source that adds flavor, moisture and calories to food. It is often added to a meal plan for chronic kidney disease to provide much needed calories to help gain or maintain weight and add flavor to food. If you are overweight and wish to lose weight, your dietitian or doctor may recommend limiting the fat in your diet. Certain kinds of fat may also be recommended for you to use if you are concerned about your blood lipid levels.

Potassium regulates nerve and muscle function. Almost all foods contain some potassium. Some foods that are very high in potassium are avocadoes, bananas, dried beans and peas, dried fruits, milk and nuts, oranges, potatoes, tomatoes and winter squash. How often these foods can be eaten, and/or their portion size, may need to be limited depending on your individual needs.

Calcium and phosphorus are minerals that work together in the body to keep your bones strong and healthy. This balance is changed when the kidneys are unable to filter out enough phosphorus. Phosphorus levels are then increased in your blood. When this balance of calcium and phosphorus is upset it can cause bone disease and contribute to the calcification of arteries and organs including your heart. The consistent use of phosphorus binding medication and following a diet that limits foods high in phosphorus may be needed. Almost all foods have some phosphorus, but the highest levels are found in dairy products (cheese, milk, yogurt), dried beans, nuts, chocolate and cola drinks. Your doctor and renal dietitian will help you balance your dietary intake and medications.

Sodium helps regulate the fluid balance in your body. High-sodium foods may upset this balance in chronic kidney disease. Some foods that have the highest amounts of sodium are cured and processed. This includes smoked meats and smoked or processed cheeses, ham, bacon, sausage, cold cuts, cheese and snack foods like corn chips, pickles, pretzels, potato chips, and salted nuts. Some foods that do not taste salty may contain a lot of sodium. Examples are canned soups, ketchup, mustard, relishes, some seasonings, steak sauces, meat tenderizers, canned or packaged foods and restaurant foods. When you prepare foods from scratch, you can control the amount of sodium used.

Healthy Seasoning: The Spice List

When you must limit salt, herbs and spices can add extra flavor to your foods. Most common herbs, spices and seasonings can be used in a meal plan for chronic kidney disease. It is important to use pure spices rather than those mixed with salt. Suggested spices include fresh garlic, fresh lemon or lime juice, garlic powder, pepper, onion powder, paprika, small amounts of green pepper or onion, vinegar and wine.

Avoid using salt substitutes or seasonings that contain potassium chloride. Although most salt substitutes do not contain sodium, most may have a large amount of potassium. Potassium can actually be more harmful to you than salt.

Following are some suggestions for blending spices with specific foods.   Allspice beef, eggs, fish, fruits, vegetables, beverages, baked products, desserts Basil lamb, fish, eggs, vegetables, sauces Bay Leaf beef, chicken, veal, fish Cinnamon chicken, pork, fruits, baked products, beverages, vegetables Cloves beef, pork, fruits Curry (salt-free) beef, chicken, lamb, veal, eggs Dill chicken, veal, fish, vegetables Ginger chicken, pork, fruits, vegetables, baked products, beverages Marjoram eggs, fish, meats, poultry Mustard Powder meats, poultry, fish, eggs, vegetables Parsley beef, chicken, fish, salads, sauces Rosemary beef, lamb, chicken, turkey Sage meats, fish, stuffing, vegetables Savory egg dishes, meats, poultry, stuffing, rice, vegetables Tarragon chicken, fish, meats, egg dishes, sauces, vegetables Thyme fish, meats, poultry, eggs, stuffing, vegetables

It is best to crush or rub leaf-type herbs to release their full flavor. Remember, herbs and spices should not overpower the taste of your food, so add them in small amounts. However, since salt enhances or increases flavors, you may need slightly more of a spice than a standard recipe calls for.

Some Final Words

You may find that meal planning is a challenge for you at times. Look at the Sample Menus section in this cookbook for suggestions on how to incorporate recipes in your meal 4 plan for chronic kidney disease. These meal plans have been calculated to provide approximately (per day):

2000 calories 70 grams protein 2 grams sodium 2 grams potassium 1000 mg phosphorus

The recipes in this book will help you cook tasty foods that are good for you. Your renal dietitian can help you choose the best ingredients and portion sizes for new or favorite recipes that you may have.

Each recipe has been analyzed for the following nutrients: calories, carbohydrates, protein, fat, sodium, potassium and phosphorus. Each recipe has also been analyzed for renal and renal diabetic exchanges using the National Renal Diet Exchange Lists. (If you are interested in obtaining additional information about these lists, ask your dietitian.) The National Renal Diet Exchange Lists include a “salt exchange” which contains 250 milligrams of sodium. There are recipes in this cookbook that utilize this salt exchange.

Every attempt has been made to analyze these recipes for both renal and renal diabetic exchanges. However, some of these recipes may be too high in sugar for those patients with diabetes. Those recipes have the comment “Not suitable for patients with diabetes” at the end of the recipe.

The analysis of these recipes was calculated using Practor Care, Neutri Practor 6000, San Diego, California, 1990; Food Processor II, ESHA Research, Salem, Oregon; and Pennington's “Bowes & Church’s Food Values of Portions Commonly Used,” 16th edition.

Next: Sample Menus

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No portion of this publication may be reproduced without prior written permission from the National Kidney Foundation, Inc.

© 1991, National Kidney Foundation, New York, NY
© 1996, Second Edition The National Kidney Foundation, New York, NY
© 2002, Third Edition, National Kidney Foundation, New York, NY

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