Diet and the Predialysis Patient

Diet and the Predialysis Patient

By Peggy Harum, RD, CS, LD

Long before you need dialysis, changes are taking place in your body. You lose the ability to get rid of phosphorus in your urine. Your kidneys become unable to make a special hormone to keep your bones strong.

Your kidneys will also become unable to make red blood cells and you will most likely become anemic. Eventually, the kidneys will stop making urine and you will need dialysis. Fortunately, physicians know patients will not survive very long if they wait too long to prescribe dialysis. Usually, dialysis is prescribed when the kidneys have about ten percent of function remaining. Diabetics may require dialysis sooner than non-diabetics.

Much research has been done to determine if low protein diets will help delay the progression of kidney disease. The results are inconclusive. But we have learned tight blood pressure control (120/70) and a low protein diet can help in some kinds of kidney disease. For example, a diabetic patient has a good chance of delaying dialysis by having good blood pressure and a low protein diet. In these cases, the watchful eye of a renal dietitian is extremely important because patients tend to become malnourished and develop malnutrition.

The main purpose of routine follow up is to ensure a successful outcome. In other words, don’t expect to have good luck following a special diet without seeing the renal dietitian frequently.

The information provided is for both nondiabetic and diabetic patients. The amount of protein allowed in the diet is dependent upon your size. You will most likely be allowed 0.6 grams of protein per kilogram of desired body weight. If you weigh 154 pounds, or 70 kilos (2.2 pounds = 1 kilogram), you are allowed 70 x .0.6 or 42 grams of protein per day. The secret of the diet is PORTION SIZE.

The sample menus of this diet will show you where the protein is found in the diet. There are small amounts of protein in fruits, juices and in non-dairy products. These are not counted in the daily allowance. There is no guarantee the low protein diet will delay the progression of kidney disease. But it may be worth talking to your renal dietitian or doctor about it.

Sample Diet for Diabetics

45 grams of protein, 2200 calories, 2000 milligrams sodium, low phosphorus diet

Amount of Protein Breakfast

1 gram 8 ounces apple juice
4 grams 1 English muffin
1 tablespoon unsalted margarine
Diet jelly
Coffee or tea with sugar substitute, Cremora® or Polyrich

Snack

1 gram 1 cup cantaloupe or 1/2 cup pineapple juice
1 gram 1 cup grapes
Diet 7-UP®

Lunch

7 grams 1 ounce unsalted tuna fish
Chopped celery, chopped onions, dried dill
1 tablespoon regular mayonnaise
4 grams 2 slices white bread
1 gram 1 cup tossed salad with cucumbers, romaine
1 tablespoon oil (or *creamy garlic dressing), vinegar or lemon as desired
1 gram 2 peach or pear halves
Iced tea, diet Sprite® or coffee

Snack

1/2 gram A small raw apple

Dinner

14 grams 2 ounces chicken (one thigh = 2 ounces after cooking without the bone)
4 grams 1 medium baked potato (1 cup) or 2/3 cup rice
2 tablespoons unsalted margarine
2 grams 1/2 cup fresh asparagus
2 grams 1 small fresh tomato sliced
1/4 gram 4 fresh strawberries
2 grams 1 inch slice angel food cake
Iced tea with sugar substitute and lemon or Perrier® with lime

Snack

2 grams 3 graham crackers
1/2 gram 1/2 cup grape juice
1/2 gram 1 small fresh pear

47 grams protein; 2220 kcal

Note:
1. You are allowed 1/2 teaspoon salt per day.

2. Always weigh meat, fish, poultry or seafood without bone or shell after cooking.

*Creamy Garlic Dressing Ingredients:
2/3 cup oil, such as canola oil or olive oil; 1/3 cup vinegar, such as garlic, cider, wine or tarragon; 1 or 2 cloves garlic, pealed and chopped; 1 teaspoon Dijon mustard; ground black pepper. Preparation: combine ingredients in a blender for about 30 seconds.
Analysis (per one cup): 1282 calories, 0.3 grams protein, 16 mg phosphorus, 35 milligrams sodium, 100 milligrams potassium.

Sample Diet for Non-Diabetics

About 45 grams protein, 2400 milligrams sodium, low phosphorus diet

Protein Breakfast

1/2 gram 4 ounces orange juice
2 grams 3/4 cup puffed rice with Polyrich as desired, sugar as desired
2 grams 1 slice white toast or ½ English muffin
1 Tbsp. unsalted margarine
1 Tbsp. jelly
Coffee or tea with Coffeemate® or Polyrich as desired

Snack

1/4 gram 4 fresh strawberries and Cool Whip®
2 grams 1 inch slice angel food cake
Coffee with sugar and Cremora®

Lunch

4 grams 2 slices bread, regular mayonnaise as desired
7 grams 1 ounce chicken (please weigh after cooking without skin and bone)
1 gram 1 cup lettuce with onions and cucumbers
1 Tbsp. oil and vinegar or recipe for creamy garlic dressing
1 gram 1 small tomato sliced
1/2 gram Fruit cocktail in heavy syrup (1/2 cup)
1 cup Sprite® or iced tea with sugar and lemon

Snack

1/2 gram Baked apple with 1 Tbsp. honey
1 ounce mints or gum drops (six each)

Dinner

14 grams 2 ounces steak (weigh after cooking without bone) You may sauté or fry in allowed oils margarine
4 grams 1 medium baked potato (1 cup)
1 Tbsp. unsalted margarine
2 grams 1/2 cup canned corn (rinse and drain)
2 grams Small blueberry muffin
Unsalted margarine
1 gram 1 cup Romaine salad with scallions
Wine vinegar and oil dressing
1/2 gram 1 cup cantaloupe or grapes
1 cup cranberry juice, 7-UP® or sweetened tea

Snack

1/2 gram 1/2 cup applesauce
1 cup lemonade

45 grams of protein.

You are allowed to use 1/2 teaspoon of salt per day. Please use generous amount of allowed canola or olive oil or unsalted margarine. Please use additional sugars and sweets if your weight is below desired weight (your dietitian will advise you).

Always weigh meat or equivalent after cooking without bone or shell.

Peggy Harum, RD, LD is a renal dietitian from Miami. Ms. Harum has worked with AAKP for many years in developing dietary resources for kidney patients.

This article originally appeared in the September 2007 issue of aakpDelicious!