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Dialysis Diet and Nutrition

IF YOU ARE CONSIDERING HOME DIALYSIS, one of the things you might want to think about is diet. This page will briefly review the types of home dialysis and the best diet for each type. There are two types of peritoneal dialysis (PD): continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) or automated peritoneal dialysis (APD). There are also three types of home hemodialysis: conventional home hemodialysis, daily home hemodialysis and nocturnal home hemodialysis.

PD uses the lining of your abdomen, called the peritoneum, to filter fluid and wastes out of your blood. About two liters of fluid, called dialysate, is placed into the peritoneal cavity (belly) through an abdominal catheter and allowed to remain for a period of time. During this time wastes and extra fluids travel
from the body into the dialysis solution and are then removed when the solution is drained. This process, called an exchange, is done several times a day. It can be done manually using gravity (CAPD) or with a machine (CCPD or APD) called a cycler that typically does the exchanges while you sleep.

Both CAPD and CCPD have the same diet restrictions. During PD, protein and waste products are lost with each exchange, so protein needs to be replaced. The high protein diet is needed to build, maintain and repair body tissues. High-quality protein such as eggs, chicken, fish and lean red meats should be eaten at each meal.

Potassium, a mineral in many foods, is more liberal or less strict in PD compared to in-center hemodialysis (HD). In PD, potassium leaves the body and needs to be replaced daily. Too much or too little potassium in your body can be dangerous and harmful to your heart. Although potassium is found in salt substitutes, fruits and vegetables, milk, meat, chocolate and nuts, fruits and vegetables are the best choices for keeping potassium in the normal range.

Many on PD are able to eat an orange, half of a banana or one tomato daily to keep their potassium in normal range. Milk, chocolate and nuts are high in phosphorus and salt substitutes are not recommended.

For people on PD, fluids and sodium restrictions are more liberal. Moderate intake of fluid can help improve dialysis and flush out wastes. Sodium, a mineral that can affect your blood pressure, is found in table salt, canned foods and processed, pickled and cured foods. It is usually best to limit table salt and salty foods to prevent too much fluid weight gain, which can cause high blood pressure and heart trouble. Phosphorus, a mineral found in milk, cheese, nuts, dried beans, lentils, peas and corn products,
is limited in PD

You need to take phosphate binders with each meal to remove phosphorus from foods eaten. Calories give your body energy. Most of your calories come from the foods you eat, but with PD the sugar in the dialysate gives you more calories. Your body takes in the sugar and can cause weight gain. Conventional home HD, similar to in-center HD, is done three times a week but at home. The diet, equivalent to in-center HD, is limited in terms of one’s intake of sodium, potassium, phosphorus and fluids.

Daily home HD consists of two to three-hour treatments done five to six days a week totaling about 12 hours of dialysis per week. Since daily home HD is done more often, more toxins and fluid are removed. Those on daily home HD have increased energy levels and decreased use of blood pressure medications. Phosphorus, potassium, sodium and fluid restrictions are more liberal than in-center HD.

In nocturnal home HD, treatment is done eight to 10 hours during the night, six to seven nights a week. One of the benefits of nocturnal home HD is there are almost no dietary restrictions. Because phosphorus removal is improved, many people can stop taking phosphate binders and are encouraged to eat more phosphate and dairy products. Since dialysis is done nightly, there is usually no fluid, sodium and potassium restriction. Appetite is also improved due to better and frequent removal of toxins and wastes.

The five types of home dialysis have different dietary considerations to think about. Whatever type of home dialysis you choose, your health care team will continue to be available and serve as a valuable asset to you.



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