Dietary Advice for Children on Dialysis
Kidneys normally remove waste products such as phosphate, potassium, urea and extra fluid from the body. These waste products and fluids come from foods you eat and liquids you drink. Dialysis is used to help remove these waste products but unlike kidneys, it is unable to remove them completely. Diet is therefore important in the management of children on dialysis. The diet will help to control blood levels of phosphate, potassium and urea whilst making sure that your child gets enough energy and protein to grow and gain weight properly.
The aims of the diet whilst on Dialysis are to:
PROVIDE ENOUGH:
REDUCE INTAKE OF:
Drinks may have to be reduced in children who produce little urine
Dietary advice may change with time and will depend upon your child’s growth and body weight, blood results and appetite. You may be asked to record the food that your child eats over a period of 2 to 4 days to provide the dietician with enough information to advise on any changes required.
The dietary advice is just as important as dialysis and medications that your child may be prescribed.
This guide contains information to help children eat the right diet whilst on dialysis
Dietary Advice is just as important as the dialysis and medications that your child may be prescribed
The body converts food into energy which is then used or stored. The amount of energy is measured in calories (kcal). Your child will need enough energy in the diet to grow and lead a normal active life.
CARBOHYDRATES (starches and sugars), and FATS AND OILS are the main sources of energy in the diet.
| STARCH |
Eat plenty of:
|
|---|---|
| USEFUL TIPS: |
Vary white and wholemeal bread and whole wheat cereals or bread/cereals Containing added dietary fibre. They are also a good source of vitamins and minerals. Don’t forget high fibre cereals are a rich source of phosphate. |
| SUGAR |
For Extra energy have:
|
| USEFUL TIPS: |
Flapjack or rice cakes are a great energy snack. |
Note:- if you are advised to consume more sugary foods and drinks to protect your teeth by including it at mealtimes rather than as a snack
REMEMBER TO CLEAN YOUR TEETH AT LEAST TWICE A DAY AND AVOID SUGARY DRINKS AFTER YOUHAVE CLEANED YOUR TEETH AT NIGHT
| Saturated Fats (solid fats) | Monounsaturated Fats | Polyunsaturated Fats |
|---|---|---|
|
|
Sunflower oil/margarine, corn, groundnut, or canola oils |
High fat foods which provide more energy may be encouraged when your child’s appetite is reduced.
Try to have a balance between polyunsaturated and monounsaturated fats
Try to swap foods high in saturated fat for healthier foods containing mono/polyunsaturated fat.
Why do we need protein?
Protein is needed for growth, building muscles and the repair of tissues. Urea is a waste product of protein metabolism, which is normally excreted into the urine by the kidneys. A build up of urea in the blood is called uraemia and can cause poor appetite or a feeling of sickness. Dialysis helps to remove urea, but it is not as good at removing it as kidneys that are working well. Eating too much protein increases your urea level in the blood. However, it is important your child gets enough to grow properly and replace the protein that is lost in dialysis fluid.
Poultry eg: chicken, turkeyRemember: dairy products are high in phosphate.
A number of high protein body building supplements are available to buy. We would not recommend these products as they put greater demands on kidneys that are not working well.
Calcium and phosphate are important for the growth and development of strong bones. Phosphate is released from food into stomach during digestion and is then absorbed into the blood. Healthy kidneys clean the blood by removing phosphate. When the kidneys are not working well calcium and phosphate can build up in your blood.
Your child may not be aware of any symptoms of high phosphate level, but serious changes may be happening causing problems in the future.
Try to restrict dairy products
Cottage cheese and full fat cream cheese, eg. Philadelphia contains half the amount of phosphate compared to other cheeses. Feta and mozzarella cheese are also lower phosphate options
Processed cheese, eg. Primula, Dairylea, Laughing Cow.
If your child is finding it difficult to restrict their milk intake there are some alternatives to cow’s milk, eg. SnoPro or ProZero. Ask your dietician.
Other foods high in phosphate to limit:
Tinned salmon and mackerel are lower in phosphate if the bones are removed.
PHOSPHATE BINDERS work like magnets, they bind to the phosphate released from food in the stomach and stop it from being absorbed into the blood.
Some phosphate binders can be swallowed whole, whilst others are chewed. The most common ones are made from calcium carbonate.
If you eat snacks between meals you may need to take a phosphate binder with each snack. If you miss a meal you do not need to take a binder.
SPEAK TO YOUR DIETICIAN ABOUT WHICH IS BEST FOR YOU.
The potassium in the foods and drinks you consume need to be reduced if the level of potassium in the blood is high. A high level can be dangerous as it can be harmful to the heart.
Your dietician will advise you on the level of restriction required, as this will vary depending upon the amount removed by dialysis and the amount lost in urine.
Squash, water, carbonated drinksSavoury snacks are high in salt, so should not be eaten every day
Rather than steaming, grilling, frying or microwaving, boil all vegetables to remove some potassium and discard the water
Useful Tip: A portion is equivalent to the amount a child can hold in the palm of one hand.
Speak with your dietician about more detailed advice.
Lower salt products may contain potassium instead of sodium, so check the ingredients first.
To help remove potassium it is best to peel, slice and soak potatoes, then boil. After boiling they can be mashed, fried or roasted.
Red skin potatoes peeled make better chips as they keep their shape after boiling!
More details will be given by your dietician.
Salt (sodium chloride) makes your body retain water and it can contribute to high blood pressure. Salty food also makes you thirsty.
Salt intake is usually restricted to a NO ADDED SALT DIET. This means you should avoid adding salt when cooking and avoid adding it to food at the table. You should also avoid foods that are high in salt. Below is a list of foods high in salt and some ideas of lower salt foods you could swap to:
| Salty foods to avoid or reduce: | Lower salt alternatives: |
|---|---|
| Salted crisps, nuts, savoury snacks | Lightly salted tortilla chips or corn snacks |
| Other tinned foods with added salt Eg baked beans or canned vegetables | Sweet snacks instead of savoury |
| Smoked meats and fish | Unsmoked meat and fish Low salt stock cube or gravy powder |
| Bacon, sausages, sausage rolls and other Processed meats | Lower salt tinned products, eg reduced salt baked beans |
| Chicken nuggets, dippers/dinosaurs | Unsalted margarine |
| Potato products (waffles, alphabites, faces) | Fresh fish, poultry and meat |
| Most cheeses, eg cheddar, edam, stilton, Cheese spread, processed cheese | Cottage cheese, full fat soft cheese |
Do not use a salt substitute as they are usually high in potassium, eg. Lo Salt
Looking at food labels when shopping will allow you to choose foods lower in salt (sodium).
Food labelling often doesn’t show the salt content but instead shows the sodium content (salt is sodium chloride)
Per 100g of food, 0.3g or more of sodium (0.7g salt) is a lot (food should be avoided).
To convert ‘sodium’ to ‘salt’, multiply the sodium value by 2.5. For example if a food contains 0.4g sodium this is equivalent to 1.0g salt. (0.4 × 2.5 = 1.0g).
Herbs and spices can be used in cooking instead of salt to add flavour.
Fluid requirements will depend upon the amount of urine that the kidneys produce and the amount that is removed by dialysis.
Remember that some foods are mostly fluid and may need to be included within the total fluid allowance such as:
Foods containing fibre help to prevent constipation. However, they are a source of phosphate and should be encouraged with moderation. It is important to avoid constipation as this may reduce your child’s appetite or be responsible for poor drainage of dialysis fluid if on peritoneal dialysis.
High fibre foods to encourage include:
Children on peritoneal dialysis in particular tend to be more prone to constipation. Your child may need a laxative to help prevent constipation
High fibre foods are a source of phosphate. Try brands of white bread with added fibre.
Vitamins and minerals are required for growth and general good health. This is usually in the form of a tablet that can be crushed. Children on dialysis may have poor appetites and may need a special renal specific multivitamin supplement daily.
Some fruit and vegetables are restricted when trying to reduce potassium levels, this will reduce vitamin C intake.
Water soluble vitamins (mostly B and C) are lost into the dialysis fluid.
Vitamin A can accumulate to toxic levels when the kidney function is impaired. Fish oil supplements often contain high doses of Vitamin A. All vitamin supplements containing high doses of Vitamin A should be avoided.
Discuss with your dietician before using any over the counter vitamin supplements.
Your child may become anaemic because the hormone which stimulates the body to produce red blood cells and store iron is made by the kidneys. You should try to offer foods that are high in iron where possible but an iron supplement may also need to be prescribed.
Iron from cereal products is better absorbed in the presence of vitamin C
At times when your child’s appetite is poor, nutritional supplements may be required to maintain their weight gain and growth. There are a range of nutritional supplements available which may be prescribed for your child.
Sometimes adequate nutrition cannot be achieved with oral supplements alone and a form of tube feeding may need to be considered. This will be discussed with you if it is necessary.
NKF Controlled Document No. 298, Dietary Advice for Children on Dialysis, written 30 December 2010. Last reviewed 30 December 2010.
Content compiled by members of the Children’s Renal & Urology Unit, QMC Campus, Nottingham University Hospitals.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.