Dietary information for patients new to peritoneal dialysis

It is important to ensure that you are eating the right amount of food to maintain a healthy weight, support your immune function and body processes, and maintain good energy levels to be able to carry out your daily activities. 

Some PD patients struggle with taste changes and poor appetite, which makes it difficult to eat enough food to meet nutritional needs.

If you suffer from the above symptoms try eating little and often and add a few extra snacks between your meals.

Proteins are the small building blocks needed for the growth and repair of body tissues. Some protein is lost from your body during each PD exchange, therefore it is important to replace these losses with more protein in your diet, to protect your body tissues.

We recommend that you eat a portion of protein with two to three meals per day, and with some snacks to make up for these losses. You should aim to have even more if you develop peritonitis, which is a type of infection common in PD patients. This is because during the infection your protein losses will be even greater.

A portion of protein is one of the following:

• Palm size of meat / chicken / fish / tofu
• Two eggs
• Two tablespoons of high protein yoghurt/ quark cheese or cottage cheese
• Three to four tablespoons of beans and pulses

Milk, hummus, and cheese also contain small amounts of protein.

Your dietitian can advise you on eating the right amount of energy and protein for your needs. 

Phosphate and potassium are minerals which come from food. Kidneys are responsible for the removal of their excess from the body. If kidney function is low and sufficient amounts cannot be removed with PD, these minerals start building up in the body dietary restriction may be required to maintain healthy levels of these minerals in your blood.

High phosphate levels may cause itchy skin. Over time high phosphate levels may cause weakening of the bones and hardening of blood vessels, which can lead to development of heart disease.

Your dietitian will help you to reduce high phosphate foods while maintaining a good quality diet. You can also ask your PD nurses for a diet sheet before seeing your dietitian.

Tip: many processed foods, like meats or soft drinks, contain phosphate additives. Check the ingredients list and avoid those containing additives with ‘phos’ in their name (e.g., Phosphoric acid).

Most foods contain phosphate and so is not possible to remove all phosphate from your diet. You may be prescribed a phosphate binder medication (e.g., Sevelamer, Osvaren or Fosrenol) in addition to a low phosphate diet if dietary changes alone are not sufficient to maintain good phosphate levels.

Remember: phosphate binders need to be taken around your mealtimes to bind phosphate
from your food, like a magnet, preventing it getting into your blood. 

Too high or too low potassium levels can interfere with the rhythm of the heart and in severe cases even lead to a heart attack. High blood potassium is not very common on PD, as it is removed daily. For this reason, you may be able to relax your previous potassium restrictions and add more potassium containing foods to your diet once you start PD.

However dietary potassium restriction may still be required if your blood potassium is too high despite starting PD.

It is crucial to check with your PD Consultant, PD nurse or dietitian if you are unsure whether you should be restricting potassium in your diet.

Most fruit and vegetables contain potassium and patients often avoid these due to fear of them causing high potassium levels.

We would like to strongly discourage this practice. If you have high potassium levels, aim to restrict less nutritious high potassium foods first, such as chocolate, crisps/ other potato and nut-based snacks, coffee, fruit juices, processed meats with potassium additives (check the ingredients list); and boil rather than steam your vegetables.

Fruit and vegetables are very nutritious and reduce the risk of development of many PD related conditions, such as heart disease. They also improve bowel habits, which in turn helps to remove more potassium from your body.

You should aim to enjoy five to six portions of fruit and vegetables per day. Portion = 80g (a handful).

If your potassium is high, please ask your dietitian to help you choose fruit and vegetables with lower potassium content. You can also ask your PD nurse for the pictorial low potassium diet sheet prior to seeing a dietitian.

Eating high-fibre foods regularly will help to prevent constipation, which is common in PD patients, and can make your PD painful or less effective. You should be opening your bowel two to three times per day.

High-fibre foods include fruit and vegetables, oats, wholemeal bread, high-fibre breakfast cereals (Weetabix, bran flakes, porridge oats), beans and pulses (these contain some potassium and phosphate, but it is poorly absorbed by the body).

Strategies to prevent constipation

• Start your day with a high-fibre breakfast: porridge oats, Bran flakes, Weetabix and some berries or stewed apple.
• Include fruit and vegetables with each meal and some snacks (aim for five to six portions per day): side salads, boiled vegetables, fruit as a snack.
• Swap white bread, pasta, rice for wholegrain and wholemeal varieties; experiment with different grains (e.g., quinoa, freekeh, bulgur wheat or buckwheat).
• If your potassium levels are well controlled add seeds and some nuts to yoghurts, cereals, salads.
• Gentle exercise can help with bowel movement. Aim to walk or perform other forms of exercise like stretching, at least 30 minutes a day. Contact your GP or Physiotherapist for more advice if your mobility is poor.
• If your potassium is well controlled try gradually adding Psyllium Husk fibre to your diet, e.g., sprinkle one to two teaspoons into cereals and milk or yoghurt, add to stews or simply mix with 250ml of water. Remember to take it at least two hours away from your medications, and always take it with some fluid.

Fluid is removed from your body by dialysis and when you pass urine. Drinking more fluid than is removed can cause ‘fluid overload’. This is harmful to your heart, will increase your blood pressure and can lead to shortness of breath.

Your daily fluid allowance depends on the amount of urine you pass and may change over time, as your urine output is likely to decrease in time.

In general, the more urine you produce, the more you can drink. Please ask your doctor or PD nurse about your daily fluid allowance.

Fluids in foods like gravy, sauces, soups, jelly, and ice cream, in addition to all hot and cold drinks, all count.

Too much salt in the diet is linked to high blood pressure. It can make your body retain water and removing fluid on PD more difficult, causing blood pressure drops and body cramps. Salt will also make you thirsty and makes following a fluid restriction more difficult.

You can reduce salt in your diet gradually to still be able to enjoy your foods. Your taste buds will quickly adapt to using less salt and you will find that after about a month food will start to taste much better.

It is useful not to add salt automatically when cooking or about to eat. We often only use salt out of habit.

To reduce the amount you eat, try these suggestions:

• Marinating meat and fish in advance to give them more flavour e.g., use garlic, onions, lemon.
• Adding a small amount of red wine to stews and casseroles, and white wine to risottos and sauces for chicken.
• Try using a very low salt stock cubes, based on herbs and spices.
• Cut down on manufactured and processed foods: Try using fresh or frozen meat, fish, and vegetables rather than pre-prepared dishes or ready meals whenever possible.
• If buying tinned foods, choose those labelled ‘no added salt’ or ‘reduced salt’.
• Limit eating salty foods such as bacon, tinned meats, sausages, beef burgers, meat pies, smoked fish, olives, tinned and packet soups, salted peanuts and crisps.
• Try plain roasted meats/ poultry or fish with herbs and spices instead.

Warning: do not use salt substitutes e.g., Losalt, as they contain potassium.

Salt Label Reading Information

• High: more than 1.5g salt per 100g (or 0.6g sodium)
• Medium: between 0.3g and 1.5g per 100g (or 0.1g sodium)
• Low: 0.3g salt or less per 100g (or 0.1g sodium)

No more than one tablespoon of bottled sauces per day.