Principles of Dietary Education patient on Dialysis

Minas P. Zilakos, MD,
Ioannis G. Griveas, MD, PhD

1 / How many calories do I need per day?

  • per kilo of body weight 25 to 35 kcal Example: A 75 kg patient needs about 2000 kcal.

2 / How many meals do I need per day?

  • Three balanced meals, ie every 4 to 6 hours.

3 / What is allowed and in what quantities?

  • Meals can include all kinds of foods
  • we do not lack any kind
  • we apply simple rules
  • we know what to avoid
  • we choose alternatives

Meat

choose {fresh or frozen}:

  • Veal
  • pork meat
  • chicken
  • turkey
  • fish

avoid

  • ready, packaged
  • pre-cooked meats
  • bacon
  • cold cuts
  • viscera
  • bones of small fish
  • seafood
  • Meat is a key source of protein of high biological value necessary for the patient on dialysis.
  • I need protein 1 to 1.2 grams per kilogram of body weight, ie an average of 100 grams of protein per day.
  • An additional source of protein of high biological value is egg and milk. indicative quantities 1 chicken breast: 30 grams of protein, 1 can of tuna: 40 grams of protein 1 egg: 6 grams of protein 1 glass of milk: 8 grams of protein.
  • We calculate for each meal that includes meat, as a quantity of it, the size of the palm of one hand.

Fat-Oils

choose

  • margarine
  • olive oil

avoid

  • animal meat fats
  • butter of animal origin
  • Becel pro active blue {contains a lot of potassium}

Dairy Products

choose

  • almond milk
  • rice milk
  • Philadelphia / Cottage cheese
  • cream cheese
  • feta {size a matchbox-very good rinse}

avoid

  • yellow cheeses
  • hard cheeses
  • indicative quantities
    • 1 cup of milk (cow, goat, sheep)
    • 1 yogurt
    • 50 grams of cheese

Bread-Cereals

choose

  • fresh white breads
  • white spaghetti / rice (not whole grain)

avoid

  • Bread and cereals rich in fiber
  • ready-made products such as croissants, donuts, cookies
  • products containing sesame
  • indicative quantities
  • two slices of bread
  • a hot-dog loaf
  • 2 tortillas
  • a cup of rice / spaghetti
  • 1 tsp. corn flower soup

Legumes-Vegetables ! peeled, cooked (roasted or boiled)

choose

  • cucumber
  • endives
  • cabbage
  • Lettuce of all kinds
  • carrot
  • eggplant
  • cauliflower
  • broccoli
  • green beans
  • peppers
  • radishes
  • corn
  • onion-garlic

avoid

  • Potatoes-sweet potatoes
  • tomato- tomato juice
  • spinach
  • beets
  • zucchini
  • asparagus
  • mushrooms
  • okra
  • artichoke
  • avocado
  • The legumes are sparing and boiled at least twice, due to their high phosphorus content! Indicative quantity: 1 to 1.5 cup

Fruits

choose

  • apples (1)
  • pears (1)
  • peach (1)
  • tangerine (2)
  • pineapple (half a cup)
  • plums (half a cup)
  • berries (half a cup)
  • strawberries (half a cup)
  • cherries (10)
  • grapes (15)
  • watermelon (1 slice)
  • chestnut (2)

avoid

  • orange-grapefruit {and their juices}
  • banana nectarine
  • melon
  • apricot figs
  • dried grapes dates
  • dried fruit

Juices

Apple-lemonade-peach-grape-cranberries Quantity: 200 ml (!)

other foods that contain potassium and should be avoided:

  • Alcoholic beverage
  • Nescafe
  • Tea
  • Nuts

Sweets

indicative quantities: instead of fruit a little sweet a day

choose

  • Sweets, which are based on cream
  • jam
  • honey

avoid

  • sweets, based on chocolate
  • sweets, which contain fruits and nuts
  • If diabetes coexists, I choose sweeteners as a substitute for sugar.

What do I do with phosphorus?

-I take, according to the instructions of the nephrologist of the unit, the phosphorus-binding pills together with the meal or up to 30 minutes after the end of the meal.

Avoid

  • Packaged food
  • canned food
  • tahini
  • Sesame
  • chocolate wafers
  • candies
  • cola type soft drinks
  • nuts (consumption of various sauces: mayonnaise, mustard, ketchup in very small quantities).

What do I do with salt?

The maximum allowed is one teaspoon a day.

It is forbidden to consume substitute salt as it contains a large amount of potassium!

Avoid

foods rich in salt:

  • meat paste
  • canned food
  • seafood
  • pickle
  • tomato paste
  • cooking cubes
  • salted nuts
  • cookies
  • potato chips
  • pizzas

to flavor the food I choose and replace the salt with: 

  • herbs
  • spices
  • lemon juice
  • vinegar
  • a spoon of sugar

What do I do with thirst?

The liquids we consume include:

  • Water • Juices • Coffee • Tea • Alcoholics
  • Soft drinks • Soups, etc. liquid food.

The total amount to be taken is estimated at 10 times the patient’s weight in ml, daily. that is, a 75 kg patient should consume approximately 750 ML on average per day.-

choose

  • tap water
  • Homemade lemonade
  • homemade tea
  • Greek coffee
  • french coffee
  • espresso

avoid

  • baking soda mixed with water
  • cola type soft drinks
  • Nescafe
  • cappuccino
  • tea packed in a box
  • Orange juice
  • energy drinks
  • alcoholic beverage
  • Ways to deal with thirst
  • Frequent brushing of teeth
  • Consume a small amount of bread with oil or margarine
  • sugar-free mastic
  • water ice cubes or juice ice cubes
  • slice of lemon
  • consumption of drugs with less water
  • mouthwash with water which, we will throw away and we will not swallow it

Ways to deal with weight loss / appetite

  • eat small and frequent meals
  • if our taste is reduced or the food has a bad (metallic taste), we choose egg, chicken or fish using lemon juice, vinegar and even strong spices.
  • We cover calories by consuming carbohydrates with products rich in calories: sour cream, sweet mayonnaise, margarine

It is NOT recommended and we do NOT replace food, which must contain all the nutrients, with vitamin supplements.