Peritoneal Dialysis diet
Summary
The regular daily nature of Peritoneal Dialysis makes control of potassium levels and most other dietary problems a bit easier, but a slightly higher protein intake is often recommended. Fluid intake is not quite as restricted as it can be for haemodialysis patients, but you should still watch for fluid retention problems. Sugar present in the PD fluid means that peritoneal patients should restrict their calorie intake a bit more than haemodialysis patients.
Watch that you consume enough fibre to avoid constipation – a side effect of PD.
What is a peritoneal dialysis diet?
The peritoneal dialysis diet is designed for patients who choose peritoneal dialysis (PD) instead of hemodialysis. It is a slightly different diet than the hemodialysis diet, due to the differences in the dialysis treatments. Unlike hemodialysis, PD is performed daily. As a result, the body does not buildup as much potassium, sodium and fluid, so the diet is more liberal.
What can I eat?
Protein requirements are higher because protein is lost through the peritoneal membrane. Due to this protein loss, your dietitian will instruct you to eat more protein. Patients on PD are at risk for infection, so a diet with adequate protein is needed to keep the body strong.
Unlike hemodialysis patients, PD patients are likely to keep normal or low potassium levels. You may be encouraged to eat potassium-rich foods like tomatoes, orange juice and bananas if your blood test levels are too low. You will also be able to choose from a variety of nutritious foods to round out your PD diet.
What can’t I eat?
Your phosphorus intake will need to be limited. Phosphorus is not cleared well through PD and can cause complications to your health, such as weak bones, heart problems, joint pain or skin ulcers.
The peritoneal dialysis diet is not as restricted in sodium and fluid compared to the diet for hemodialysis, because dialysis is performed daily. It is still important to keep sodium and fluid intake within the goals determined by your healthcare team. Sodium makes you thirsty, which can lead to fluid intake above the recommended amount. This can cause swelling, shortness of breath and high blood pressure. Your PD treatments may be adjusted to help balance the right amount of sodium and fluid.
You will get some additional calories through the dialysate (dialysis solution), so your dietitian may recommend you eat slightly fewer calories so that you do not gain excess weight.
Why do I have to eat this way?
Your dietitian and doctor will strongly recommend you eat this way so your PD treatments will be effective and you can feel your best. You will also reduce the risk of other health problems associated with dialysis and kidney disease.
How does it help?
Phosphorus is not cleared well through peritoneal dialysis. This mineral can build to high levels in the bloodstream and cause complications such as weak bones and heart problems and skin ulcers. Sodium causes your body to hold onto more fluid and raises your blood pressure. You may feel uncomfortable and short of breath. By limiting foods that contain these minerals, you lessen the risk of developing these complications.
Your dietitian may recommend you eat fewer calories because of the dextrose that is present in the dialysate. Dextrose is a type of sugar. In PD, the dialysate fills the peritoneum and stays there for several hours until it is drained and exchanged with new solution. Your body absorbs some of the glucose from the dialysate. This could mean you are getting an extra 500 calories a day. These extra calories add up and you may gain solid weight. Your dietitian will coach you on an eating plan that will be in the right caloric range determined for your body type, health condition and level of activity so you can stay at a healthy weight. The diet will also contain nutrients to help you remain strong.
What about fluid intake?
Your dietitian will give you specific instructions regarding your fluid intake. Fluid intake is not as restricted with the peritoneal dialysis diet as it is with the hemodialysis diet, because PD treatments are performed daily.
How long do I have to follow the peritoneal dialysis diet?
You will follow the peritoneal dialysis diet for as long as you are on PD. Your dietitian may make changes to the diet to reflect your current condition.
How do I know if the peritoneal dialysis diet is working?
You will notice improved appetite and energy level, better blood pressure and less swelling. Your PD sessions will be effective at eliminating waste and excess fluid from your body.
Lab tests are another way to determine if the peritoneal dialysis diet is working. Once the renal team will test to see whether you are getting enough protein by checking your blood albumin level. Several times a year your doctor will order a peritoneal dialysis adequacy test to check the effectiveness of your dialysis. This test includes normalized protein nitrogen appearance (nPNA), a test result that helps to determine if you are eating enough protein.
Your dietitian will also monitor your health and conduct a nutrition assessment when you start on PD and then every year thereafter. This assessment will check your body for any signs of nutrition problems, changes in weight and energy levels or any issues that may interfere with eating. This assessment will include an individualized nutrition plan.
If I follow the peritoneal dialysis diet will my kidneys get better?
The PD diet cannot reverse existing kidney damage. Nothing can reverse or cure the damage that has already been done. The PD diet will help you by making your treatment more effective and keeping you healthy and feeling well.
