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Diet on Peritoneal Dialysis

Information for people with kidney disease who are undergoing peritoneal dialysis.

Classification: DT (Dietitian) Advice is complex, condition specific and requires a Dietitian with knowledge, skills and experience in the condition.

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  • To support the dietary education for long-term condition management of people with chronic kidney disease and undergoing peritoneal dialysis. The target group will:

    • understand that they need to follow a low phosphate and potassium diet due to their kidney disease
    • know the risks associated with high blood serum potassium and phosphate levels
    • know their blood serum potassium and phosphate target ranges
    • understand that normal restrictions may be relaxed while on peritoneal dialysis
    • understand the importance of good nutrition to improve health
    • understand that they are at increased risk of poor nourishment, so must aim to acheive a healthy weight through increased protein and balanced energy intake
    • be able to identify foods high in potassium and phosphate, and suitable alternative foods
    • know that phosphate bingers are/may be needed to achieve their target blood serum phosphate level
    • know that phosphate binders must be taken with foods containing phosphate if they are to be effective
    • be aware of the impact of additives on controlling phosphate levels
    • be aware of the benefits of cooking from fresh, without processed foods
    • know the risks of salt in the diet and why it is important to reduce/control salt intake with renal disease
    • know the recommended daily maxiumum salt intake is 6g/day
    • know how to read and interpret food labels to reduce their salt intake
    • be able to identify high salt foods
    • know how to choose reduced salt alternative foods and flavourings to reduce their salt intake
    • understand how to include fibre to minimise constipation
    • know that PD fluid contains glucose, whichmay lead to weight gain through increased fat stores, not muscle gain

    Evidence Base:

    • European Guidelines for the Nutritional Care of Adult Renal Patients (EDTNA) 2003.
    • McCance and Widdowson’s Composition of Foods Integrated dataset (CoDID, 2015 accessed from https://www.gov.uk/government/publications/composition-of-foods-integrated-dataset-cofid).
    • Fouque D. et al (2007). European Best Practice Guideline on Nutrition. Nephrology Dialysis Transplantation, Volume 22, Issue suppl_2
    • NICE (2013) Hyperphosphataemia in chronic kidney disease: Management of hyperphosphataemia in patients with stage 4 or 5 chronic kidney disease. Clinical guideline 157.
    • Kalantar-Zadeh K., Gutekunst L., Mehrotra R., Kovesdy C.P., Bross R., Shinaberger C.S., Noori N., Hirschberg R., Benner D., Nissenson A.R. and Kopple J.D. (2010) Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease. Clinical Journal of the American Society of Nephrology, 5, pp. 519-530.
    • National Kidney Federation. (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney International,113, pp.S1-130.
    • Christian S Shinaberger (2008). Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease? The American Journal of Clinical Nutrition, Volume 88, Issue 6, 1 December 2008, Pages 1511–1518
    • British Dietetic Association (2013). Renal Nutrition Specialist Group – low phosphate diet rationale. www.bda.uk.com/regionsgroups/groups/renal/groupresources/lowphosphatedietrationale
    • Schlemmer et al (2009). Phytate in foods and significance for humans: Food sources, intake, processing, bioavailability, protective role and analysis. Mol. Nutr. Food Res. 2009, 53, S330 –S375
    • Hannah J et al (2017). Phosphorus in food: new insights and recommendations for practice. Journal of Kidney Care, vol 2 no 3 p 66-72.
    • NHS 5-a-day portion sizes. https://www.nhs.uk/live-well/eat-well/5-a-day-portion-sizes/ (Accessed 2019).
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