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Diet in Peritoneal Dialysis (PD)

Peritoneal Dialysis

nephroplus | June 9, 2016

Continuous Ambulatory Peritoneal Dialysis is a type of dialysis that is done daily. It helps to clean the waste products that build up in the blood when the kidneys are not functioning well. In peritoneal dialysis, the lining of your stomach is used to filter the blood. The diet helps to relieve stress on the kidneys and improve the effects of dialysis by managing the nutritional needs. As compared with hemodialysis, PD allows you to enjoy a relatively unrestricted diet. The diet can vary a lot from one person to the next. Also, your needs may change over with time.  Little or no restriction may depend on the bio chemical parameters and clinical symptoms. Your dietitian can help plan you plan the right meal.

PD offers the patients the opportunity to dialysis at home rather than going to the dialysis unit. It offers flexible time for dialysis and cuts down on travelling time to the unit especially in unfavorable climatic condition. The chances of missed session are very less thus reducing the accumulation of waste toxins in the body. It gives you an opportunity to spend more time with your family and participate in other activities. It gives you more freedom than HD and above all it does not require many food and fluid restriction as on HD.

There are two types of PD

CAPD: Continuous Ambulatory Peritoneal Dialysis – In this type you manually do the exchanges three to four times a day or advised by the consultant.

CCPD: Continuous Cycling Peritoneal Dialysis – In this type a machine also known as cycler does the exchanges automatically while you sleep.

Energy: Normal or over weight patient may require calories restriction to compensate for additional calories absorbed from dialysate. Those who fall under normal Body Mass Index may require calories between 25-30 Kcal/kg/Ideal Body weight. PD is conducive to weight gain and development of associated co morbidities in patients receiving adequate nutrition, due to delivery of additional 400-700 kcal per day in dialysate glucose. Elevation of both LDL and VLDL is very common in renal disease. Initial dietary guidance should concentrate on restricted intake of simple sugars and visible fats in the diet

 

Proteins: Protein requirement is difficult to achieve with diet alone, particularly in those with low appetite and severe nausea. The protein loss varies from 6 -12.5 gram per session. To compensate for protein loss 1.2 -1.5 g proteins per kg per day is recommended. High biological value proteins and nutritional supplement can help you reach the desired intake.

Potassium: Many patients do not need to restrict potassium at all due to continuous clearance, and some may need to deliberately eat high potassium foods due to low potassium count. However, a few may need to restrict their potassium. It is advisable to eat low potassium food liberally and high potassium food in moderation. Count the potassium in your meal enjoy all your favorite food in moderation.

Phosphorus: Clearance of phosphate is not particularly effective with either PD or conventional HD. Dialysis does not remove enough phosphate from the system. A combination of diet and medicines are usually needed to control it. Diet alone is rarely enough to control phosphorus; a supplementation of phosphate binders is often required. Binders are effective only when it is taken along with the meal as it works by preventing phosphorous to be absorbed in the blood steam after the food is being digested. The time of ingestion of binders is very important for its efficacy.

Sodium: Irrespective of the type of dialysis moderate sodium restriction is required in both cases. The allowance may differ with the type of dialysis. Hypertensive patients should have aggressive sodium restriction. In PD total dietary sodium allowance can be between 2500 mg-4000 mg per day. Sodium is connected to fluid intake and how much fluid your body holds on to; if you eat foods high in sodium you will get thirsty and drink more fluid. Food rich in sodium are table salt, pickle, papad, salted biscuits and all canned foods.

Fluids: Patients with substantial fluid output does not require fluid restriction. They lose water up to 2 L/day by ultrafiltration depending on the dextrose concentration of dialysate. Fluid restriction is required only if volume of urine goes down.

 

Nutritional parameters according to type of Dialysis

 

Nutritional Parameter Stage 5 – Hemodialysis Stage 5 – Peritoneal Dialysis
Calories (Kcal/kg/day) 30-35 25-30
Protein (g / kg / day) 1.2 1.5
Sodium (mg/day) 2500 2500-4000
Potassium (mg/day) 1500-2000 Restriction only if hyperkalemia
Protein Loss 6-9 g per session 9-12.5 g per 24 hrs
Calcium (mg/day) 6-9 g per session 9-12.5 g per 24 hrs
Phosphorous (mg/day) 800-1000 Less than 1200
Fluids (ml / Day) 500 ml +previous day urine output 500 ml +previous day urine output + Ultra filtration

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