Grabbing a fast meal on the run or going out for a nice dinner may be more challenging when following a renal diet. Here are some tips to help kidney patients keep sodium, potassium and phosphorus in check.

• Choose grilled, broiled or roasted beef, chicken, pork chops, fish or seafood. Avoid breaded items—these add extra sodium and fat.
• Kabobs or fajitas are usually made from fresh meats and vegetables. Ask for sauces or toppings on the side.
• Buttered noodles, plain pasta with olive oil and garlic or steamed rice are lower in potassium compared to potatoes and tomato sauce pastas.
• Checkout the fresh vegetables available. Make lower potassium choices like green beans, cauliflower, broccoli, summer squash or carrots.
• Go for a grilled or broiled chicken, fish or hamburger on a bun with lettuce, onion, mayonnaise, mustard or tartar sauce. Limit ketchup to 1 packet. Forget the high sodium pickles and processed cheese.
• For sandwiches, choose turkey, roast beef, tuna or egg salad instead of cured and heavily processed meats. Top with onions, lettuce, a thin tomato slice, bell peppers, cucumbers, alfalfa sprouts and a small amount of mayonnaise, mustard or oil and vinegar.
• Choose a side salad with dressing on the side, macaroni salad or coleslaw instead or potato salad, chips or French fries.

For more ideas on eating out read Fast Foods and the Dialysis Diet on www.DaVita.com.

Eating breakfast out is a special treat for some and a daily routine for others.

Knowing the best choices for a kidney diet helps you stay within your goals to keep intake low in sodium, potassium and phosphorus. Here are some tips to help keep a kidney-friendly breakfast.

• Order poached or fried eggs. Scrambled eggs may have added milk and salt. Request no added salt.
• Low cholesterol egg product is lower in phosphorus compared to eggs. Request it instead of scrambled eggs, or to use in omelets.
• Choose omelets made with lower potassium vegetables such as onion, bell pepper, mushrooms. Go easy on the cheese or request cream cheese to replace American, cheddar or Swiss cheese.
• Avoid avocado, chili, salty meats and cheese as omelet fillings.
• Limit bacon to 1-2 slices occasionally. Avoid other higher sodium meats like sausage, ham, Canadian bacon and lox.
• Use caution when ordering fast food breakfast sandwiches. English muffins or sourdough toast are much lower in phosphorus and sodium than biscuits. Omit the cheese.
• Limit high potassium breakfast foods like hash browns and orange juice. One small hash brown patty with a small amount of ketchup may be ok occasionally if other potassium sources are limited.
• Choose apple, grape or cranberry juice. Order a small glass if fluids are limited or request fresh berries instead.
• Pancakes and waffles are high in phosphorus and sodium. French toast is a better choice.
• Decline refills on coffee, tea or water if fluids are limited.
• Ask for nondairy creamer for cereal instead of milk.

For ideas on breakfast meals check out the breakfast recipes on DaVita.com.

Putting together all the pieces of a kidney diet may make dining out a challenge. By following a few guidelines, it is possible to stick with a renal diet and enjoy eating out.

• Be familiar with the restaurant choices before you go. Pick up the takeout menu or check the restaurants website to view the menu. If you need help selecting the best diet choices, bring the menu to your renal dietitian and ask for help.

• If you are on a low potassium diet, cut back on higher potassium foods during the day if you plan to eat out at dinner. The same applies to sodium, phosphorus and fluids. By ‘saving’ some of your choices during the day, you can enjoy a bit extra at dinner and still stay within your diet goals.

• Bring phosphorus binders with you and take them with the meal. These medications work to bind phosphorus in the stomach and gastrointestinal track as food is digested. Timing with the meal is important.

• To reduce sodium, request foods to be prepared without extra salt or MSG when possible.

• Request condiments, sauces and salad dressings on the side and limit the amount used.

• Order the smaller size beverage and decline refills to help limit fluid intake.

• If meal portions are large consider splitting an entrée or taking half home.

• Instead of mixed dishes, order a steak, chicken, shrimp or fish entrée. These are usually lower in sodium, potassium or phosphorus compared to casseroles and mixed food entrees.

• Share dessert and avoid those with chocolate or nuts. Stick with fruit pie, cobbler, angel food or pound cake, sherbet or sorbet. Many restaurants offer fresh berries as a dessert option.

For additional information see the DaVita.com article Dining out on the Dialysis Diet.

Low sodium is one component of the renal diet recommended for people with chronic kidney disease and those on dialysis. Salt is an acquired taste. This means people who follow a low sodium diet can readjust to the flavors in food with very little or no salt over time—but there is an adjustment period. Herb and spice mixtures are a wonderful way to add extra flavor to foods without extra sodium.

Many commercially prepared herb and spice mixtures are available. Mrs. Dash® seasoning blends are readily available in a variety of flavors, and no sodium or potassium is added. Be sure to read labels because some seasoning blends, like Lemon Pepper may contain salt. Other low sodium blends may contain potassium chloride as a replacement for sodium chloride.

Create your own mix of favorite herbs and spices. Place the blend in a shaker on the table so it’s always visible and in reach. Add seasoning blends to marinades, homemade salad dressings and sauces. Sprinkle over meat, poultry or fish before cooking. Add to salads and vegetables for extra flavor.

You can easily make your own herb and spice seasoning blends to help add new flavors to your kidney diet. For best results, crush or grind herbs and spices together before placing in a shaker. For more ideas on using herbs and spices check out DaVita.com’s easy seasoning blends and recipes that incorporate seasoning mixtures.

Mexican Seasoning

Basic Meat Coating Mix

Meat Marinade

Basic Salad Dressing

Sara’s Vinaigrette Salad Dressing

Italian Dressing

High gasoline prices are contributing to rising food costs. Since many people on dialysis are unable to work full-time due to treatment time or disability, the increased cost of living calls for new measures to save pennies whenever possible. Start to control food costs by deciding what  to buy before you leave the house.

Grab your diet plan and grocery flyers and start making a grocery list. You can identify the lower potassium, sodium and phosphorus foods on sale by referring to your kidney diet guide while browsing through the grocery ads. Studies show that shoppers who use a list are less likely to buy impulsively. Grocery flyers help guide you to the sale specials and this can make a big difference.

For example, in one store’s ads this week Read more…

Research on dieting for weight loss and what works for long term weight maintenance is extensive. One tool shown to help weight loss dieters maintain their weight is a food diary. This is a useful tool for dialysis patients or anyone on a kidney diet making new and long lasting changes in eating habits.

A food diary is a record of the amount of foods and liquids consumed. It may include additional information Read more…

A handful of grapes make a healthy snack for a kidney friendly diet—tasty, convenient and full of phytochemicals—amazing plant components that provide health benefits.  Anthocyanins are a polyphenol antioxidant that gives the red to purple color to grapes, grape juice and red wine.  Resveratrol is another polyphenol antioxidant found in grapes.

These and other phytochemicals in grapes protect against heart disease by keeping blood vessels relaxed, preventing inflammation and oxidation of free radicals.  This may be a benefit to anyone with kidney disease because cardiovascular disease and inflammation risks are greater in kidney patients as compared to the general public.  Phytochemicals have also been linked to cancer prevention and protection against nerve degeneration that occurs with aging.

Nutrients in Grapes

1/2 cup grapes contains 1 mg sodium, 88 mg potassium, 4 mg phosphorus
4 fluid ounces grape juice contains 4 mg sodium, 167 mg potassium, 14 mg phosphorus
4 fluid ounces red wine contains 5 mg sodium, 149 mg potassium, 27 mg phosphorus

What about raisins?  Read more…

Understanding food labels is even more important for those following a kidney diet. Since phosphorus is often missing from the Nutrition Facts, it’s important to know how to find hidden sources on the ingredient list.

Look for obvious sources of phosphorus in the ingredients: cheese, milk, yogurt, nuts, seeds, dried beans and peas, bran, whole wheat or whole grains, organ meats, peanut butter and chocolate.

One not-so obvious source of phosphorus is the leavening agent, baking powder. One teaspoon contains over 450 mg phosphorus and over 350 mg sodium. Products made with baking powder include biscuits, pancake mix, quick breads and many commercially prepared bakery products.

Cereals and cereal bars may be another phosphorus contributor. Many cereal boxes list phosphorus in mg or as a % of Daily Value (DV). Use these numbers to interpret:
50 mg or up to 5% DV is low phosphorus
51-150 mg or 5-15% DV is medium phosphorus
Over 150 mg or greater than 15% DV is high phosphorus

Another hidden source of phosphorus is Read more…

This Friday, July 4th is a time for all Americans to celebrate freedom and independence. Parades, picnics and backyard barbecues are a few favorite ways to spend the day. By planning ahead and following a few guidelines, people with chronic kidney disease and those on dialysis can join the holiday celebrations and still maintain control of their diets.

DaVita.com offers a great list of recipes tagged for your Independence Day event. Try the Honey Mustard Grilled Chicken or Lisa’s Awesome Burgers for an entrée. Wash it down with Minted Lemonade or Watermelon Summer Cooler and enjoy Red, White and Blue Pie for dessert. Check out the variety of salad and pasta recipes for additional side dishes.

For a list of healthy tips for fun social events, see DaVita Dietitian Maria’s article “Surviving summer socials on the dialysis diet”.

Keeping sodium, fluid, potassium and phosphorus intake within reason is the key to enjoying July 4th and feeling your best by the end of the red, white and blue holiday weekend.

The Daily Value (DV) on food labels was established for the general public to help determine if a food is a high or low source of specific nutrients.

For people with healthy kidneys a high potassium intake is considered healthy. The daily goal is to consume enough high potassium foods to provide at least 3500 mg potassium.

Once the kidneys can no longer remove potassium (usually in later stage 4 and stage 5 CKD), and blood potassium values rise above normal (3.5-5.0 mEq/L) a lower potassium diet is usually prescribed.

Some but not all foods include potassium on the Nutrition Facts Label. An understanding of what to look for can help make grocery shopping easier. Here’s a general potassium DV guideline to help interpret the numbers when reading food labels:

• Up to 4 % DV = 0-140 mg, low potassium
• Up to 7 % DV = 141-250 mg, medium potassium
• Up to 14% DV = 251-500 mg, high potassium
• Over 20% DV = 700 mg or more, very high potassium

Each person has individual requirements for potassium depending on kidney function, lab values, appetite and type of dialysis treatment. It’s a good idea for people with chronic kidney disease to always check with their kidney care team rather than guess about their diet requirements for potassium.