What foods should a patient with Chronic Kidney Disease (CKD) stage 5 in dialysis eat and avoid in an Indian setting?

Dietary Management for CKD Stage 5 Dialysis Patients in Indian Setting

For CKD stage 5 dialysis patients in India, consume 1.0-1.2 g/kg body weight/day of high-quality protein from lean meats, fish, eggs, and dal, while strictly limiting sodium to less than 2.3 g/day (approximately one teaspoon of salt), restricting phosphorus-rich foods, and individualizing potassium intake based on your blood levels rather than blanket avoidance. 1, 2

Protein Requirements - What to Eat MORE

Target: 1.0-1.2 g/kg body weight/day 1, 3

• Emphasize high biological value proteins (at least 50% of total protein): chicken, fish, eggs, lean mutton 3
• Include fatty fish twice weekly: pomfret, rawas (Indian salmon), bangda (mackerel) for omega-3 fatty acids 3
• Plant proteins acceptable: moong dal, masoor dal, but count toward total protein 1
• Avoid excessive protein (>1.3 g/kg/day) as this worsens uremia 1

Sodium Restriction - Critical for Blood Pressure and Fluid Control

Target: Less than 2.3 g sodium/day (approximately 5-6 g salt/day or one teaspoon) 1, 2

Foods to AVOID (High Sodium):

• Pickles (achar), papad, chutneys 2
• Processed foods: packaged namkeen, chips, biscuits 2
• Salted buttermilk, commercial masala mixes 2
• Canned foods, sauces, ketchup 2
• Bakery products with baking soda/powder 2
• Do NOT use salt substitutes - these contain potassium which is dangerous 1

Cooking Tips:

• Use lemon juice, fresh herbs (coriander, mint), spices (jeera, dhania) for flavor instead of salt 2
• Avoid adding salt at the table 2
• This restriction prevents excessive interdialytic weight gain (should be <1.5 kg between sessions) 1

Phosphorus Management - Prevent Bone Disease

Target: 10-12 mg phosphorus per gram of protein consumed 2, 3

Foods to LIMIT or AVOID (High Phosphorus):

• Dairy products: milk, paneer, curd, cheese (despite being good protein sources) 2
• Whole grains: brown rice, whole wheat atta (use refined grains instead) 1
• Nuts and seeds: cashews, almonds, peanuts, til (sesame) 2
• Dark colas and soft drinks 2
• Processed meats and cheese 2
• Dried beans and peas in large quantities 1

What to Do:

• Use phosphate binders with meals as prescribed by your doctor 2
• Choose white rice over brown rice 1
• Use refined flour (maida) over whole wheat for rotis 1
• Limit dairy to small amounts; use low-phosphorus alternatives 3

Potassium Management - Based on YOUR Blood Levels

Potassium intake must be individualized based on your serum potassium levels, not universally restricted 1, 2

If Your Potassium is HIGH, AVOID:

• Bananas, oranges, chikoo, mango 2
• Coconut water, fruit juices 2
• Tomatoes, potatoes (unless double-boiled and water discarded) 2
• Spinach (palak), methi, other leafy greens 2
• Dried fruits: dates, raisins, dried figs 2
• Whole nuts and seeds 3

Potassium-Lowering Cooking Methods:

• Double-boil vegetables: cut into small pieces, boil in large amount of water, discard water, boil again in fresh water 2
• Peel and soak potatoes overnight before cooking 2
• Avoid cooking water from vegetables 2

If Potassium is NORMAL, you can include:

• Moderate amounts of fruits: apples, papaya, guava, pears 2
• Vegetables: bottle gourd (lauki), ridge gourd (turai), snake gourd, cabbage, cauliflower 2

Fluid Restriction

Target: 1.5-2 liters per day total (including water in food, tea, dal, etc.) 2, 4

• Monitor daily weight - sudden gain >2 kg in 3 days indicates fluid overload 4
• Count all liquids: water, tea, milk, dal, rasam, sambhar 2
• Patients with residual urine output may tolerate slightly more 2

Energy Requirements

Target: 35 kcal/kg body weight/day to prevent muscle wasting 3

Good Calorie Sources:

• Cooking oils: use canola oil, rice bran oil, olive oil (these provide omega-3 without high potassium) 3
• Refined carbohydrates: white rice, refined wheat products 1
• Limited sweets and sugars (if not diabetic) 3
• Avoid trans fats from vanaspati, dalda 3

Foods to Emphasize in Indian Context

Proteins (1.0-1.2 g/kg/day):

• Chicken (skinless) 3
• Fish: pomfret, rawas, bangda (twice weekly for omega-3) 3
• Eggs (egg whites are lower in phosphorus) 3
• Small amounts of dal (moong, masoor) 1
• Lean mutton (occasionally) 3

Vegetables (double-boiled if high potassium):

• Bottle gourd (lauki), ridge gourd (turai), snake gourd 2
• Cabbage, cauliflower, beans 2
• Cucumber, pumpkin (kaddu) 2

Grains:

• White rice (not brown rice) 1
• Refined wheat flour rotis 1
• Avoid whole grains due to phosphorus 1

Fats:

• Canola oil, rice bran oil for cooking 3
• Avoid coconut oil in excess 3

Critical Restrictions Summary

AVOID Completely:

• Salt substitutes (contain dangerous potassium) 1
• Pickles, papad, processed foods 2
• Dark colas 2
• Coconut water 2
• Whole nuts and seeds (use oils instead) 3
• Excessive dairy products 2

LIMIT Severely:

• Table salt to <1 teaspoon/day 2
• Fluids to 1.5-2 L/day 2
• High-potassium fruits/vegetables (if serum K+ elevated) 2
• Phosphorus-rich foods 2

Vitamin Supplementation

• Folic acid: 1 mg/day 3
• Vitamin B6 (Pyridoxine): 10-20 mg/day 3
• Vitamin C: 30-60 mg/day (not more, to avoid oxalate buildup) 3
• Water-soluble vitamins are lost during dialysis 3

Alcohol

Limit to 1 drink/day for women, 2 drinks/day for men (if consuming at all) 3

• Alcohol provides empty calories without nutrition 3

Essential Implementation Points

• Work with a renal dietitian for individualized meal planning adapted to Indian foods 2, 5
• Get nutritional assessment every 6 months 2, 3
• Monitor interdialytic weight gain - should not exceed 1-1.5 kg 1
• Common pitfall: Restricting protein too much leads to malnutrition; dialysis patients need MORE protein than pre-dialysis patients 1, 6
• Another pitfall: Blanket potassium restriction may be unnecessary if your levels are normal 1
• Indian Expert Panel specifically recommends <5 g salt/day for CKD patients 1

Special Considerations for Indian Diet

• Traditional Indian diet is often high in sodium (pickles, papad) and potassium (coconut, leafy greens) - these require the most modification 1
• Use spices and herbs liberally for flavor instead of salt 2
• Dal provides good protein but also phosphorus - balance carefully 1
• Avoid restaurant food which is typically very high in salt 2
• Home-cooked food with measured salt is essential 2