Dialysis from the sharp end of the needle

Deja Vu? Salt Causes Hypertension in Dialysis Patients

By Peter Laird, MD

As a physician, one of the most interesting aspects of watching the nightly news is to hear of some "new" research paper telling us of a "new and novel" finding that is worthy of mention on a news cast. Many times I get a feeling of Deja Vu about the alleged "new" report because it is an issue that I had learned in my training many years before.  If this had only happened once or twice, I might have an eerie feeling about such a report, but instead it appears to be a pattern of modern medical research to simply spin its wheels on rehashed subjects.  NephrOnline has one such report that caught my attention today: Lowering sodium intake might be the best way to manage hypertensioin in dialysis patients:

The investigators found that dry-weight can be assessed inexpensively through relative plasma volume monitoring (which uses photo-optical technology to assess changes in volume of a patient’s blood) and body impedance analysis (which determines lean body mass). They also discovered that restricting salt intake can help control blood pressure and make it easier for patients to get down to a proper dry-weight.

While in medical school, I learned of the relationship between sodium intake and volume expansion of the intravascular space.  Throughout my career, in hundreds of patients, I used this information in critically ill patients in the ICU to support inadequate blood pressures with the proper saline solution. I understand the role sodium plays in hypertension, particularly the effect of high sodium on the blood pressure of dialyzors with decreased or no urine output. I understand sodium's role because it has been understood for a long time. Dr. Belding Scribner saw blood pressure control as a primary marker of adequate dialysis and as a result Scribner for decades educated and chided his patients to limit sodium as the key to successfully using dialysis. There is no doubt that confirmatory studies are important and should be done, but it is even more important to accept the original studies in hand, such as the experience in Tassin which has been preaching this very issue since the 1970's with dozens of published reports on the subject.

In the meantime, I eagerly await many unanswered questions about dialysis that I ponder every day that I hook up to my portable NxStage machine.  Here is a partial list of my own questions that I look forward to seeing in a new and novel study one day:

• What is the optimal frequency, duration and intensity of dialysis?
• What is the optimal water soluble vitamin replacement dosage?
• What is the cause of sudden cardiac death in dialysis patients?
• What is the cause of myocardial ischemia during hemodialysis sessions?
• What is the optimal hemoglobin level?
• What is the optimal renal diet?

I am sure that there are dozens of questions that researchers would likewise wish to be answered that could be easily added to my short list.  However, noting the correlation between salt intake and hypertension is not on my short or long list since that has long since been answered to my satisfaction years ago. 

When, my fellow medical colleagues, will the true issues of dialysis ever be addressed?  I have now been on hemodialysis for nearly four years and the same questions that I wondered about every time the needle enters my arm I still wonder about.  Is it time for more deja vu, or is it instead time to wake up and answer the difficult questions we have had for nearly fifty years?

Denny's piles on the salt

By Bill Peckham

RenalWeb links to a WebMD article about a lawsuit (PDF link) filed by the nonprofit Center for Science in the Public Interest:

Noting that the CDC recommends most adults get no more than 1,500 milligrams per day of sodium, Jacobson said that certain Denny's dishes contain far more sodium, such as the 2,580 milligrams of sodium in the Moons Over My Hammy ham, egg, and cheese sandwich.

That is a lot of sodium, it makes Devilled Sausages & Creamy Garlic Mash look healthy.

Denny's responded that they post their menu's nutritional information on their website (PDF link) and further:

Denny's believes the lawsuit filed by CSPI is frivolous and without merit, and the company will fight it aggressively in court. With hundreds of items on the menu, Denny's offers a wide variety of choices for consumers with different lifestyle, understanding that many have special dietary needs. In June 2009, the company launched Better for You items, allowing guests to replace favorites with lower-sodium and fat alternatives. Additionally, earlier this month, Denny's launched a Better for You kids menu.

That seems fair. You don't have to order the Moons Over My Hammy. Can you really say their whole menu is too salty?

Yes as a matter of fact, you can say that the Denny's menu is dangerously salty. An easy way to see this is to consider the mgs of sodium per calorie. Adults should get 1,500 to 2,500 calories a day (depending on how hard your day is) so as a general rule your food should have about 1mg of sodium per calorie. The Moons Over My Hammy breakfast provides just 780 calories for nearly two days worth of salt with lunch and dinner still to come.

Aside from soda and ice cream based deserts almost all of items Denny's menu have 2 to 3 mg of sodium per calorie. You would be hard pressed to eat a meal without ingesting your daily limit of sodium. Stray from some of the skewers and you're pretty much guaranteed to be over salted. Eating out should not be such a health risk.

Salt: News from the American Heart Association

By Anna Bennett

For those of you keeping score, the American Heart Association just issued a press release (nod to HDCN for the link) about recently published data from the CDC. (Bolding my emphasis)

“The new CDC data adds to a growing body of scientific evidence that supports this recommendation – there are now a substantial number of scientific studies that show a direct relationship between salt intake and a rise in blood pressure. An upper limit of no more than 1,500 mg could significantly reduce the rate of high blood pressure in the United States.”

The U.S. food supply contains excessive amounts of sodium (salt), which makes limiting sodium (salt) consumption to less than 1,500 mg difficult. According to the CDC report, Americans over the age of 2 consumed a daily average of 3,436 mg between 2005-2006, up from a daily average of 3,329 mg from 2001-2002.

I am curious to hear the Salt Institute's take/spin on this data.  It is right there.  Every little effort can help for people to live a longer, healthier life.  We need to be aware of what we eat, because in some cases, it is killing us.  As I have written before - (so much that we now have a Salt topic), about the NYC War on Salt, and about Hidden Salt, and the reality of excessive salt, we need to be aware. I am just glad that The American Heart Association is on board to counteract the marketing efforts of the Salt Institute.

Let's get real: Salt

By Anna Bennett

The Salt Institute and its British doppelganger The Salt Association, are salt industry trade associations (advocates for the salt industry).  From their websites, we are led to believe that salt is getting a bad rap, after all we need salt to live.  On that one point, I will agree. Our bodies do need to maintain fluid balance (homeostasis) to survive.

What our bodies do not need is an excessive intake of dietary sodium.  This is where I disagree with both the Salt Institute and the Salt Association.  The Salt Association not only calls the NYC War on Salt "foolhardy"  but also provides journal articles to support their position on the perils of a low salt diet.  Richard Hanneman, Salt Institute President, posted a comment to my initial post with two studies both showing that a low salt diet was not beneficial to patients in compensated congestive heart failure; and in patients with recently compensated heart failure.

These studies were done on patients who were in the full throes of cardiac disease.  While the nuance is appreciated, the overall indisputable public health fact is WE ARE EATING TOO MUCH SALT. 70% - 80% of our daily salt intake is from processed foods. 

Using excessive salt as a preservative, flavor masker/enhancer is big business. Con Agra, Pinnacle Foods Group, are two of the biggest.  Check out the products that they produce. Name brand, shelf stable, and even the foods labeled "healthy" are over laden with salt.  Of course the industry is threatened when a major city tries to educate its population.  What would happen if people actually started to read their food labels and made educated choices when grocery shopping?  Or, if fast food actually were forced to highlight their sodium content at the point of purchase.  An educated public is dangerous.  It may force manufactures to rethink their ingredients or they may just have their Institutes and Associations beef up their marketing trying muddy the discourse and give the appearance of unsettled science.

NYC's War on Salt is about awareness, and trying to fight an epidemic of ill health that is crippling our society.  We can toss medical studies back and forth and discuss this for years (that would be just fine to the Institutes). Declaring war on salt is a public health measure that is long overdue.  Drawing the line by shinning a spotlight on the excess sodium in processed foods is ground zero.

How much sodium should be in a normal 2000 calorie per day diet? That is not an easy number to pin down.  The USA consensus seems to be for a normal, healthy person, < 2,400 mg per day.

The Canadians (who's governmental healthcare is a bit LESS influenced by lobbying, marketing and special interest) put the normal/healthy intake number firmly at 1,500 mg per day.  In this case, I'll stick with the Canadians for guiding my base salt intake.

How much salt is in a:

Wendy's Breakfast Burrito	910 mg per burrito	60% daily sodium
Big Mac	1040 mg per sandwich	69% daily sodium
KFC Chicken BLT Salad	1020 mg per salad	68% daily sodium
Subway Roast Beef Salad	480 mg per salad	32% daily sodium
Domino's Deep Dish Pizza 1 slice (1/8) no toppings	530 mg per slice	35% daily sodium

The list could go on and on and on.  In this fast food environment it is very difficult to adhere to the RDA diet.  One meal could easily fill the whole days requirement.  Yet the Salt Institute is concerned that The City of NY is being foolhardy in declaring "War on Salt".

In these current economic times, one company seems to be recession proof.  McDonalds - more and more people are eating fast, cheap meals there.  A McDonald's side salad would be great: 10mg of salt.  If you add a packet of Newman's Own low fat sesame ginger dressing you add 740 mg of sodium  (49% of your daily sodium).

When you are on dialysis (or trying to keep a transplanted kidney viable) you need to be AWARE of everything that goes in your mouth, and the ramifications of what you eat.  It could be the difference between comfort and cramping, thirst and dehydration and in the long run, life and death.

Salt Institute: Putting profit before health

By Anna Bennett

Thanks to a particularly irresponsible recipe distributed by the Kidney Support Network of Australia in their Christmas Newsletter, we at DSEN have been looking even deeper into the dangers of salt and the misguided "experts" who promote today's excessive salt use in both the CKD community and the general public.

Unlike tobacco, which has no health merits, salt (NaCL) contains electrolytes, and we need some salt in our diets for proper cell function and overall health. If we are in any stage of CKD, we need the bare minimum of salt in order to not do any further damage to our bodies.  This is why we are put on a low sodium diet as soon as we are diagnosed with CKD.  This is a difficult balance, when we need some salt, but we need to control our intake, and we as a society have been inundated with salt in our modern diets.  Salt in all of its various forms is a preservative and flavor enhancer.  We are used to it.  In some cases we crave it, and we have to retrain our taste buds.

Now here is the battle that we have to fight.  The Salt Institute exists to promote the use of salt in all of its forms.

From their website:

The primary activity of the Salt Institute is advocacy -- to governments, our customers and the general public – creating and providing information about the production, distribution and uses of salt, including the benefits and costs associated with salt usage.

Yes, in our hypertensive, overweight society, there is an institute that exists to promote the benefits of using salt.  They refute health issues.  They call NYC's public health measures "foolhardy".

Take a look at the letter Richard L. Hanneman, President of the Salt Council sent to the Commissioner of Mental Health and Hygiene of New York City when NYC declared war on salt to combat the spiraling out of control health issues of the 8 million + people of the City of New York.

Excerpt from the letter (bolding my emphasis):

We urge you to join with us in seeking federal funds for a controlled trial of the health outcomes of salt reduction. Such a study can utilize the proven protocols of the Trials of Hypertension Prevention and be accomplished in five years at modest cost compared to those your policy would impose on consumers and food manufacturers. Until we have a controlled trial to formally test the hypothesis that reducing dietary salt will improve health outcomes imposing such a policy on the entire population would be foolhardy. We strongly urge you against the course of using the citizens of New York as a grand experiment of this generally-believed but as-yet untested hypothesis.

All I can say is that I doubt that Mr. Hanneman ran that letter past his cardiologist.  And I doubt that Mr. Hanneman has a friend or relative who is in CKD5 due to hypertension.  As a matter of fact, the Salt Council proselytizes that a low salt diet actually causes hypertension - tell that to the overweight middle aged man standing next to you in line at KFC (aka future CKD5 patient #505,339 - if he survives heart attack, stroke or type II diabetes).

From the letter:

We presented the science and left with you a compendium of the published studies describing the literature and showing:

The salt/blood pressure discussion has misunderstood the impact on blood pressure which is heterogeneous; a significant portion of the population when placed on a low-salt diet actually increase their blood pressure

The Salt Institute wants us to need salt.  After all, salt production and consumption is the whole reason why the Salt Institute exists - not for our welfare, but for the industry's profit.

All of this propaganda is being spewed at healthy people.  We, the community of CKD sufferers know better.  I applaud NYC for trying to educate people before it is too late - before they have a stroke or heart attack or their kidneys fail.  The Salt Institute is advocating that we study salt for another five years, put the health of the people on the back burner until science gives us more definitive proof.  (As if the growing numbers of the CKD5 population aren't enough - there is your study.)  When I was in-center, I could look around at the faces in the 30 chairs (always full) surrounding me, and I could pick out those with hypertension  - generally the ones eating cheap Chinese takeout and potato chips while dialyzing. This is a perfect, tragic example of why we need public education as soon as possible.  It is preventative medicine - the cheapest form of medicine available  - stop disease before you have to treat it.

The city of NY wants to tell people that they should think before eating that bag of chips, or that fast food chicken or any other food where excess salt is insidiously lurking - before it is too late.

NYC Says NO to Salt

By Anna Bennett

We at DSEN have been writing about salt and how salt has a negative affect on those with CKD - both in the hastening the onset of CKD5 and too much salt making dialysis inefficient. In an effort to promote better health (and lessen the burden on our underfunded over stressed public healthcare system) the city of New York has started a campaign to Cut the Salt. 

Although there is no mention of CKD, this is a step in the right direction to keep people off dialysis.

Americans’ salt intake has increased dramatically in recent decades. We now consume almost twice the recommended limit of salt each day – but not by choice. Nearly 80% of the salt in our diet is added to processed and prepared foods before we buy them. Reducing salt in food will lower blood pressure in people with hypertension. Salt reduction will also help prevent strokes, heart attacks, and other problems in people who don’t have clinical high blood pressure.

The initiative calls on food industry leaders to help develop, and then adhere to, sodium targets for all products, using categories such as breads, breakfast cereals and prepared entrees. The goal is to achieve substantial, gradual reductions in salt levels across a wide range of foods. Meeting salt reduction goals will require significant changes in food manufacturing practices, but the changes are feasible.

The website also contains some helpful links:

Their Health Bulletin with facts and helpful hints, including a page with the sodium content of popular foods - which is full of sobering numbers.  Like one tablespoon of ketchup is 8% of your daily sodium.  One canned biscuit (the kind you pop and bake) is 24% of your daily sodium.  This list blows my Beware Hidden Salt post out of the water, and just goes to show that salt is everywhere.

The New York Times picked up on this story with the article Throwing the Book at Salt and created a graphic of Where Salt Lurks.

This is all information that you can use to live a healthier and longer life.

Beware hidden salt

By Anna Bennett

We hear it again and again - too much salt is bad for you. DSEN has a category of posts on CKD & Salt and Nancy Spaeth recently wrote a detailed comment about salt and the importance of sodium control.  That is the salt that we can see, the salt that we have control over - not putting the salt shaker on the table, cooking without salt.  BUT in today's over processed/fast food environment you may be ingesting salt without even realizing just how much. Moderating sodium in your diet means limiting yourself to about 1500 mg of salt per day.

photo by Craig Jackson

Salt has many names: Some of the sodium ingredients used in food processing include: salt, sodium, monosodium glutamate (MSG), baking powder, baking soda, disodium phosphate, sodium benzoate, sodium hydroxide, sodium nitrite, sodium propionate and sodium sulfite. All of these affect your body's fluid volume, your thirst level and your body's ability to be efficiently dialyzed - you won't be able to pull off enough fluid during a conventional incenter run if you have too much salt on board - too much sodium would make it mathematically impossible for a 3.5 hour 3x a week dialysis schedule to balance the fluid between your blood, your cells and your interstitium.  Your body would have to have fluid removed from its blood compartment faster than it could transfer fluid in from the interstitium. This fluid deficit in the blood compartment is what causes cramping and you won't even finish dialysis at your dry weight. Hours later your cells and interstitium would release their fluid surplus into your blood stream leaving you chronically fluid overloaded. It's a vicious cycle that can start to wind down once salt is brought under control. For more on the body's three fluid spaces see Bill's post Dr. Agar on fluid and solute removal.

Salt is a preservative, and in general the convenient, shelf stable food that you buy pre-made or pre-mixed from the grocery store has too much salt in it.  And I'm not even writing about processed meat - pretty much anything packed in plastic from your deli aisle - turkey slices, Bologna, hot dogs - these meats are treated with sodium and other preservatives to last longer on the shelf. When you are making yourself that Oscar Meyer shaved turkey sandwich (2oz = 460 mg salt) on Wonder Bread (2slices = 260mg), you are adding significantly to your salt consumption.  It may be a quick meal now, but it is shaving time off your life span - you're "saving time", so that you can die earlier. That doesn't make much sense.

Here is how salt can sneak up on you (from Hidden Sodium in food)

• Twizzlers Black Licorice Twists - four strands have 200 milligrams; four strands of Twizzlers Strawberry Licorice have 115 mg.
• Raisin-bran cereals - Kellogg’s has 350 mg per cup; Post, 300 mg; Total, 230 mg.
• Jell-O Instant Pudding & Pie Filling Mix - the chocolate flavor contains 420 mg per serving; lemon, 310 mg; chocolate fudge, 380 mg.
• Prego Heart Smart Traditional Italian Sauce - this has an American Heart Association logo on the label which means saturated fat and cholesterol are restricted, but not that it’s low in sodium. This sauce has 430 mg per half-cup.
• Aunt Jemima Original Pancake and Waffle Mix - prepared as directed, the pancakes have about 200 mg of sodium each.

More Salt Resources:

Top Ten ways to limit your salt intake

World Salt Awareness Week

Hidden Sodium in Supermarket Meats

DaVita sodium and chronic kidney disease

If you're on dialysis, moderate your salt intake. It makes dialysis less of a burden and health impact aside, eating fresh, home made food tastes much better.

World Salt Awareness Week is February 2nd - 8th

By Bill Peckham

World Action on Salt and Health (WASH) is holding its 2nd annual World Salt Awareness Week on February 2nd. This year the focus is salt eaten outside the home. That's a helpful focus - there is no reason people can't salt food to taste rather than having it over salted back in the kitchen. There are a lot of people who have not yet gotten the message, WASH has a lot of education work still to do.

No, really. People with CKD (actually everyone) should not eat a lot of salt

By Bill Peckham

RenalWEB links to an interesting announcement from the American Society of Nutrition Salt reduction may offer cardioprotective effects beyond blood pressure reduction. There is a lot of research that tells us controlling salt is an important part of living with CKD. This research from the American Society of Nutrition that "salt reduction may offer cardioprotective effects beyond blood pressure reduction" is not specific for people with CKD it is a recommendation for everyone.

For people with CKD controlling salt is even more important. This year World Kidney Day on March 12th is being held in collaboration with World Hypertension Day on May 12. The reason for this collaboration is that the vast majority of people with early stages of CKD will die prematurely before they progress to needing renal replacement. This is due in large part to poor cardiovascular health. Everyone with CKD, without exception, needs to protect their cardiovascular health. Controlling salt intake is an important tactic in this fight. The sponsors of World Hypertension day, the World Hypertension League (I hope they all wear jump suits with rank designation patches) have compiled a lot of research into how everyone, including everyone with CKD, can protect their cardiovascular health.

The paper relevant to salt A Dash of Salt and Tone: Recent trials providing new insights into the diet-blood pressure healthlink, makes it clear that control of salt intake is an important part of a healthy diet and  "individuals typically considered to be at the highest risk for hypertension and cardiovascular events, the elderly and African-Americans, had the greatest reduction in blood pressure with these dietary alterations." Simple "dietary interventions consisting of reduced salt intake and increased use of fresh fruits, vegetables and low-fat dairy products" go a long way to a healthy heart. It's a great idea for a partnership and the people running the World Kidney Day effort should be applauded for this year's focus on cardiovascular health.

So it was with great dismay that while wandering cyberspace I came across this recipe in the Kidney Support Network's Xmas 2008 newsletter (pdf link). Per serving: Sodium (mg) 1530; Potassium (mg) 945; Phosphorus (mg) 370. 1530mg of Sodium per serving! I think the World Hypertension League would judge Devilled Sausages & Creamy Garlic Mash unfit for human consumption (to the Pressuremobile team!).

That's just ridiculous. I wrote to the Kidney Support Network:

I was looking through your newsletter - I would like to know more about your organization. For instance some details about the hemodialysis van that is available, I think that would be a great thing to make available here in the NW United States.

But I was SHOCKED and ALARMED by the recipe included in your December newsletter: Xmas Edition 2008 1530 mg of salt per a serving!?! That would be dangerous for people without kidney problems; for people with kidney problems it is without any doubt contraindicated. Salt causes thirst.

Eating one serving of Deviled Sausages & Creamy Garlic Mash would create a thirst that could only be satiated by drinking far too much fluid. People on dialysis must not eat this dish.

Hypertension is a leading cause of stage 5 chronic kidney disease. A diet high in salt can exacerbate hypertension. One serving of Deviled Sausages & Creamy Garlic Mash would very nearly use up a person's day allotment of sodium.

See the abstract Low sodium diet for dialysis patients: myth or reality?, talk to your own Dr. Agar to the south or believe the Rigby, Scribner, Ahmad's paper from 2001  Interdialytic fluid weight gain is mainly caused by sodium intake which makes the rather obvious point again that sodium intake drives thirst

For the sake of your community's health you must redact the recipe from the newsletter at once. And I would suggest rather than getting your recipes from Nestle Australia you should instead ask for permission to take recipes from "Cooking Without a Grain of Salt" available on Amazon.com

Reading it now, after sleeping on it, I would have written it differently but the reply I received makes it clear that it wasn't a mistake. That they do, in fact, think of Devilled Sausages & Creamy Garlic Mash as food for humans:

I hear and understand your concerns about the salt content in the recipe, however it  wasn’t just from Nestle for the general public as I think you have assumed, it was from a site specifically for kidney patients and was checked by dietitians who are our contacts here locally (here in Australia) prior to publishing it. From memory the recipe came from an American site DaVita, as we had to seek their permission to publish, but I will look into it further.

One of the unfortunate issues with diets for kidney patients is that they are all different – and there are very few recipes suitable for everyone. Some people have the fluid restrictions you speak of and others do not, some have to watch protein intake and I have heard of others who are put on high protein diets. It is extremely difficult for generalizations and what we encourage is everyone to do is to educate themselves on what they are able to consume based on their illness and treatment and monitor their health appropriately.

Okay it is true that some small number of people who are on dialysis and still have urine output do not have to strictly control their fluid, most are those who's CKD is due to PKD. I had some fluid output for the first four years of dialysis but that is a poor reason to hang your argument on because the relative numbers are small. The recipe is not healthy and it is particularly unhealthy for people with no renal function who the organization is dedicated to serve. Come on. 945mg of Potassium!

I never got past the sodium to notice the potassium until writing this post. This recipe is dangerous. If someone has this on the first night of their dialysis weekend and then has leftovers they could easily end up in the hospital or in the ground. Go ahead and keep in mind the varied needs of people with CKD but that should not conflict with offering only healthy menu ideas.

And no, the recipe did not come from DaVita, I will eat this blog if a DaVita dietitian signed off on this salt and fat concoction. It is beyond all belief that DaVita would shill for Maggi's little balls of death or whatever it is the recipe calls for. Google says the only other place the recipe shows up is on Nestle New Zealand. World Kidney Day is coming, let's all try to eat a healthier diet, a diet without a lot of salt. It's a simple way for everyone to live healthier and for people with CKD it is doubly important.

Dialysis/Kidney friendly menu planning

By Anna Bennett

When I was incenter on dialysis 3x a week - healthy menu planning was an issue.  When I went home on NxStage, I was much less restricted, and the planning became easier.

I started on a renal diet when I was in CKD3 I had many years to adapt to low protein and no salt (see Bill's post on top 10 ways to limit salt intake).   The transition to a dialysis diet was still a big adjustment - I ended up having to supplement my protein (once you start dialysis, the battle is to keep your protein up which is the exact opposite of the pre-dialysis renal diet).  And I counted the days until I could start high dose home hemo.

I have always maintained that the easiest way to transition into a renal diet is to modify what you are already enjoying,  I wrote a post about reworking your recipes to have less protein (while in CKD3 - CKD4).

I also collect cookbooks, and obsessively look on line for recipes.  It is possible to be a "foodie" and be on dialysis.  It just takes some work.  One website that I relied on was food.com.  I would type in some renal friendly ingredients, hit search and it would search its database for possibilities, I would then have to modify recipes to be dialysis friendly when necessary, but all in all it made me feel like I wasn't being forced into a fixed diet and ultimately, it was my choice.

A quick search of Amazon.com showed some CKD5 cook book possibilities as well:

Cooking for David: A Culinary Dialysis Cookbook

The Cleveland Clinic Foundation Creative Cooking for Renal Diets

The Cleveland Clinic Foundation Creative Cooking for Renal Diabetic Diets 

Dialysis Diet, Revised Edition

Since diet affects people with kidney disease in such a major way, I am surprised that there aren't an overwhelming amount of resources.  Bill has some good on line resources (from CKD Links to knowlege and resources)

• Dialysis and CKD Recipes and Nutrition Information
  • USDA Nutrient Data Laboratory
  • Recipes from the Northwest Kidney Centers
  • Culinary Kidney Cooks
    • Recipe of the Week
  • IHD Diet and Recipes Discussion Board
  • Recipes from Davita

And then there is always DaVita's Diet Helper.  If you want dialysis friendly menu planning with little effort, and very little input on your part, this is the service for you. 

After you go through a quick, free online registration, the helper will provide you with a dialysis friendly menu for every day of the year.

(click to enlarge) Here is a sample day's menu.  When you have registered with the website, you simply click on the item, and the recipe and food values pop up for that individual recipe.

Top ten ways to limit salt intake

Apropos of Home Dialysis Central's featured paper on the impact of sodium intake - here are the Top Ten Tips for Shaking the Salt Habit (pdf link) from the Northwest Kidney Centers:

1. Avoid meats that are labeled, “Enhanced.” They are injected with salt water and have up to 10 times the salt of regular chicken, turkey, pork and other meats.
2. Talk with your butcher. Ask them to point out to you meats that are “fresh” and don’t have salt water added. You’ll save money too, since you won’t be paying a premium price for salt water!
3. Avoid meals that just need a microwave to heat them up.
4. Make your own fast frozen meals. Whip up two casseroles; portion one into individual containers and freeze. Then, when you need a quick meal, your microwave can be your best friend!
5. Avoid foods that are labeled, “Instant” or ‘Quick.” Often these foods have salt added to speed up the cooking.
6. Take just a few minutes more and make real oatmeal, or put rice in a rice cooker while you make the rest of the dinner.
7. Avoid lunchmeats and processed meats and cheeses.
8. Use peanut butter, cream cheese with jam, egg salad, rinsed tuna, or sliced leftover meat from last nights dinner.
9. Avoid foods that have 400mg of sodium or more per serving. Try and keep your daily intake to about 2,000mg of sodium.
10. Buy fresh foods and cook them yourself. Try our fast stir-fry recipe (Salt-Free Stir-Fry) in the recipe section. It took just 12 minutes to cook in our test kitchen, and while it was cooking, the rice in a bag finished up.

More on salt's impact on stage 5 CKD

Nephron.com links to an abstract Low sodium diet for dialysis patients: myth or reality? by Chazot, Collonge and Charra. This September 2007 paper again links sodium control to lower fluid gains between dialysis treatments. The authors are from Tassin France, well know for their commitment to extended dialysis. It was here during a 1996 trip that I was provided the best meal to date while dialyzing. Four courses - with wine or beer available. It is my understanding that funding of the kitchen has since been cut back which in turn has impacted dialyzor's willingness to extend their treatments.