Sodium and the Renal Hemodialysis Diet

Healthy kidneys get rid of extra sodium in the urine. When kidney disease occurs the body is not able to get rid of sodium and it can build up leading to complications. Sodium is an electrolyte (a mineral with an electric charge) that is needed for proper nerve and muscle function. It also helps balance the fluids in the body. However, with kidney disease, your kidneys cannot effectively remove excess sodium from your blood. This in turn causes you to become thirsty, and drink more and become overloaded with fluids because your kidneys are also unable to remove excess fluid.  As sodium and fluid builds up in your body and bloodstream, your blood pressure rises. Having high blood pressure can cause even more damage to your kidneys. Your heart is also negatively affected from too much sodium in the body.   When there is too much sodium in your bloodstream and high blood pressure, your heart has to work harder causing it to become weak and enlarged. 

Limiting sodium in your renal diet can help to control your blood pressure and reduce the amount of fluid your body retains.  Most kidney patients need to reduce sodium intake to 2,000 to 3,000 milligrams per day.  This amount may differ for you, or the person you are helping to care for. The exact amount is determined by your dietician or health care provider and is based on a number of different things.

Salt is the main component in sodium.  Lets face it, most of us could probably benefit from knowing how much salt we are actually eating, then cutting back on the amount in our diet. Salt is the number one seasoning used by Americans. We pickle, cure, preserve with salt. We cook with salt, and a salt shaker sits on most of our dining tables. If you start tracking how much salt you personally intake, you would be very surprised.

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Steps to Lower Your Sodium Intake

There are some steps you can take to limit the amount of sodium in the foods you eat and the beverages you drink.  

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Talk to Your Healthcare Provider

Talk to your dietician and/or other healthcare provider. I’m sure as a patient or caregiver or family member, you know this right? However I have found that my own patients really needed some help when it came to talking to their  providers.  Keeping a food diary gives them a good starting point each time to begin a conversation. Your dietician will assist you in creating a plan that will help balance your sodium intake in order to best support the health of your kidneys, and, in turn support a healthy heart, and good health overall. 

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Read Food Labels

Read food labels.  Processed foods can have a lot of salt in them. This was a big one for me!  I expected things like my favorite potato chips to have lots of salt.  However, I found high levels of salt in some foods I had never thought of as high in salt.  Reading those labels is a big eye opener.  Look for food labels that say: unsalted, reduced sodium, no salt added, sodium free, and low sodium.   If you are choosing foods with these low sodium labels; just be aware that sometimes those that say low sodium often have added potassium. Since we are also concerned about how much potassium is in our diet, you will need to of course avoid these foods with the added potassium.

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Limit Adding Salt when Cooking

When cooking, limit the amount of salt you are adding, or just leave it out entirely. Experiment with different herbs and spices to add flavor. 

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Remove Salt Shaker

Remove the salt shaker from your kitchen table. You can try replacing it with a herb seasoning blend that you like.

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Skip Salt Substitute

Skip the salt substitute. Unfortunately, many of these contain a large amount of potassium as the substitute for sodium.  

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Eat Less Processed Foods

Eat less processed foods.  Processed foods are typically high in sodium.  As much as 90% of the sodium that Americans eat comes from processed foods and foods prepared in restaurants! Foods such as packaged meats, canned foods, fast foods, and salted snacks are the more obvious sources of high sodium foods to avoid. It's easy to see (or taste) and understand that the bag of potato chips you buy for a snack when you stop to gas up your car is high in salt/sodium.   

The less obvious sources of high sodium, ones that are often overlooked by most of us, can quickly add a lot of sodium to our diet. Things like dressings and sauces add high amounts of sodium to a carefully planned meal. This one was a little shocking to me! Let me give you an example. Adding just one tablespoon of an Italian salad dressing to your salad can add as much as 245 mg of sodium! If we are honest here, most of us do not measure out our dressing by the tablespoon, and probably use much more than that. Seasoning packets, like the type we get with take out food are another example. 

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Video

In this video developed by Haelo UK, Renal Dietitian Sarah Brooks discusses how to control salt intake. The transcripts of the video follows.

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Video Transcript

Thank you for taking the time to watch this information video on how to control your salt intake. Salt is also called sodium chloride sodium is a mineral found in our bodies that helps to control fluid balance and blood pressure.  Sodium is found in lots of foods naturally however food manufacturers add it to a lot of processed foods for flavor for this video.  

We will talk about sodium as salt.  Too much salt can increase our blood pressure which increases our risk of kidney disease, heart disease and stroke.  A high salt intake can damage your kidneys.  Further, it can also increase the amount of water that your body holds. It might show on your hands, your legs and you might have shortness of breath.  

If you’ve been on a fluid restriction by your medical team, controlling your salt intake will help to reduce your thirst. This will help you to stick to fluid restriction.  We need to limit salt to 6 grams a day. What 75 percent of this is already hidden in foods like ready-made meals, soups, sauces and cereals. Reducing your salt intake has many benefits as we've heard. But it doesn't have to mean reduced flavor.  

You can reduce your salt intake by limiting processed meats like ham, sausages, burgers, and ready meals. Homemade foods means you can control the amount of salt. That you add the less, the better.  Stock cubes can be high in salt, even reduced varieties only have up to 25 percent less than their for salt alternatives. Very low salt stock cubes have up to 90 percent less. So it's worth looking out for these. 

Take the salt shaker off the table and use pepper, ginger, garlic, chili, herbs,or spices to flavor meals and soups. They can be fresh or dried. 

Seasonal vegetables tend to have more flavor. Marinating meat and fish in advance gives a stronger flavor.

Takeaways can have up to 10 grams of salt in them. Consider swapping doner kebabs, chicken curry, or chow mein with grilled chicken pita or battered fish with vinegar. Or make your own take away style food at home.

Did you know you can ask some takeaway shops and restaurants to not add salt?

Please don't use low salt or other reduced salt alternatives. They actually removed some of the sodium and add potassium. So they're not effective. It's better to just get used to a reduced salt taste anytime.

Most products now have a traffic identification system which helps you to identify something that is high in salt. Look out for red, amber, or green or brown signage in food packets. It may take you a while but once you know what's low in salt, you can buy all the time.

So here we can see the salt content in common food products.

So you can see just how easy to reach that six gram daily maximum allowance of salt.  It can take a couple of weeks for your taste buds to adjust to a regime salt diets but it's worth it in the long run. With it helping to reduce your blood pressure, reduce strain on your kidneys, and if you're on a fluid restriction, it can help to control your thirst which will help you stick to your fluid restriction. If you'd like more information on how to control your salt intake or if you'd like to speak to a dietitian just ask your medical team for a referral.

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Reference

National Kidney Foundation

Haelo UK

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About the Author

Elizabeth Custer is a registered dietitian at Huntington Health and USC Arcadia.  She completed her Bachelor's Degree in clinical nutrition at University of California Davis, and dietetic internship at Sacramento State University.  She has worked in many settings including acute hospital, sub-acute, skilled nursing, psychiatric, outpatient, retirement, and convalescent facilities. As a registered dietitian, her primary role includes assessing patients, providing nutrition education, and implementing medical nutrition therapy for a variety of medical conditions, such as chronic kidney disease, cardiovascular disease, hyperlipidemia, diabetes, hypertension, and more. Her passion lies with direct patient care and her experience in clinical, food service, and managerial roles has allowed her to deliver high-quality, evidenced-based strategies to promote health, well-being, and manage nutrition-related diseases. Elizabeth presented her research paper on food insecurities among students at the California Association of Nutrition and Dietetics Annual Conference in 2018.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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