Getting Enough Protein on PD
As a peritoneal dialysis (PD) patient you have likely discussed increasing your protein intake in your diet while you were getting your PD training or when you met your renal registered dietitian (RD). Do you know why you need to eat enough protein? Meeting your protein needs may help you to get healthier and stay healthy. One of the main reason is that PD treatments or exchanges, as we call them, cause extra losses of protein. Your body needs more protein on PD than your usual intake prior to starting PD. You will probably ask yourself “How do I know if I am getting enough protein daily?”
Estimating Protein Needs
The best person to answer that question would be your dietitian. He or she will calculate the right amount of protein on PD according to your height, weight and nutritional needs. As per the NKF Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines, it is suggested to consume at least 1.2 to 1.3 grams of protein per kilogram of body weight. (1) For example if you weigh 70 kg (154 lbs.), you will need 85 to 105 grams of protein each day. About 50% of it needs to come from high biological value (HBV) protein sources. If you follow a vegetarian or vegan eating plan your dietitian will work with you to create a plan using plant-based protein sources.
Lab results like your blood levels of blood urea nitrogen (BUN), potassium and phosphorus are also considered in assessing your protein intake. When you have an infection, a recent burn or have undergone a surgery, most likely your protein needs will increase. If you are underweight, you will need more calories in addition to protein.
Protein performs several essential functions in the body:
- Aids growth and maintenance of body tissue
- Maintains osmotic pressure and fluid balance in the blood
- Forms components of enzymes, hormones, and growth factors
- Forms components of antibodies
- Promotes wound healing and repair capabilities
- Provides energy
Putting Protein into a Plan
Let’s say your dietitian recommends to aim for 8 ounces of HBV protein a day in your meal plan. One way to meet this is by eating one egg in the morning, 1/4 cup of cottage cheese for a snack, 3 ounces of tuna salad for lunch and 3 ounces of lean pork for dinner. Picture a deck of cards to represent 3 ounces of cooked meat. Your dietitian will give you more specific information on measuring and estimating portions to be sure you get enough protein on PD.
Plant and Animal Protein
You may choose to do both–eat animal protein as well as plant-based protein foods. Plant-based protein foods have extra benefits. They have no saturated fat or cholesterol and contain more fiber and nutrients. Plus, there is the additional benefit of contributing to our environment. (2, 3)
Good sources of high protein foods include fresh lean meats, poultry, fish, eggs as well as yogurt, cheese, milk, beans, lentils and nuts. These foods have the organic form of phosphorus which is absorbed 45% to 60%.
Try to avoid processed meats such as hot dogs, sausages and bologna as these may contain inorganic phosphorus additives that are absorbed 90 to 100%.
Check out these high protein recipes from DaVita.com:
- Beef Chipotle Burritos
- California Pork Chops
- Grilled Chicken Marsala
- Omelet with Summer Vegetables
- Vegetarian Egg Fried Rice
- White Egg Salad
Foods high in protein go hand in hand with phosphorus. Make sure you take your phosphorus binders as prescribed with meals and snacks that contain high protein foods. Binders block some of the phosphorus in your foods to help keep normal phosphorus levels. .
Eating enough protein on PD to meet additional needs due to PD therapy is important. Depending on your lab blood test results and nutritional status, your dietitian will let you know how much you need to have daily from each food group. Planning a menu with your food preferences and using kidney-friendly recipes may help improve your meal satisfaction. Enjoy your food!
- KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, http://kidneyfoundation.cachefly.net/professionals/KDOQI/guidelines_nutrition/nut_a16.html , accessed 7/1/19.
- Shivam Joshi MD NYU presentation “Plant-Based diets in CKD” presented at NKF Spring Clinical Meeting in Boston May 2019
- DaVita Dietitian Connection patient education “Plant based protein sources for vegetarians” 2019.
Visit DaVita.com and explore these diet and nutrition resources:
This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.