Eat Well / Thanksgiving for dialysis patients
Dialysis changes the Thanksgiving math in one surprising way: protein needs go up, not down, so there's room for more turkey, not less. Fluid, potassium and phosphorus additives still need watching, and this guide works through each one, dish by dish.
Yes. The KDOQI 2020 guideline sets dialysis protein at 1.0 to 1.2 grams per kilogram of body weight a day, higher than stage 3 to 5 kidney disease, where the range is 0.55 to 0.6 grams (0.6 to 0.8 with diabetes), followed with a care team's supervision. The book counts one meal as a third of the day.
In practice, that means the "More turkey" plate for a guest on dialysis carries more turkey than the equivalent plate for stage 3 to 5, and it grows with body weight:
| Body weight | Turkey, "More turkey" plate |
|---|---|
| 99 to 132 lb (45 to 60 kg) | 2 oz (57 g) |
| 143 to 198 lb (65 to 90 kg) | 3 oz (85 g) |
| 209 lb and up (95 kg and up) | two servings of 2 oz (57 g), in place of the pie |
The National Kidney Foundation counts any food that is liquid at room temperature toward a fluid limit, not just drinks: gravy and soups, gelatin, ice cream, and ice itself. At the table, that means gravy has to be counted the same way a glass of water would be:
Ice counts too, even though it has no nutrition numbers of its own to show here.
The National Kidney Foundation's rule of thumb is that a food with 200 milligrams of potassium or more per serving counts as "higher." A few Thanksgiving dishes cross that line only at a full serving, and drop back under it at a smaller one:
| Dish | Full serving | Smaller serving |
|---|---|---|
| Turkey | 208 mg, 3 oz (higher) | 139 mg, 2 oz (lower) |
| Green bean casserole | 226 mg, 1/2 cup (higher) | 150 mg, 1/3 cup (lower) |
| Orange-thyme glazed carrots | 210 mg, 1/2 cup (higher) | 140 mg, 1/3 cup (lower) |
| Potato and cauliflower mash | 177 mg, 1/2 cup (lower) | stays lower at a full serving |
The mash is soaked before cooking, which pulls out some of the potassium a classic mashed potato recipe keeps; a classic mashed potato at the same half-cup portion runs about 390 milligrams.
Potassium is listed on every Nutrition Facts label; phosphorus usually is not, so the ingredient list is where to look. Any word with "PHOS" in it is a phosphorus additive. Enhanced meats, including basted and self-basted turkeys, are counted by the National Kidney Foundation among foods with added phosphorus.
This is the one place to be careful even while everything else is flexible. Most salt substitutes are made with potassium chloride in place of sodium chloride, and the National Kidney Foundation advises anyone limiting potassium to be very cautious with them. A salt-free herb blend of dried herbs and spices, with about 1 milligram of sodium and 21 milligrams of potassium per teaspoon, does the same flavor job without that trade-off.
A plate for every stage, including dialysis
Thanksgiving Without the Second-Guessing sets out plates by kidney stage and body weight, with fluid counted in milliliters and higher-potassium dishes marked. $29.99 $9.99, a Thanksgiving deal, with one month of MedMenu Pro, free.
General information based on published guidelines. Your care team sets personal targets.
Yes. The KDOQI 2020 guideline sets a higher protein range for people on dialysis, 1.0 to 1.2 grams per kilogram of body weight a day, than it does for earlier kidney disease stages. At Thanksgiving, that usually means more turkey, not less, compared to a plate for stage 3 to 5 kidney disease.
A quarter cup of gravy is 60 milliliters of fluid, and 2 tablespoons is 30 milliliters. The National Kidney Foundation counts any food that is liquid at room temperature toward a fluid limit, including gravy, soup, gelatin and ice, not just drinks.
At a full serving, the turkey, the green bean casserole and glazed carrots all sit a little over the National Kidney Foundation's 200-milligram higher-potassium line, and drop back under it at a smaller portion. The potato and cauliflower mash, made with soaked potatoes, stays under the line even at a full half cup.
Check the ingredient list, not the Nutrition Facts panel. Phosphorus usually isn't listed with a number the way potassium is, but any ingredient name containing "PHOS" is a phosphorus additive.
Most salt substitutes are made with potassium chloride in place of sodium chloride, and the National Kidney Foundation advises anyone limiting potassium to be very cautious with them. A salt-free herb blend seasons food without adding either sodium or much potassium.