How to Enrich your Diet (for Kidney Patients)

Introduction

The aim of this leaflet is to provide easy tips to help you to increase your dietary intake and build yourself up.

If you have kidney disease, your kidneys can’t clean your blood and remove waste products as well as they normally do. This leads to an increase in waste products in your blood, which can cause poor appetite or a change in the way that things taste. It can also cause nausea, vomiting, fatigue, and changes in bowel habits. Because of this, it can be difficult to eat enough protein and calories each day to keep you well, and to keep your muscles strong. If you are on dialysis, it is important that you obtain enough of these nutrients to prevent loss of muscle mass, as your requirements increase further on dialysis.

You might notice that you have lost weight or muscle. Sometimes people with kidney disease have fluid retention which means that your weight might not change on your scales, even if you are losing flesh weight. It is important that you look for other signs of weight loss such as your clothes, watch or rings becoming looser.

Eating enough can help you to stay mobile and means that you are able to do the things that you need to do each day with less help. Eating well can also help to keep your immune system strong.

If you have been given individualised dietary advice by your kidney dietitian previously, check whether you still need to follow this whilst you are not eating well. If you are taking phosphate binders, you may need to take an extra binder if you are having snacks between meals, but your dietitian will be able to advise you on this.

Tips

Little and often
Eating ‘little and often’, can be helpful if you have a small appetite and cannot manage big meals. Aim to eat or drink something nourishing six times each day, i.e. breakfast, mid-morning, lunchtime, mid-afternoon, evening meal and bedtime.

Everyone’s appetite varies between good and bad days and from hour to hour. Make the most of the good times by eating well and enjoying some of your favourite foods.

Keep active and get some fresh air daily
If you have lost your appetite, you may find that getting a little fresh air each day can help to stimulate your appetite. Having a little exercise or keeping physically active (within the limits of your personal ability) each day can also help improve your appetite.

Fortifying your food with extra energy and protein
Milk: Use full fat or jersey milk and full fat dairy products rather than the reduced fat varieties on your cereals, in drinks and cooking.

Breakfast: Use full fat or jersey milk freely on cereals. Spread full-fat cream cheese, unsalted butter, or peanut butter thickly on bread, toast and crumpets. You can also add a boiled, fried or poached egg to your toast.

Meat, poultry, fish and pulses: These foods are a good source of protein. You need to have protein foods at least twice per day to help maintain your strength and muscle mass. If you can, try and choose fresh meat and fish such as fillets of fish and pork chops, instead of processed options such as fish fingers, chicken Kiev’s etc. These tend to be higher in salt and phosphate, which can affect your blood pressure and the strength of your bones.

Sauces made with full fat milk such as cheese, white, or parsley sauces will add extra protein and energy.

Vegetables: Melt unsalted butter, margarine or olive oil on top of hot vegetables. You may also like to add some grated cheese for extra calories and protein.

Sauces such as cheese or white sauce can be added to cauliflower, leeks and marrow.

Soups are a less preferable option when it comes to meal options as they are typically low in energy and protein. However, if you do opt for soup, add things such as double cream, croutons, and grated cheese to increase its energy and protein content. If you have a fluid allowance, make sure that soup is included in this.

Potatoes: Potatoes can be fortified by adding unsalted butter or margarine, full fat milk, cream, and/or grated cheese on top.

Desserts and puddings: Desserts and puddings are a great way to increase energy and protein in your diet. Have a dessert after at least one of your meals each day e.g. milky puddings, fruit pies and crumbles or meringues. If necessary, wait a while between the main course and dessert. Add custard, ice cream or cream to puddings. Make desserts, custard and milk puddings with full fat or jersey milk. Thick and creamy yoghurts or fromage frais are also good options. Jelly can be made with full fat or jersey milk as opposed to water to increase its energy and protein content. If the doctor has advised a fluid allowance, it is important to factor puddings such as jelly, custard, ice-cream into this.

Drinks: Milky drinks are more nutritious than water, squash, tea or coffee. Use full fat or jersey milk when making drinks. Milkshakes are a useful source of energy and protein and make very good snacks between meals. Ensure soups, sauces, gravies and drinks are all factored into your fluid allowance, if you have one.

Snacks: Eating small snacks between meals can boost the amount of energy you take in each day. Keep snacks like biscuits, marshmallows, buttered popcorn, corn or maize-based crisps (e.g. Skips, Quavers, Doritos, Nik Naks etc) handy to nibble between meals. Remember to significantly reduce your intake of any snacks containing dried fruit, liquorice, fudge, potassium-containing additives or chocolate if you are following a low potassium diet. These items are also typically high in sugar. Plain, unsalted nuts are a good source of protein and fibre.

Other: Adding mayonnaise or salad cream to your food will also add extra energy. Use oil-based dressings on salads. Use additional oils in cooking.

Feeling sick
The smell and preparation of food cooking can make some people feel sick so, if someone can help out, let them do the cooking.

Cold foods such as sandwiches or picnic-style foods can help, as they tend not to smell as much as hot foods.

Avoid greasy or fatty foods.

Try eating bland foods, such as cereal or toast.

Try eating dry foods, such as a biscuit, cracker or toast first thing in the morning before you get up.

Ginger biscuits may help.

Take sips of clear fizzy drinks as these can help with feeling sick. Try sparkling water, ginger ale or lemonade.

Go out for meals.

If feeling sick is an ongoing problem, ask your nurse or doctor about anti-sickness medications.

Too tired to cook

If you find that you are too tired to cook a meal from scratch, ready meals can be very helpful. There is now a wide range of ready meals that are easily available from supermarkets. You could also try a meal delivery service (either frozen meals to heat up at home, or a hot meal delivery service).

Examples of quick meals:
Ready meals: can be high in salt so try to choose lower salt meals where these are available. Traffic light systems are a good way of indicating a meal’s salt content. Choose meals with a green/amber salt content if possible (low/medium salt content). Try not to add extra salt to ready meals. Use herbs and spices such as pepper to add flavour instead.

Toast with plenty of butter and cheese, ham, poached or scrambled eggs, sardines, pilchards, mackerel or pate. If you a have a sandwich toaster, try different fillings e.g. ham and cheese, tuna and cheese or tuna and mayonnaise.

Filled omelette: Ham or cheese.

Filled sandwiches and rolls: Cheese, full-fat cream cheese, tuna, salmon, fish fingers, eggs, cold meat (eg ham, chicken or beef), bacon, hummus.

Buffet or finger foods: Keep a supply of foods you like to eat, eg chicken legs, cocktail sausages, sausage rolls, pasties, pies, quiches, flans, scotch eggs and dips. These are ideal to graze on throughout the day.

Useful foods to keep at home

Below is a list of foods you may like to keep in your kitchen, depending on your likes and dislikes.

In the cupboard:

• Long life milk (UHT)
• Tinned macaroni cheese, spaghetti Bolognese, stew, ravioli etc
• Tinned meat and fish eg tuna, sardines and pilchards
• Tinned vegetables and potatoes
• Tins or cartons of milk pudding, custard or rice pudding
• Snacks eg corn or maize crisps, biscuits, plain (unsalted) nuts
• Sweet and savoury biscuits (avoiding any containing dried fruit or chocolate)
• Variety of breakfast cereals (avoiding those containing dried fruit or chocolate)
• Cakes eg cream cake, light fruit cake, scones, teacakes, croissants.

In the fridge:

• Full fat milk
• Eggs
• Yoghurt, fromage frais, crème caramel and desserts, especially the thick and creamy varieties
• Cheese, including cream and hard varieties
• Flans, quiches, pasties and pies
• Cooked meats eg ham, chicken, roast pork or roast beef.

In the freezer:

• Ready meals eg pies, lasagne, roast dinners, fish fillets or fish fingers, cod in cheese or parsley sauce
• Frozen vegetables
• Frozen desserts
• Ice cream.

Haemodialysis

If you are a haemodialysis patient and travel to a unit to attend sessions, you may be away from home for more than six hours and miss at least one meal. It is therefore important that you bring a meal, or some nourishing snacks with you to dialysis.

Although you may be given snacks such as packets of biscuits, these don’t give your body as much energy or protein as a meal does. Regularly missing meals on dialysis days can result in weight loss and loss of muscle strength and low energy levels.

Examples of meals that you could bring with you to dialysis include a sandwich and snacks (ham/cheese/egg/tuna sandwich with a yogurt, piece of fruit and buttered popcorn) or a pasta salad with ham/tuna/cheese/egg.

Nutritional supplements

Your dietitian may discuss nutritional supplements with you if they feel you may benefit from them.

Once you are feeling better and eating well, you should go back to your usual healthy eating diet. Do contact the dietitians to let them know how you are.

Contact numbers

We hope that you have found this information useful. If you have any questions or are worried about anything, please speak to the following Dorset County Hospital staff:

Department of Nutrition and Dietetics: 01305 255377 / 01305 254415 or email kidneydietitians@dchft.nhs.uk

About this leaflet

Authors: Olivia Chaffey and Joanna Pulman, Kidney Dietitians
Written: October 2023
Approved and updated: April 2025
Review date: April 2028
Edition: v2

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk