Dietetic information

Dining out is a lot of fun.  It is possible to choose from most menus when following a renal diet.  The suggestions below will help your child choose well and prevent high potassium, phosphorous and salt intake as well as fluid overload.

It may be helpful to contact a restaurant or hotel before your visit to discuss your child’s diet.

General tips

• Soups are generally high in potassium and salt and will form part of your fluid restriction and should be avoided
• Most vegetables are high in potassium and request if possible these are boiled rather than steamed
• Bread or garlic bread is a good option as a starter or side dish
• Avoid free refills for drinks
• If your child takes a phosphate binder remember to take this with you to the restaurant
• If your child has a poor appetite, phoning the restaurant before your visit may enable you to explain the situation and come to some agreement, eg sharing your meal with your child or requesting a smaller portion at a     reduced cost     

Asian

Asian food such as Chinese, Thai, Malay, Japanese and Vietnamese usually consist of meat, fish or poultry combined with fresh vegetables.  Steaming, deep frying or stir fry are common cooking methods; vegetables cooked in this way will be high in potassium.

Top tips:

• Ask for your food to be cooked to order so that it may be prepared without soy, fish, black bean, hoisin or oyster sauce.  Ask for food to be cooked in ginger, chilli or garlic instead to add flavour or you could ask for a small   serving of sauce on the side
• Try choosing dishes with sweet and sour, lemon, orange, plum sauce
• Order plain boiled or steamed rice or noodles as they contain less salt than fried rice or noodles
• Avoid soups
• Choose meat and fish dishes but avoid dishes that contain prawns or tofu
• ·Nuts and green leafy vegetables such as bok choi, Chinese spinach or Chinese cabbage should be avoided due to their high potassium content
• Ideas for starters: omelette, prawn or sesame toasts, prawn crackers, dim sum, spring rolls, sushi, tempura, duck pancakes, crispy wontons
• Ideas for main courses: lemon chicken, duck in plum sauce, chow mein, sweet and sour dishes, meat or fish kebabs
• Ideas for desserts: pineapple or apple fritters, toffee apples or sorbet

Indian

Indian food often combines meat, fish or poultry with fresh vegetables and potatoes.  Sauces are often tomato based and are made using fresh herbs and spices; they are therefore often high in potassium.  Indian dishes can often be large and filling.  Ask for small portions or share your dish

Top tips

• A portion of boiled rice, chapaati or naan bread makes a filling accompaniment.  This will therefore limit your intake of sauce
• Ideas for starters: poppadoms are okay but limit the toppings such as raita, mango chutney or lime pickle.  Pakoras or samosas, naan bread (avoid peshwari naan due to the dried fruit content), chappaatis
• Ideas for main courses: dishes without a sauce, eg biryani, tandoori, tikka, bhurji, bhuna, meat kebabs are good options.  Keema, dupiaza and korma are cream-based sauces and therefore good alternatives.  Avoid dhal or dhansak dishes or dishes containing sea food.  Basmati, saffron, biriyani rice dishes are good choices
• Ideas for desserts: jelabi
• Avoid main courses and side or rice dishes containing dried fruits or nuts

Mexican

Mexican food gives you the option to prepare your own dish, eg fajitas/tacos/tostadas.  Avoid dishes with lots of cheese, eg quesadillas or nachos

Top tips

• Ideas for fajita fillings include minced meats, beef or chicken and salad vegetables such as lettuce, cucumber, onion
• Avoid refried beans, salsa and guacamole.  Sour cream can be used in moderation
• Avoid chilli con carne as this contains kidney beans and tomatoes making it a high potassium dish
• A dessert option would be churros.  Ask for chocolate sauce on the sideIdeas for fajita fillings include minced meats, beef or chicken and salad vegetables such as lettuce, cucumber, onion
• Avoid refried beans, salsa and guacamole.  Sour cream can be used in moderation
• Avoid chilli con carne as this contains kidney beans and tomatoes making it a high 

Spanish tapas

Tapas provides a wide range of small dishes some of which will be renal friendly.  Some dishes can be high in salt, eg olives, manchego cheese and smoked/cured meats such as chorizo and salami.

Ideas for tapas dishes: calamari, tortilla Espanola, pescado blanco frito (deep fried white fish), rice-based dishes such as paella, ensalada mixta (without tomatoes)

Italian

• Limit antipasti dishes containing cheese, olives, smoked/cured meats and marinated vegetables as these can all be high in sodium
• Avoid adding extra hard cheese to dishes, eg parmesan or parmegianno regianno
• Add black pepper, olive or chilli oil for flavouring dishes
• Ideas for starters: breads, eg ciabatta, focaccia, herb or garlic bread, dough balls or sticks are good choices with olive oil and balsamic vinegar.  Insalata mista (without tomatoes).  Avoid olives, cured meats (eg parma ham) or cheese or tomato-based dishes can be high in potassium and salt

Pizza

Pizza is usually both high in salt and potassium.  Salt is found both in the pizza base and in the toppings.  If you choose to have pizza have 2 slices with a small salad and some bread.  Vegetable toppings such as spinach, tomatoes, mushroom, artichoke and sweetcorn can all be high in potassium; choose lower potassium alternatives such as green peppers, onions, leeks or pineapple.  Meat and fish toppings such as chicken, tuna, beef are lower in salt than salami, pepperoni, ham, bacon, anchovies, sausage or olives.  Avoid pizza with extra cheese as a topping

Try garlic or pesto as an alternative to the traditional tomato topping

Pasta

Pasta is low in potassium, phosphate and salt and makes a good choice when eating out.  If possible, order the sauce on the side to allow you to control how much you add.  Olive oil and garlic, cream, white wine sauce or pesto are good choices.  Sauces such as marinara, Napoli or arrabiatta are all tomato-based and high in potassium.  Lasagne and spaghetti bolognese are both tomato-based and high in potassium.  Rice-based dishes such as risotto are an alternative option but avoid mushroom risotto and request a small portion as this is high in salt

British

British food encompasses a diverse range of foods these days.

Breakfast is one of the easiest meals to eat out.  Good options include porridge, cereal, bread (eg crumpets, toast, English muffins, croissants, bagels), waffles and pancakes which can be served with jam, honey and syrup.  Hot food options include omelette, scrambled egg, boiled egg, small portion of baked beans, fried bread.  Limit cured or salted meats eg ham, bacon or sausages and black pudding.  Mushrooms, tomatoes and hash browns are high in potassium and should be avoided

Avoid fresh fruit juices.  Choose tinned (drained of juice) or stewed fruit – apple, pear, mixed berries are a good option.  Avoid bananas, melon and any dried fruit

Lunch – sandwiches (French bread, sliced bread, ciabatta, bread roll, tortilla wrap etc) choose white bread and select roast beef & mustard, tuna mayonnaise, chicken, turkey, egg salad, cottage cheese

Main meal

• Where possible choose a meal that is prepared to order
• Ask that salt and salt seasonings are not added
• Ask for sauces and gravies to be served on the side instead of over the food so that it can be added sparingly
• Remove batter or coating from breaded items to reduce the salt content, eg fish in breadcrumbs or batter
• Choose: grilled or roasted steaks, chops, lamb shank, chicken or fish seasoned with black pepper, lemon, garlic or ginger.  Mashed potato topped pies, eg shepherd’s pie or cottage pie.  Roast dinner are good choices.  Serve with roast potatoes that have been pre-boiled first or mashed potato

Salad or salad bars

Salads can be a healthy choice as a main meal or side dish.  As a main meal salad can be served with bread, pasta or rice

• If you are creating a salad from a salad bar choose from the following low potassium options: lettuce, carrots, radishes, cauliflower, green peppers, celery, apple, onions, cucumber, beetroot, noodles, pasta or rice salad, cottage cheese, canned fruit cocktail, canned peaches and pears, canned pineapple.
• Choose olive oil, lemon, balsamic vinegar or vinegar as a dressing
• Avoid raw spinach, olives, pickles, bacon bits, tomatoes, fresh mushrooms, cheese, kidney beans, chickpeas, seeds, nuts, potato salad, bean salad, relishes

Fast foods

Fast food can be an option for an occasional treat on a renal diet.  It does require some planning.  Many fast food items are pre-salted; asking for a portion of fries without salt is a better option

Subway – choose 6” sub; good ideas for fillings include chicken breast, tuna, ham, egg mayo, beef, turkey breast, club, sweet onion teriyaki and salad.  The wraps available are all okay for those following a low salt diet.  Avoid subs and wraps with extra cheese, dressings and those which double-up the filling, eg turkey breast and ham

Burger King – choose a plan hamburger or Angus burger, ocean catch, chicken bites or chicken fillet strips.  The chicken burger, cheeseburger and veggie beanburger all contain more salt and may also be a source of potassium and phosphate.  Ask for fries without salt

Pizza Hut/Dominoes Pizza – see Italian section for lower salt and potassium pizza topping ideas.  Limit pizza to 2 slices and serve with garlic bread, dough balls and small side salad

McDonalds – choose a hamburger/mayo chicken/grilled chicken salad.  Avoid Big Macs/big tasty/chicken legend burgers as they have a very high salt content.  Ask for fries without salt

KFC – grilled chicken wings are the lowest salt option at KFC although remember that if you eat more than one the salt content can get very high.  Another better option is the KFC snackers.  Avoid fillet burgers, double downs and crispy twisters as they are extremely high in salt

Cornwall Pasty Co/Greggs – most pies, pasties, sausage rolls are very high in salt

Fish and chips – remove batter from battered fish as this is high in salt.  A small portion of chips can be eaten as a treat but remember these are not pre-boiled so will be high in potassium.  Serve with bread and side salad to fill you up.  Avoid battered sausages and burgers as these are high in salt.

A note about fries: Remember fries can not only be covered in salt but are also high in potassium as they are not pre-boiled.  They are therefore recommended as strictly an occasional treat only!

Coffee shops, eg Starbucks or Costa Coffee  

Try to choose tea, fruit tea or cold fruit squash, eg Fruit Shoot instead of coffee options which are high in potassium and often served with milk which will also make them high in phosphate.  Coffee shops offer a range of snacks – try to choose toasted bagel, plain muffin, sandwich filled with chicken, turkey, beef, tuna or salmon.  Sweet options include a slice of plain shortbread or a doughnut.


Remember – eating regular take-aways is not recommended.  The information given here is only to guide you to make better choices when having a take-away as an occasional treat

We are fast approaching the time of year when following a renal diet can be a great challenge.  At Christmas there are often a lot of foods that are not normally there to tempt you.  Some of these are high in potassium and salt but do not despair!  There are lots of traditional foods you can enjoy and the following may also highlight a few new things to try.

Your traditional Christmas meal can be enjoyed with just a few alterations.

·         Soup is high in salt and counts as part of your fluid.  Try alternative starters such as prawn cocktail, pate and toast, tinned fruit cocktail drained of the juice
·         Have turkey or your usual Christmas meat with a little stuffing, spoonful of cranberry sauce or small portion of bread sauce.  Be careful with sausages and salty meats such as bacon
·         Remember to pre-boil roast potatoes first and do not have a bigger portion than normal
·         Boil vegetables in plenty of water.  Try to avoid large portions of brussel sprouts or parsnips.

What about the pudding?

Dried fruit is very high in potassium so you need to be careful not to eat too much Christmas pudding, cake or mince pies.  Have a small portion of Christmas pudding on Christmas day and serve it with cream or brandy butter.  Throughout the Christmas period if you are going to eat a mince pie or Christmas cake only eat a very small amount of one or the other.

Why not try the recipes below which are lower in potassium.

Alternative pudding suggestions:
·         Trifle
·         Lemon meringue pie
·         Arctic roll
·         Brandy snaps with cream
·         Shortbread
·         Pavlova
·         Pannacotta
·         Steamed treacle sponge

Fluids

You need to be careful with your fluid over the Christmas period.  If  you are visiting people and entertaining you may feel under pressure to drink more but try hard to keep to your normal fluid intake.

Drinks to avoid
·         Cola drinks
·         Sparkling fruit juices, eg Appletiser, Peartiser, Schloer
·         Fruit juice
·         Milk, hot chocolate, coffee

Drinks recommended
·         Lemonade, cherryade, orangeade or limeade
·         Water, sparkling water, flavoured water
·         Squash/cordial
·         Tea and fruit tea

Sweets and snacks

Try pastilles, fruit jellies, jelly beans, dolly mixtures, popcorn, peppermint creams, marshmallows, boiled sweets or Turkish delight instead of chocolate

You should try to limit the following: dates, figs, dried fruit, nuts and crisps as they are all very high in potassium

Try these snacks which are lower in potassium
·         Bread snacks
·         Rice crackers
·         Toasted croutons
·         Plain popcorn

Christmas Recipes

Below are some recipes that you can try over the Christmas season.  These are recipes the whole family can enjoy!

Pitta crisps with tzatziki dip

Ingredients
4 pitta breads
2 tablespoons olive oil
Ground black pepper
For the dip
1 small pot of low-fat plain yoghurt
1 teaspoon mint sauce
70g cucumber finely diced

Method
1.       Brush each pitta bread on both sides with olive oil.  Tear or cut each pitta bread into about 6 pieces and spread out on a baking tray
2.       Bake the pitta breads for about 20 minutes or until crisp and lightly browned.  Leave them to cool on a wire rack
3.       Mix the yoghurt, mint sauce and cucumber in a bowl to make the dip

Low potassium Christmas pudding

Ingredients
250g (9oz) canned pineapple pieces
100g (4oz) demerara sugar
50g (2oz) glace cherries, roughly chopped
175g (6oz) self-raising flour, sifted
Grated rind of 1 lemon
100g (4oz) unsalted butter
2 eggs, beaten
50g (2oz) sultanas
2-3 teaspoons mixed spice

Method
1.       Drain the pineapple through a sieve.  Chop the fruit into smaller pieces
2.       Cream the butter and sugar until light and fluffy.  Beat in the eggs
3.       Fold in the cherries, pineapple pieces, sultanas and lemon rind
4.       Gently fold in the flour and mixed spice
5.       Transfer into 1½ pint pudding basin and cover with a piece of buttered foil with a centre pleat to allow for expansion.  Steam for 1½ hours until firm
6.       Turn out and serve with double cream or custard

Renal mincemeat

Ingredients
1 large Bramley apple, peeled and grated
25g (1oz) margarine
50g (2oz) glace cherries
50s (2oz) sugar
1 heaped teaspoon mixed spice
100g (4oz) chopped candied peel
1 tablespoon brandy or rum
Few drops of brown food colouring

Method
1.       Put all the ingredients in a large bowl and mix thoroughly
2.       Use to make mince pies

Panacotta

Ingredients
6g gelatine sheets (4 sheets)
500ml single cream
150g (6oz) sugar
1 vanilla pod or a few drops of vanilla extract

Method
1.       Soak the gelatine sheets in cold water until soft.  Once soft squeeze out the excess water
2.       Mix the single cream with the sugar and vanilla in a saucepan then gently warm the mixture.  Once this is warm (but not boiling) add the gelatine sheets
3.       Stir well and sieve before you ladel out into single ramekins.  Chill for 24 hours

Low potassium Christmas cake

Ingredients
250g (10oz) glace cherries, halved
250g (10oz) mixed peel
200g (8oz) tinned prunes, drained and chopped
2 tablespoons honey
1 tablespoon almond essence
4 eggs, beaten
1 dessertspoon brandy
250g (10oz) plain flour
250g (10oz) soft brown sugar
250g (10oz) unsalted butter
1 teaspoon nutmeg
1 teaspoon mixed spice
25ml (1fl oz) water
Few drops of caramel colouring

Method
1.       Cream the butter and sugar until soft and fluffy.  Sieve the flour and spices together
2.       Add the eggs and flour alternately to the creamed mixture.  When mixed well add the cherries, prunes and mixed peel
3.       Add the brandy, water and honey.  Beat well until a dropping consistency is achieved
4.       Place in a greaseproof lined, well greased baking tin (18cm) and bake at Gas Mark 4/150°C/ 300°F for 3½-4 hours

Alternative marzipan

Ingredients
150g (4½oz) margarine
100ml (3fl oz) water
4 teaspoons almond essence
250g (9¼oz) caster sugar
250g (9¼oz) semolina
Grated rind of 2 lemons

Method
1.       Heat the water and let the butter melt in it
2.       Add the sugar and grated lemon rind.  Heat until the sugar has dissolved
3.       Add the semolina and stir over a gentle heat for 5 minutes or until the semolina has cooked
4.       Stir in the essence
5.       Pour into a dish and chill until firm, use icing sugar for rolling out

Cover the top and sides of the cake with the marzipan

Glace icing

Ingredients
250g(9¼oz) icing sugar
2-3 tablespoons water
½ teaspoon lemon juice

Method
1.       Sieve the icing sugar and mix with the lemon juice and enough water to make a thick paste
2.       Cover the sides and top of the cake with the icing

Stem ginger ice cream

Ingredients
500ml double cream
70g chopped stem ginger
½ fresh vanilla pod, scraped
4 dessertspoons stem ginger syrup

Method
1.       Pour the double cream into an electric mixer or large bowl and whisk until it starts to form stiff peaks
2.       Add all the other ingredients.  Mix well and then place in a suitable container that will fit in the freezer
3.       After about 20 minutes take the ice cream out and give it a stir.  Leave for approximately one hour and then serve.

Zingy spiced pears

Ingredients
6 medium pears, peeled and sliced
150g (6oz) soft brown sugar
2 tablespoons ginger (crystallised)
1½ teaspoons rum extract
¼ teaspoon ground cinnamon
Dash of ground all spice
25g (1oz) margarine

Method
1.       Arrange the pear slices in a baking dish
2.       Combine the brown sugar, ginger, rum extract, cinnamon and all spice
3.       Sprinkle the brown sugar mixture over the pears.  Dot with margarine
4.       Bake at Gas Mark 4/180°C/350°F for 20 minutes
5.       Serve hot or refrigerate for at least one hour to serve chilled

Christmas biscuits

Ingredients
225g (9oz) plain flour
1 teaspoon mixed spice
½ teaspoon ground cinnamon
50g (2oz) caster sugar
400g (4oz) half fat spread
1 egg, beaten

Method
1.       Stir together the flour and spices.  Stir in the sugar and rub in the half-fat spread until the mixture resembles breadcrumbs
2.       Add the beaten egg and knead into a ball.  Cover and chill for 30 minutes
3.       Pre-heat the oven at Gas Mark 5/190°C/375°F.  Roll out the biscuit mixture onto a lightly floured surface to a 3mm thickness
4.       Cut out Christmas shapes such as stars and trees using biscuit cutters or a template
5.       Lift the biscuits onto the baking sheet, prick lightly with a fork and bake in the oven for 10-12 minutes until lightly browned

Steamed treacle pudding

Ingredients
1 tablespoon black treacle
3 tablespoons golden syrup
175g (6oz) self-raising flour
1 rounded teaspoon baking powder
175g (6oz) butter, softened
3 large eggs

Method
1.       Butter a basin and add golden syrup
2.       Take a large mixing bowl, sift the flour and baking powder into it, add the softened butter, eggs, sugar and black treacle
3.       Whisk for about 2 minutes until it is thoroughly blended.  Spoon the mixture into the basin and level the top using the back of a tablespoon
4.       Place a sheet of foil over some greaseproof paper, make a pleat in the centre and place foil side up on top of the pudding.  Pull it down the sides and tie with some string.  Trim off excess paper
5.       Steam for 2 hours, checking the water level halfway through
6.       To serve loosen the pudding all round using a palette knife, turn out onto a plate and pur an extra 3 tablespoons of golden syrup over the top

Children’s Renal Christmas Menu

Starter

Prawn Cocktail
Tzatziki with pitta crisps (see our recipe)
Garlic bread

Main course

Roast turkey/pork/beef/lamb/chicken/duck/pheasant/goose/quorn
Parboiled roast potatoes – boiled new potatoes – mashed potatoes
Boiled carrots, cabbage, swede, broccoli, cauliflower
Small portion of gravy

Dessert

Lemon meringue pie
Pannacotta (see our recipe)
Pavlova
Stem ginger ice-cream (see our recipe)
Brandy snaps with cream
Renal Christmas pudding (see our recipe)

It is important not to eat too much salt as it may make your body retain water and it can contribute to high blood pressure.  Salt also makes you thirsty.  Over 80% of the salt we eat comes from processed foods - food we buy in tins and packets, or in convenience and take-away foods.

How to cut down on the family’s salt intake:

-          Try not to add salt to food either while cooking or at the table.  (Sea salt is no different and we do not recommend use of salt substitutes such as Lo-Salt or Selora.)

-          Try to reduce the amount of processed food that you eat as nearly all of it has had salt added.

It takes a few weeks for your taste buds to adjust to having less salt so it may be easier to cut down gradually.

Food labelling

By reading food labels you can make better choices and choose foods lower in salt

As a general rule:
 
A little = 0.1g sodium/0.25g salt
Moderate = 0.5g sodium/1.25g salt
A lot = more than 0.5g sodium/more than 1.25g salt

To convert ‘sodium’ to ‘salt’ multiply the sodium value by 2.5; eg 1g of sodium = 2.5g of salt


Salty foods to eat less of
 
-          Bacon, sausage, sausage rolls, corned beef, tongue, spam, luncheon meat, ham, salami, meat pies, meat pastes.  Limit chicken nuggets, dippers, dinosaurs etc to once or twice a week
-          Smoked meats and fish
-          Most cheeses, eg cheddar, edam, stilton, cheese spread, processed cheese
-          Take away meals
-          Marmite, Bovril, pickles, stock cubes, gravy granules, butter and margarine
-          Crisps, corn snacks, salted nuts, mini cheddars, twiglets
-          Tinned and packet soups
-          Pot noodles/micro noodles
-          Tomato ketchup, soy sauce, brown sauce
-          Potato products (waffles, alphabites, faces etc)

Lower salt foods to choose

-          Fresh fish, poultry and meat
-          Cottage cheese, low fat soft cheese
-          Kallo organic very low salt vegetable stock cubes
-          Marigold Swiss vegetable reduced salt bouillon powder
-          Use gravy powder and meat juices to make gravy
-          Home made meals using fresh ingredients
-          Herbs, spices, garlic, pepper, vinegar, lemon juice
-          Unsalted butter and margarine
-          Sweet snacks instead of savoury
-          Salt ‘n’ Shake crisps (without salt sachet), unsalted nuts, peanuts and raisins
-          Lower salt products, eg reduced sugar/salt baked beans, reduced salt ketchup and mayonnaise

Breakfast cereals and breads vary in salt content.  Compare labels on brands and choose lower salt ones

Ready meals can contain a lot of salt.  Compare labels and choose the ones with the lowest salt content

Reducing salt intake is especially crucial for individuals with respiratory conditions such as asthma, which can be managed with medications like Proair Albuterol https://serv-u-pharmacy.com/news/proair-albuterol.html. This medication helps in relieving symptoms of bronchospasm, but maintaining a low-salt diet can further assist in minimizing respiratory issues and enhancing the effectiveness of the medication. Adopting a lifestyle that includes both responsible medication use and a balanced diet can lead to improved overall health and better management of respiratory conditions.

Pack-Up Ideas

Lunch is an important meal for everyone.  This leaflet aims to give you ideas for renal friendly packed lunches for your child to enjoy.  The suggestions can be used for school lunches, picnics, holidays and days out.

Savoury ideas

Sandwiches can be made to be more appealing by simply changing the bread.  There are lots of different types and shapes of bread and most types can be frozen ready for use.  These include:
- Pitta bread
- Tortilla wraps
- Savoury muffins
- Mini baguettes/French sticks
- Ciabatta
- Bagels
- Croissants
- Teacakes
- Crispbread
- Garlic bread (unsalted butter)
- Rice cakes
- Crumpets

You could try making your own bread and reduce or cut out the salt in the recipe.  Make it into different shapes such as knots.  Also try sprinkling on a small amount of sesame seeds to add a little flavour.                             Note - Wholemeal bread is higher in phosphate therefore it is best to alternate with white bread.

Savoury snacks

Foods to avoid:
- Potato crisps
- Nuts
- Cheesestrings

Foods allowed:
- Walkers Sunbites
- Goodies corn snacks
- Doritos lightly salted or other brand of lightly salted tortilla chips
- Homemade popcorn (unsalted)
- Philadelphia Dunkers

Kidney-friendly fruit and vegetables to include in lunchboxes

- Cucumber
- Green pepper
- Celery
- Spring onion
- Apple
- Pear
- Clementine/Satsuma
- Plum
- Grapes (10)
- Cherries (10)
- Tinned fruit (discard the juices)

Fluid

It is a good idea to include a drink with lunch, eg fruit squash, fruit shoot-type drink (check fruit juice content is less than 7%) or water

Snack swaps!

The following gives you ideas for snacks to avoid and kidney-friendly snacks to have instead

Foods to avoid
- Chocolate biscuits
- Fig rolls
Try instead
- Jammy Dodgers
- Custard creams
- Shortcake
- Pink wafers

Foods to avoid
- Chocolate bar
Try instead
- Rice Krispie marshmallow square

Foods to avoid
Liquorice Allsorts
Try instead
- Marshmallows
- Iced Gems
- Boiled sweets

Foods to avoid
- Chocolate cake
- Fruit cake
Try instead
- Jam Swiss roll
- Victoria sponge cake
- Iced doughnuts/fingers

Foods to avoid
- Tinned salmon
Try instead
- Tinned tuna (in spring water)

Foods to avoid
- Hard cheese, eg cheddar
- Processed cheese, eg Dairylea
Try instead
- Cottage cheese
- Philadelphia
- Boursin
- Boiled egg (within restriction)

Foods to avoid
- Corned beef
- Haslet
- Spam
Try instead
- Sliced roast meat/chicken (check salt content)

Foods to avoid
- Pickle
Try instead
- Reduced salt mayonnaise

Foods to avoid
-          Sliced tomato
Try instead
-          Sliced cucumber
-          Avocado
-          Hummus
-          Spring onion
-          Cress

Suggested recipes

Crunchy chicken wraps

Ingredients
-          100g reduced-salt mayonnaise
-          4 large (8”) flour tortillas
-          1 stalk celery, diced
-          1 medium carrot, diced
-          ½ medium green pepper, diced
-          230g cooked chicken

Method
1.       Spread 2 tablespoons of mayonnaise over each tortilla
2.       In a separate bowl combine the diced vegetables
3.       Place ¼ cup of vegetables and ¼ of chicken on ¼ of each tortilla
4.       Fold the outside of the tortillas inwards and roll up like a burrito
5.       Wrap each tortilla in foil to help keep shape

Low salt and easy macaroni and cheese

Ingredients
-          330g pasta
-          2-3 cups boiling water
-          30g grated cheddar cheese
-          30g soft cheese (eg Philadelphia)
-          1 teaspoon margarine or salt-free butter
-          ¼ teaspoon dried mustard

Method
1.       Boil water, add pasta and cook until tender
2.       Drain
3.       While still very hot stir in butter, soft cheese and mustard and then sprinkle with cheddar cheese

Chicken Fusilli Salad

Dressing ingredients
-          110ml olive oil
-          50ml vinegar
-          ½ teaspoon white pepper
-          ¼ teaspoon dried basil
-          1 teaspoon sugar

Salad ingredients
-          90g fusilli pasta (any pasta shape will work) cooked
-          230g cold cooked chicken, diced
-          70g frozen peas, boiled and drained
-          75g chopped green pepper
-          100g sliced courgette
-          1 medium carrot, sliced thinly
-          100g shredded lettuce

Method
1.       Put dressing ingredients in jar with lid and shake to blend ingredients.  Chill for at least 2 hours.  Shake again before mixing with salad
2.       Mix together pasta, chicken, peas, courgette, green pepper and carrot in large bowl
3.       Add dressing and toss well.  Divide lettuce onto 4 plates and top with salad mixture

Tortilla beef rollups

Ingredients
-          2 flour tortilla, 6” size
-          2 tablespoons Philadelphia
-          140g roast beef, cooked
-          ⅓ red onion, chopped
-          ¼ green pepper, cut in strips
-          8 cucumber slices
-          2 lettuce leaves

Method
1.       Spread the Philadelphia over tortillas
2.       Divide ingredients in half to make 2 tortillas.  Layer each tortilla with roast beef, red onion, pepper strips, cucumber and lettuce.
3.       Roll up
4.       Slice each tortilla into 4 pieces or serve whole

Chicken and pineapple wraps

Ingredients
-          280g chicken, cooked and diced
-          100g pineapple, drained
-          100g reduced-salt mayonnaise or salad dressing
-          ½ green pepper, chopped
-          ⅓ medium carrot, shredded
-          ½ teaspoon pepper
-          4 pieces flatbread or 6” flour tortillas

Method
1.       Combine all ingredients in a bowl
2.       Refrigerate until chilled
3.       Serve chicken salad wrapped in flatbread or a flour tortilla

Sandwich alternatives

Crackers with Philadelphia cream cheese
Try having crackers (low salt variety if possible) with cream cheese for a change.  You can top the cream cheese with thin slices of cucumber or ham.  Try a selection of crackers, crispbreads and unsalted rice cakes for variety.

Dippers
Try cutting some pitta breads into wedges, spread with a little olive oil and bake in a pre-heated oven at 170°C/325°F/Gas Mark 3 for about 10 minutes or until the wedges are golden brown.  Pack up 2 little tubs of any of these for dipping in the wedges:
-          Cream cheese
-          Sour cream
-          Hummus

As well as pitta dippers, try cucumber sticks for dipping.

 

Why is a potassium restriction needed?

You have been advised to restrict the potassium in your diet as you have increased levels of potassium in your blood. 
High blood potassium levels can be dangerous and can be harmful to the heart.
The foods are colour coded as traffic lights.  This system indicates the amount of potassium in the foods you eat.

Foods lower in potassium: can have daily (green)

Foods moderate in potassium: have twice a week (orange)

Foods highest in pottasium: have once a week (red)

The main principles of a low potassium diet:

· Encourage fruit and vegetables but limit to 2 servings of each a day (try to pick from the green section).

· Boil all vegetables rather than using a steamer, microwave or pressure cooker and discard all vegetable water. Do not use the water  in soups or gravy.

· All potatoes must be peeled and cut into small pieces before cooking and boiled until cooked, throwing away the cooking water. 

· Limit milk to half a pint a day.

· Limit milk based desserts, eg. yoghurts/ice-cream/custards.

· Avoid salt substitutes because they contain potassium e.g. LoSalt, Ruthmol or Solo.

Vegetables

Less than 2.5 mmol - low
	Beansprouts  (60g)	0.7
	Cucumber (30g)	1.2
	Swede (boiled, 60g)	1.3
	Tomato sauce (20g)	1.4
	Onions (boiled) / pickled onions (60g)	1.6
	Chick peas (canned, 60g)	1.7
	Gherkins (4 pickled, 60g)	1.7
	Marrow (60g)	1.7
	Pesto (green, 40g – 1/4 jar )	1.8
	Green pepper (60g)	1.8
	Runner beans (boiled, 60g)	2.0
	Frozen mixed veg (boiled, 60g)	2.0
	Onions (raw)/ leeks (boiled, 60g)	2.3
	Spring greens (boiled, 60g)	2.4
	Carrots (boiled, 60g)	2.5

2.5 - 4 mmol - moderate
	Cabbage (boiled, 60g)	2.6
	Peas (frozen/mushy, 60g)	2.7
	Green beans (60g)	2.7
	Houmous (60g)	2.9

	Beetroot (pickled, 60g)	2.9
	Onions fried (60g)	2.9
	Broad beans (boiled, 60g)	3.0
	Broccoli/ courgette (boiled 60g)	3.2
	Cauliflower (boiled, 60g)	3.3
	Lettuce/sweetcorn (60g)	3.3
	Radishes (60g)	3.7
	Aubergine (fried, 90g)	3.9
	Spring onions (60g)	4.0

More than 4.0 mmol - high
	Tofu (steamed/fried, 90g)	4.1
	Asparagus (boiled, 3 spears, 75g)	4.2
	Squash (baked-60g)	4.2
	Brussel sprouts (boiled, 60g)	4.7
	Canned tomatoes (95g)/ tomatoes (90g)	5.1
	Spinach (baby, raw, 60g)	5.2
	Parsnips (boiled, 60g)	5.3
	Mushrooms (raw, 60g)	5.8
	Butter/kidney beans (canned, 60g)	6.2
	Sweet potato (boiled, 90g)	6.9
	Tomato puree (30g)	9.6

Fruit

Less than 2.5 mmol - low
	Mandarins (canned in juice)	1.6
	Raspberries 10 (40g)	1.7
	Clementines/satsumas (60g– one)	2.0
	Apple (small)	2.1
	Cherries 10 (40g)	2.2
	Grapefruit (120g, canned in juice)	2.2
	Pear (small)	2.3
	Blackberries 12 (60g)	2.5

2.5 - 4mmol - moderate
	Apricot (40g)	2.8
	Pineapple (1 slice, no skin - 80g)	3.2
	Plum (55g)	3.4
	Peach (canned in syrup -120g)	3.4
	Strawberries 5 (80g)	3.5
	Orange (medium)	3.5
	Grapes 10 (65g)	3.6
	Mango – small bowl (80g)	3.7
	Raisins/sultanas – small box (15g)	3.8
	Grapefruit (1/2) (80g)	4.0

More than 4.0 mmol -   high
	Kiwi (60g)	4.5
	Watermelon (200g)	5.1
	Nectarine/peach	5.7
	Honeydew melon (1 slice - 150g)	5.8
	Galia melon (1 slice - 150g)	5.8
	Rhubarb (fresh ,stewed no sugar) (100g)	5.9
	Figs (25g) (ready to eat)	6.2
	Canteloupe melon  (1 slice - 150g)	8.0
	Bananas (small)	8.5
	Avocado (½ - 75g)	8.6
	Dates (dried) (50g)	9.0

Meat and Fish

Less than 8mmol - low
	Bacon (1 rasher)	1.9
	Gammon slice– boiled (45g)	2.9
	Fish fingers x 2	3.5
	Beef (minced) stewed (100g)	4.2
	Beef stew (90g)	6.2
	Roast chicken (80g)	6.7
	Haddock in breadcrumbs	7.0
	Roast lamb (90g)	7.6

8-14 mmol - moderate
	Roast turkey (70g)	8.0
	Chicken nuggets (90g)	8.0
	Lamb chop (60g)	8.0
	Steak (rump 5oz)	9.2
	Vegetable chilli (170g )	10
	Salmon steak (100g)	10.5
	Lasagne (225g)	12.5
	Pork chop (120g)	13.1

More than 14 mmol - high
	Mackerel (160g)	16.0

Carbohydrates

Less than 5 mmol -   low
	Rice noodles (140g cooked)	0.1
	White long grain rice (100g cooked)	0.4
	White pasta (140g cooked)	1.4
	Egg noodles (90g cooked)	1.5
	Brown rice (100g cooked)	2.5
	Couscous (140g cooked)	4.3

5-10 mmol - moderate
	Potato croquettes x 3	6.0
	Mashed potato (120g)	10

More than 10 mmol - high
	Potato waffles x 2	10.8
	New potatoes x 4 (130g) also fried to make chips.	12.5
	Oven chips (100g)	16.3
	Jacket potato (medium) no skin (160g)	14.7
	Roast potatoes x 4	14.5
	Chips frozen and fried (100g)	18.4
	Jacket potato (medium) with skin (160g)	24.5

Dairy

Milk is an important source of calcium in your child’s diet however it is high in potassium. Total milk intake should be limited to 300ml/day

Less than 1 mmol - low
	Double cream (tablespoon 30g)	0.5
	Single cream (tablespoon 15g)	0.5

1 - 4 mmol - moderate
	Crème fraiche (60g)	1.2
	Petit filous (60g)	2.7
	Soya yoghurt (120g)	2.8
	Custard (120ml)	4.0
	Yoghurt (fruit) per 100g	4.3
	Yoghurt (plain) per 100g	4.3
	Rice pudding (140g)	4.6

More than 5 mmol - high
	Ice cream (120g)	5.0
	Condensed milk	9.2
	Evaporated milk per 100ml	12

Drinks

Less than 1.5 mmol - low
	Squash/cordial  (200ml) (less than 10% fruit juice from concentrate)	0.3
	Ovaltine (23g)  with water	0.9
	Lemonade (330ml)	1.3
	Tea (200ml) black	1.4

1.5-3 mmol - moderate
	Coffee (2g) instant black	1.9
	Pineapple juice (150ml)	2.0
	Grape juice (150ml)	2.1
	Drinking chocolate (18g - with water)	2.3
	Fanta/Tango (330ml)	2.3

More than 3 mmol - high
	Apple juice (150ml)	3.4
	Fresh orange juice (150ml)	6.3
	Tomato juice (160ml)	9.4
	Milkshake - take away (250ml)	10.9
	Horlicks made with milk (200ml)	10.9

Snacks

Less than 1 mmol - low
	Jelly made with water	0.10
	Prawn crackers (30g)	0.10
	Jam tart (34g)	0.60
	Ginger nut biscuit x 2	0.70
	Treacle tart  (slice)	0.80
	Jaffa cake x 2	0.9
	Jam swiss roll (30g slice)	1.0
	Plain digestive biscuit x 2	1.6

1-3 mmol - moderate
	Lemon meringue pie x 1 slice	1.4
	Sweet pancakes (crepe 43g)	1.9
	Iced madeira/lemon drizzle (40g)	2.0
	Iced bun	2.1
	Apple pie (100g)	2.2
	Jam doughnuts (75g)	2.2
	Tortilla chips (30g)	2.2
	Chocolate éclair	2.3
	Chocolate digestive x2	2.3
	Corn snacks	2.5

	Flapjack (50g)	2.6
	Apple crumble (117g, white flour)	2.7
	Twiglets (small bag)	2.9
	Hot cross bun	2.9
	Danish pastry	3.0

Why is a phosphate restriction needed?

Phosphate is a mineral, it comes from the food we eat and it is important for your body tissues and bones. It is released from food in the stomach during digestion and absorbed into your blood. Your kidneys control how much phosphate stays in your body.

When your kidneys are not working properly the amount of phosphate in your body can build up and cause problems. To help control this you will need to change the types of food you eat and you may need to begin a medication (phosphate binder).

Phosphate binders

Your child may be prescribed a phosphate binder. Phosphate binders work like magnets and bind to phosphate in the stomach before it is absorbed into the blood. It is then removed through the bowels. Binders need to be taken just before meals.

If you eat snacks between meals you may need to take a phosphate binder. If you miss a meal you do not need to take a binder.

Ask your dietitian for advice. They can advise you on:

· Type of binder
· How many and when to take

Effects of high phosphate
You may not feel any symptoms of high phosphate levels however serious problems may be occurring.

Daily problems
You may experience the following:

· Itchy skin
· Red eyes
· Bone or joint pain

Long term problems
Ongoing high phosphate levels can cause:

· Bone disease
· Build up of mineral deposits in heart and major blood vessels leading to heart disease

Phosphate additives

Phosphate additives are increasingly added to food products and beverages during food processing and can contribute a significant “hidden phosphate load”

Some meats have a phosphate content 70% higher than those not containing additives.

See table below for the phosphate additives: try to limit/avoid these foods.

Phosphate Additives		Food Industry Purpose		Examples of Food
Phosphoric acid	Acid		Processed meats, cakes, chocolate, sweets, jams, vegetable fats and oils, cola drinks, beer
Sodium phosphate	Antioxidant		Processed meat, processed cheese, powdered milk
Potassium phosphate	Antioxidant		Cured meats, milk and cream powders, drinking chocolate
Calcium phosphate	Anti-caking agent, firming agent		Self-raising flour, cake and pancake mixes, powdered milk drinks, instant pasta and sauces
Magnesium phosphate	Anti-caking agent		Salt substitutes, prepared mustard
Diphosphate	Emulsifier		Processed cheese, instant mashed potatoes, cakes
Triphosphate	Emulsifier		Fish fingers
Polyphosphate	Emulsifier		Dried foods and desserts
Distarch phosphate	Thickening agent		Batters for frozen foods, custards, sauces, mayonnaise, salad dressings, pies and fillings, dried foods, drinking yoghurt, flavoured milk, whipped cream, pre-cooked pasta and noodles, starch based puddings, instant beverages

Some of the foods listed in the table have this symbol as these foods could be high in potassium or salt *
The foods in this diet sheet have been grouped in to sections and colour coded using a traffic light system


Foods lower in phosphate: can have daily (green)

Foods moderate in phosphate: have twice a week (orange)

Foods highest in phosphate: have once a week (red)


Some of the foods listed on the table have this symbol as these foods could be high in potassium or salt *

Dairy & Eggs - Portions per day: 3

<100mg
	Mayonnaise 1 tablespoon	trace
	1 egg white	5
	Single cream 1 tablespoon (15g)	10
	Double cream 1 tablespoon (30g whipped)	15
	Tzatziki, 1 tablespoon	30
	Crème fraiche  (60g)	35
	Evaporated milk 1 tablespoon *	40
	Condensed milk 1 tablespoon*	40
	Soya milk  unsweetened (100ml)	45
	Soya milk unsweetened (100ml)	50
	Cream cheese e.g. Philadelphia or Boursin (50g)	50
	Cottage cheese (50g)/Feta (30g)	85
	Ricotta (50g)	85
	Skim/semi/full fat milk 100ml *	95
	1 medium egg	95

n 100-150mg
	Custard ready to eat (120g)	100
	Yoghurt, plain (60g)	105
	Danish blue (30g)	105
	Ice cream 2 scoops (120g)	110
	Brie/Camembert (50g)	120
	Rice pudding (150g)	130
	Mozzarella (50g) / Parmesan (20g)	135

n >150mg
	Edam (30g)	155
	Greek style yoghurt , 1 pot	165
	Whole milk yoghurt  (120g pot )*	205
	Instant whip/angel delight (125g)	230
	Plain quiche 1 slice  100g	235
	Cheddar 50g*/cheese spread 30g * e.g. Dairylea, Primula, Laughing Cow	250
	Processed cheese 2 slices *	385

Meat, Meat Alternatives and Fish - Portions per day: 2 small

n < 150mg
	Fish paste, thinly spread on 1 slice bread	30
	Bacon, 1 rasher (25g*)	45
	Crab, 1/2 small can	55
	Prawns, small portion (60g*)	75
	Anchovies, canned ½ tin *	75
	Fish fingers, 2 fingers	80
	Ham, 1 slice (25g *)	85
	Cod, small fillet, baked (50g)	95
	Tuna, canned in spring water/sunflower oil, 1/2 small can (50g)	100
	Lamb, roast small portion	100
	1 Fishcake	100
	Chicken drumstick, meat/skin only (50g)	100
	Scotch egg, 1 mini	100
	Beef burger (40g)	100
	Gammon steak, boiled, small portion (50g*)	110
	Cornish pastie (150g)	110
	Mussels, 5 mussels	115
	Quorn pieces (50g)	120

	Beef, mince/beef stewing steak (70g *)	125
	Salmon, smoked (50g*)/1 canned sardine	130
	Lamb chop 65g (meat only)	140
	Shepherds pie (200g)	140
	Beef curry (90g *)	145
	Salmon, canned, 1/2 of a small can (50g)	145

n 150-179 mg
	Sausages (2)	150
	Turkey, roast, light meat, (70g)	150
	Calamari 3 pieces fried in batter	155

n >180mg
	Liver pate, spread on bread (40g)	180
	Cod small fillet in batter at home (120g)	190
	Chicken curry (140g)	195
	Quorn mince  (100g)	205
	Scampi in breadcrumbs (80g)	210
	Kipper 1 small fillet (85g grilled)	230
	Salmon steak, baked (100g)	260
	Pork chop (120g)	300
	Cod, small fillet in batter, take away (180g)	375
	Smoked mackerel (160g *)	380

Nuts, legumes and pulses - Portions per day: Nuts, legumes and pulses are good alternative to meat and fish.

Foods in this group could be used in place of meat and fish at a meal time

n <100mg
	Butter beans (50g)	35
	Chickpeas  (50g)	40
	Broad beans boiled  (50g)	50
	Hummous (30g)	50
	Split peas boiled  (50g)	60
	Mushy peas (60g *)	60
	Chestnuts dried (50g)	70
	Pinto peas (50g)	75
	Mung beans boiled (100g)	80
	Pigeon peas boiled  (100g)	110
	Red lentils boiled (100g)	100
	Sunflower seeds, 1 tablespoon (15g)	100

n 100-150mg
	Walnuts (30g)	115
	Baked beans (135g*)	120
	Soya beans boiled  (50g)	125
	Peanuts, dry roasted (30g*)	125
	Brown/green lentils boiled  (100g)	130
	Red kidney beans boiled  (50g)	130
	Pine nuts (20g)	130
	Peanut butter,  thickly spread on bread (40g)	130
	Black eyed beans  boiled  (50g)	140
	Tahini paste, 1 heaped teaspoon(20g*) /Sesame seeds, 1 tablespoon (20g)	145
	Cashew nuts, roasted (30g)	150

n >150mg
	Almond toasted (30g)	170
	Aduki beans, boiled (100g)	180
	Black gram beans cooked (100g)	185
	Quinoa, 2 tablespoon (85g)	195

Breads and Cereals - Portions per day: 5-6 per day, aim for 1-2 portions with each meal

n <100mg
	Cornflakes/Crunchy nut/Frosties  (30g)	15
	Bread sticks (20g)	25
	Rice white, cooked, 2 tablespoon	30
	Rice krispies/Coco pops/Weetos (30g)	40
	Sugar puffs (30g)	45
	Porridge (1 small portion made with water)	50
	Special K (30g)	50
	Yorkshire pudding x 1	50
	Croissant/pancake homemade	55
	Weetabix  x 1 bix /Shredded Wheat  x 1	60
	Brioche (45g) /English muffin x 1	60
	Cheerios (30g)/Shreddies (30g)	70
	Scotch pancake	70
	White bread, 2 slices (medium)	70
	Small pitta bread	75
	Chapatti  x 1 large	80
	Couscous , 2 tablespoon cooked	85
	Bagel - plain/Crumpet x 1	90
	White pasta, cooked (100g)	90

n 100-150mg
	Bran flakes (30g)	105
	Ready brek (30g)	110
	Rice brown, cooked 2  tablespoon	110
	White plain flour (100g)	115
	Granary bread , 2 slices	125
	Chapati flour white (100g)	130
	Tortilla, 1 wrap	140
	Wholemeal bread , 2 slices	145

n >150mg
	Naan bread (Mini, 60g)	180
	All-bran (30g) *	190
	Gram flour (100g)	220
	Wholemeal flour (100g)	280
	Scone  plain	330
	Chapatti flour brown (100g)	375
	White, self raising flour (100g)	465

Confectionery - Portions per day: aim for no more than twice 

n Less than <50mg
	Peppermints/marshmallows	trace
	Fruit pastilles	2
	Turkish delight (no chocolate, 2 cubes)	2
	Starburst/Chewits/boiled sweets (50g)	5
	Liquorice allsorts*	25
	Toffee (50g)	30
	Blue Riband/Time Out (1 finger)	35
	Milky Way (standard)/Kit Kat (x2 fingers)	35

n 50-100mg
	Crème egg	50
	Bounty bar/Smarties (tube)	60
	Twix (2 finger)	65
	Plain chocolate (100g)	70
	Mars bar (standard  size, 65g)	80
	Bombay mix (30g)	90

n >100mg
	Milk chocolate bar (50g)	110
	White chocolate  bar (50g)	115

Drinks

n <65mg
	Squash, lemonade, Fanta, 7 up, Tango, Cherryade	trace
	Lucozade (original only) 200ml	2

n 65-150mg  once per week maximum
	Coca cola/Dr Pepper , 330ml (can)	100

n >150mg — 1 time per month
	Cocoa made with milk  (200ml)	205
	Horlicks made with milk  (200ml)	235
	Ovaltine made with milk  (200ml)	260
	Milkshake, takeaway (250ml)	300

Children’s Dietitians
The Department of Dietetics and Nutrition
Queen’s Medical Centre Campus
Derby Road
Nottingham
NG7 2UH

Congratulations, you have had a successful kidney transplant!

This will change your life in a number of ways, including your diet.

Your new kidney means that your dialysis is no longer needed.

However before you go eating lots of things that were restricted before, here are just a few words of caution:

Many people put on a lot of weight following their transplant. Being heavy or ‘obese’ is now recognised as a risk to your health and is a threat to your new kidney.  Limit the time you spend in front of the television/computer/ video games to 2 hours or less per day.

Some of the important medicines you are taking to ensure your new kidney works well can cause you to become hungry and increase levels of fat in your blood. It is therefore important to follow healthy eating advice.

You need to choose the right foods which will keep your weight under control. Hopefully this will help to keep you fit and well for years to come.

Regular exercise (about 60 minutes daily) is an important part of a healthy lifestyle, e.g. dancing, walking, football or swimming. 

Healthy Eating Post Transplant:

Savoury Snacks:

• White bread
• Bread Sticks or crackers
• Philadelphia dunkers
• Bagels/crumpets/English muffins/teacakes
• Chapatti (white flour)
• Share and tear brioche
• Croissants
• Toast
• Plain Rice Cakes
• Melba toast
• Pitta Bread
• Naan bread
• Pancakes
• Plain popcorn
• Plain pasta/noodles/boiled rice
• Asda Savoury Rice: curry flavour or chicken and sweetcorn

*Margarine or Oils can be added to all the above*

Crisps:

Walkers Sunbite crisps - sun ripened sweet chilli Sour cream and black pepper Original Doritos Lightly Salted Asda Cheesy Balls Asda Japanese Style Rice Cracker mix Weight Watcher’s Cheese Puffs Goodies Organix Carrot stix Curly puffs cheese & herbs Noughts and crosses sauce tomato Spicy stars tomato carrot & spices

When your kidneys are not working properly you may need to reduce the phosphate in your diet. Phosphate is a mineral, important to build strong bones. High levels of phosphate in the blood takes the calcium out of the bones, which can weaken bones and long term can lead to heart disease as a young adult.

When is a phosphate restriction required?

· When kidney function is less than 60% (CKD Stage 2-5)

· When blood phosphate levels are above desired range