Vegetarian diet

Hi Dr Agar,
can people on nocturnal dialysis live safely on a vegetarian diet, and also on the more stringent vegan diet?
Is it safe to take all supplements i.e. vitamins fat soluble and water soluble, minerals, probiotics on nocturnal dialysis?

Dear Sineadee

Thanks for the question … and though this could perhaps best be asked of the nutritionist/dietician advisor to this site, I’ll have a crack at it.

Taking the second part first: Absolutely! … All of our patients – both our facility-based and our home-based HD patients (and our PD patients too, for that matter) - take a B complex + C supplement daily. It is my view that all dialysis patients should be thus ‘replaced’ with a daily supplement. The supplement we use contains: Thiamine Nitrate (Vitamin B1) 50mg, Riboflavine (Vitamin B2) 25mg, Nicotinamide (Vitamin B3) 50mg, Calcium Pantothenate (Vitamin B5) 50mg, Pyridoxine Hydrochloride (Vitamin B6) 50mg, Cyanocobalamin (Vitamin B12) 50mcg, Ascorbic Acid (Vitamin C) 100mg, Biotin 50mcg, Folic Acid 200mcg, Inositol 50mcg and Choline Bitartrate 50mcg.

As you will be aware, water soluble vitamins and amino acids are ‘inadvertently washed away’ across the dialyser membrane during dialysis and, in my view, replacement is important though unfortunately the studies done in this area to date have been few and limited and there certainly have been no studies of which I am aware that have specifically studied the contrast between the vitamin and mineral losses in conventional dialysis vs the potentially greater losses one might encounter in the more intensive dialysis methods.

Of course, some of the advantages of NHD seems to be a significant improvement in appetite and in the taste of food. Put this together with a far greater freedom to eat as desired, to eat normal floods without the usual severe restrictions the accompany conventional dialysis and to eat without the usual PO4-binder ‘chasers’ that most dialysis patients abhor and the NHD patient can thus enjoy a far more balanced and nutritious diet altogether. This improved diet also improves the intake of vitamins and minerals that can struggle to be sufficient in a conventional dialysis diet - despite supplementation. So … while we supplement both groups of dialysis patients, the NHD patients stay well ahead from a better dietary intake in the first place. As their dialysis is significantly longer - and in our unit, more frequent too - their loses are greater so, despite a better diet, we chose to supplement in the usual way.

Data in this field is sparse - to say the least. Much of what we do in nutritional supplementation is based on ‘best guess’ and that old ‘feeling in the water’. In asking this, however, you have raised an interesting question which I really should have given more thought to: and it is certainly an area open to more definitive nutritional investigation in the future. We have tended to measure some parameters (eg: B12 and folate) and extrapolate that, as patients maintain these levels well long-term, that the other less easily measured vitamin levels are thus also adequately replaced and/or sustained. I know ‘assumptions’ are not what you want to hear – but it’s the best I can do. It is not an area I know well enough to go further with in a simple answer like this.

As for the first part … I would have some significant worries about an adequate albumin intake with a vegan diet unless it is very carefully prescribed and followed. Again, this is not an area I know well and a nutritionist is likely better placed to answer your question.

Vegan-ness is something I have personally paid little attention to. It’s not been an issue to raise its head among our own patients - so I guess, to be truthful, I simply haven’t thought about it much. Perhaps I should have. We have a dietitian attached as an adviser to this site … can I suggest you ask her … and perhaps ask her to copy her answer into this thread as well?

Dear Reader

There has been an interesting discussion about renal diet at the LeeAnn Smith HDC Expert Dietitian page.

It is under the heading ‘Its Counterintuitive’.

I recommend it to you to read.