A dietitian's guide to protein for people on dialysis

Protein is a building block that is necessary for life! Food has three macronutrients — protein, carbohydrates, and fat. These macronutrients are the building blocks that make up our food and they provide us with energy, called calories. Protein can come from animal sources like meat, poultry, eggs and dairy, or from plant sources like beans, grains and nuts.

When we think about protein we often think about muscles, and particularly the kind of muscles that move us. But our organs — heart, kidneys, lungs, and others — are muscles, too. Protein helps build and repair all our muscles. When you are not feeling well, your body's protein needs are higher. If you do not eat enough protein, your body will take protein from your muscles.

Protein is also found in your blood. This form of protein is called albumin. Your body makes this protein in your liver from the foods you eat. You can think of albumin as your body's mail carrier — it delivers nutrients, vitamins, minerals and energy you get from food to the rest of your body. It also helps the fluid you drink stay in your cells and blood vessels, and it helps fight infection.

You need more albumin when you are on dialysis. When your kidneys are not working properly, both hemodialysis and peritoneal dialysis remove the buildup of waste and fluid in your blood. But dialysis also removes some of the albumin in your blood. This is why it is important for people on dialysis to have a protein source at every meal and sometimes with snacks.

Albumin helps fluid stay in your blood vessels, something that is especially important when you are on dialysis because you are not going to the bathroom like you used to. Dialysis pulls the extra fluid out of your blood, and albumin helps keep fluid in your blood — instead of pooling around your feet and ankles or around your lungs — so dialysis can remove it more easily and it causes less stress on the rest of your body.

Albumin levels are checked monthly when you are on dialysis. The goal is a level of 4.0 or higher. Research has shown people receiving dialysis treatments with an albumin level of 4.0 or higher have fewer hospitalizations and a lower risk of death. Your albumin levels can drop due to infection, inflammation or a recent hospitalization. Although these are not directly related to food, many times you eat less when you are not feeling well.

How to raise or maintain your albumin levels

• Drink 32oz or less of fluid a day — your albumin is lowered when you have too much fluid. Remember: anything that turns to liquid at room temperature is considered a fluid, not just water.
• Eat a protein source at every meal.
• Have a bedtime snack. Your liver stores extra energy that is used when you have not eaten in a while, like when you sleep, skip meals or are just not hungry. If you do not have enough stored energy, your body uses the protein stored in your muscles.
• Eat one Brazil nut daily. Brazil nuts are high in an antioxidant called selenium. Selenium helps reduce inflammation, which can lower your albumin. But be sure to eat only one Brazil nut — more will raise your potassium and phosphorus levels.
• Always have a high-protein snack like chicken, tuna or egg salad on hand. Spread it on a cracker for a tasty snack, especially when you do not have much of an appetite but still need to eat protein.
• Try a protein supplement like a protein bar or sprinkle vanilla-flavored protein powder on your morning bowl of oatmeal. Be careful, always read the label! Many protein bars and powders have a lot of potassium. Ask your dietitian which one is best for you.
• Take your phosphate binders with every meal or snack, especially a protein supplement. Where there is protein, there may also be phosphorus!

Check with the dietitian at your dialysis center for other ideas on how to increase your daily protein intake to stay as healthy as possible while on dialysis.

This information was presented in a free webinar hosted by the American Kidney Fund. The webinar, "Protein: Who needs it anyway? You do!" is available for on-demand viewing here.