What is a cataract?
A cataract is clouding of the lens in the eye. The lens is the part of the eye that focuses light (figure 1). Cataracts can cause vision loss.
What are the symptoms of cataracts?
Cataracts make a person’s vision blurry or dull (picture 1). They can also make everything look slightly brown in color. Some people notice a problem when they keep needing new eyeglass prescriptions. For some, headlights and other lights might seem to have a glare.
Is there a test for cataracts?
Yes. Your doctor or nurse might be able to see your cataracts just by looking in your eye. But if it looks like you have cataracts, your doctor or nurse will probably send you to an eye doctor. Eye doctors can usually diagnose cataracts in minutes.
If you have vision loss, it could be caused by more than 1 thing. An eye doctor can check you for the most common causes of vision loss by doing a “comprehensive eye exam.” During the exam, the doctor will:
- Check how well you see things up close and far away
- Check how well you see things that are at the center of focus, and how well you see things that are off to the sides
- Measure the pressure inside of your eye using a special device
- Look into the back of your eyes to check for signs of nerve damage
How are cataracts treated?
The main treatment for cataracts with major vision loss is surgery. This involves removing the cloudy lens and replacing it with a new artificial one. Not everyone needs treatment. If you have cataracts, you decide if and when to have surgery.
Cataract surgery is pretty simple, although rarely, it can lead to problems such as infection or pain. But the surgery can greatly improve vision in people with severe cataracts.
How do I decide about surgery?
If you are thinking about surgery, ask your doctor:
- What are the risks of surgery for me? (If you have any other health problems, ask how they might affect the results of the surgery.)
- How much is my vision likely to improve if I have the surgery?
- Is it possible that the surgery will not work?
- Are my cataracts the only thing causing my vision problems? (If you have other eye conditions, surgery might not help with those.)
- What will recovery be like?
If you need cataract surgery in both eyes, it will often be done as 2 separate procedures on different days. In some cases, both procedures can be done on the same day.
After you get all of this information from your doctor, ask yourself:
- How much do my vision problems limit me?
- Can I do all of the things I need to do with the vision I have left?
- Have I stopped doing things I love, such as reading or knitting, because I can’t see well anymore?
- How do I feel about the possible risks of surgery?
- How will I feel if the surgery causes problems or does not work?
- Will there be someone who can help me while I recover?
Think about these things. Then, work with your doctor to decide whether surgery is right for you.
Can cataracts be prevented?
You can reduce your chances of getting cataracts by not smoking or quitting if you do smoke.
How well you feel when you are on hemodialysis will depend on:
- Eating the Right kind and amounts of food.
- Controlling your fluid intake
- Attending and completing all your scheduled hemodialysis treatments
- Taking the medicines prescribed by your Kidney Doctors.
Why do I need a special diet?
Your diet is an important part of your overall treatment. Your kidneys are not working; thus, you cannot get rid of enough waste products and fluids from your body, thus you will need to limit fluids, and change your intake of certain foods in your diets.
In general, you will need to
EAT MORE (high protein foods)
EAT LESS (high salt, high potassium, and high phosphorus foods).
ADJUST AND CONTROL (the amount of fluid you can safely drink in a day).
Overall, a balanced plate is important:
For each meal, include something from these food groups:
- Protein foods – fish, poultry, meat, eggs,
- Starchy foods – bread, cereal, rice, noodles
- Fruits and Vegetables – have a variety
Each person’s diet may be different depending on his or her blood test results. If you need further advice with regards to your diet and what food you can eat, please let your Hemodialysis Team know, and we will be happy to get you in touch with a Dietitian.
What will my diet look like?
Individualized, depending on your blood test results, you may need to learn and focus more about:
- Protein
- Phosphorous
- Sodium
- Fluid
- Potassium
Protein
Do I need more protein?
People on dialysis need to eat more protein. During Dialysis you lose some protein. Protein is important to help keep your muscles strong, help wounds heal faster, strengthen your immune system, and helps improve overall health.
Eat protein-rich foods, eggs, fresh chicken/beef, fresh fish.
- Avoid processed meats such as sausages, canned meat (corned beef), canned sardines, hot dogs, fish fingers, chicken nuggets, and smoked or dried meat or fish.
- Some high protein foods such as peanut butter, nuts, seeds, dried beans, peas, and lentils are generally limited because they are high in both potassium and phosphorus.
Phosphorous
What is phosphorous?
Phosphorous is a mineral. It works with calcium to keep your bones and teeth strong. Dialysis helps remove some phosphorous from your blood.
High Phosphorus levels in your blood may cause:
- hardening of your blood vessels
- Weak and easily broken bones.
- Bone, joint, and muscle pain
- Itch
How to control your phosphorous level?
- Dialysis – complete all your dialysis treatments.
- Diet – Eat a diet lower in phosphorus.
- Phosphorus Binders – if prescribed, take with meals.
What food is high in phosphorus?
Some food naturally contains phosphorous such as milk, cheese, yoghurt, nuts, and some foods had phosphorous added to them such as cola beverages, fast foods, canned foods, and processed meats.
People on dialysis are advice to avoid “whole grain” and “high fiber” foods (like whole wheat bread, bran cereal, and brown rice) to help limit intake of phosphorous.
Rice and almond milk are low in phosphorus and can be used as alternatives to dairy milk.
Phosphorous is added to some foods and beverages during processing. Be sure to read food ingredient labels.
What are phosphorous binders?
Phosphorous-binding medications help manage phosphorous levels in your body. Some of the types of phosphorous binders that you may be on:
- Calcium Carbonate
- Sevelamer Carbonate
Phosphorous binder should be taken with food. If you forget to eat them, take them within 30 minutes of eating.
Sodium
Sodium is a mineral found in most foods. Sodium is important for water balance in the body. However, too much salt can cause a lot of problems in dialysis patients: high blood pressure, swelling/puffiness, increased thirst.
Advisable to use less salt and eat less salty food: This may help to control blood pressure. It may also help reduce fluid weight gain between dialysis sessions since salt increases thirst and causes the body to retain (or hold on to) fluid.
How can I eat less sodium?
- Prepare and cook your food at home more often (Outside food from restaurants, or fast-food meals have higher sodium content than home-cooked meals.)
- Avoid high sodium packaged, convenience or processed foods such as:
- Salted Fish
- Dried Shrimp (Udang Kering), ‘Belacan’, bubuk
- Small Dried Fish (Ikan kering – ‘Pusu’, ‘tamban’, ‘tahai’
- Pickles/Samboi/Salted Vegetables
- Instant Soup (packaged)
- Organ meats
- Flavoring sachets or stock cubes
- Instant noodles
- Read Food Labels. Avoid ingredients such as Monosodium glutamate (MSG), Baking soda, soya sauce, and sodium
- Avoid adding high salt content sauces to food: Tomato Sauce, BBQ Sauce, Soy Sauce (Kicap), Oyster Sauce.
How to add flavor without adding salt?
Season your food with:
- Fresh herbs.
- Garlic, Ginger, Onion
- Spices – Advised to use whole spices, fresh spices, and not to use curry and powdered spices.
Fluid
Why do I need to limit my fluid intake?
If you make very little or no urine, the fluid you drink will stay in your body.
Too much fluid can cause:
- High Blood Pressure
- Fluid in the lungs, making it hard to breathe.
- Puffy hands, face, and feet
- Extra work for your heart which can lead to heart failure.
- Cramping on dialysis
- Large weight gains between dialysis runs.
How much fluid can I drink?
The amount you can drink depends on how much urine you make.
Per day fluid intake can range between 500ml to 1L. The amount of fluid intake will depend on each individual and advice from your kidney doctor.
What counts as fluid?
Any food items that can melt or are liquid at room temperature will be calculated into part of your daily fluid intake.
For example, water, ice, tea, and coffee, milk, soups, ice cream, jelly, soda.
Some tips to reduce fluid intake:
- Choose lower-sodium foods – this will help reduce thirst.
- Maintain good blood sugar control, high blood sugars will cause thirst.
- Choose smaller cups. Your usual cup may hold more fluid than you think.
- Use small amounts of water to take pills.
Potassium
What is potassium?
Potassium is a mineral found in most foods. In your body, it helps your nerves, muscles, and heart to work properly. When your kidneys are not working, you cannot remove potassium easily from the body. People on hemodialysis need to keep their potassium level in a safe range.
High Potassium may cause:
- numbness or tingling in hands and feet.
- Weak muscles
- Irregular heartbeat
- Your heart to stop.
How can I control my potassium?
- Dialysis – Attend your dialysis and complete your
- Bowel Habits – Avoid constipation
- Exercise – Plan to be active every
- Serving sizes are important: A large portion of low-potassium food can become a high source of potassium.
- Diet – Read food labels. Avoid foods with potassium additives.
- Potassium additives are identified by the word potassium in the ingredient e.g., Potassium Chloride, Potassium Phosphate, Potassium lactate, Potassium Citrate.
- Example of foods containing potassium additives: processed meats and cheese, electrolyte beverages, instant or powdered beverages (3 in 1 coffee or tea mixes), canned soups and broths.
- How you prepare and cook your food can help to reduce potassium.
- Boiling root vegetables can help remove some potassium from the food into the cooking water. Discard cooking water.
- Soak green leafy vegetables for 2 hours prior to cooking.
Examples of high-potassium foods to avoid
- All vegetable and fruit juices
- Kiwi
- Tomato puree
- Melon – rock, honeydew
- Banana
- Dried fruit- raisin, mixed dried fruit
- Durian
- Dates (Kurma)
- Avocado
- Grapefruit
- Guava
- Soursop
- Pomelo
- Apricot
- Lentils/dahl/dried or tinned beans – chickpeas, kidney beans
- Rambutan
- Coconut products- milk, cream, water, or flesh
- Commercially prepared potato products – chips
Note: Always avoid Star Fruit.
Examples of suitable Vegetables that can be eaten at daily meals
- Cabbage
- Carrot
- Cucumber
- Cauliflower
- Bamboo shoot (rebong)
- Turnip (‘sengkuang’)
- Egg plant (‘terung’)
- Asparagus
- Lettuce/salad
- Marrow (‘Labu Air’)
- Pumpkin (‘labu kuning’)
- Broccoli
- Green leafy vegetables (‘sawi’, ‘bayam’, ‘kangkong’)
- Radish (Labu putih)
- Chinese cabbage
- Mushroom (fresh or canned)
- Corn (fresh, tinned, or young)
- Mixed vegetables containing a mixture of the allowed vegetables
- Local green vegetables (Lemiding, pakis, ulam-ulam)
Note: Vegetables are advised to be peeled, chopped, and soaked for 2 hours in water before cooking. Water used for soaking the vegetables should be discarded.
References:
National Kidney Foundation (https://www.kidney.org/)
National Institute of Diabetes and Digestive and Kidney Diseases (https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis/eating-nutrition)
BCRenal (http://www.bcrenal.ca/)
