Tuna Ceviche and No Tomato Salsa by Maria from Arizona

One of the most difficult aspects of chronic kidney disease is balancing potassium and phosphorus levels. Maria, a dietitian at DaVita in Arizona, always rises to the challenge of educating patients about the benefits of maintaining their diet. “Following renal guidelines is the single most important thing patients can do to improve their health.” That’s why she offers up two recipes for Tuna Ceviche and No Tomato Salsa.

“The most surprising thing I’ve learned since I’ve started working at DaVita is the importance of balance between bone and mineral metabolism,” says Maria. Unhealthy kidneys are no longer able to remove excess phosphorus and potassium from the blood. High levels of either can cause serious problems for patients and lead to a deterioration of health and spirit.

High levels of phosphorus can cause bone and heart problems. When phosphorus levels are not controlled this leads to weakened bones and low blood calcium, which causes calcium to be taken from the bones. This can lead to calcifications or hardening of soft tissues, bone pain and itching. Renal dietitians recommend that their patients on dialysis avoid foods with high phosphorus content. Doctors also prescribe phosphorus binders to be taken with meals and snacks to help absorb phosphorus from food before it enters the blood stream. While binders help, it really comes down to diet for maintaining a safe phosphorus level.

High potassium levels are also a health risk for dialysis patients, so one must consciously avoid high-potassium foods. Because the “well-balanced diet” taught in grammar school doesn’t apply here, limiting high-potassium foods can be a tricky concept to grasp. Dairy products and many fruits and vegetables, including tomatoes and bananas, need to be limited or avoided. High potassium levels can cause nausea, weakness, numbness or tingling, slow pulse, irregular heartbeat, heart failure, and in extreme cases, death. 

Dialysis is effective at removing excess potassium from the blood; however, between treatments potassium levels rise. Because of this, high potassium foods must be limited so potassium levels do not get too high before the next treatment.

Being thoughtful and consistent with the renal diet, dialysis treatment, taking prescribed medicines and maintaining a healthy lifestyle are important for good health and quality of life. To help patients achieve these goals, dietitians work to develop a personalized diet plan for each patient and go over monthly lab results including phosphorus and potassium levels. Maintaining a strict diet is a challenge, but the rewards can be worth the effort. 

Maria feels that the most rewarding aspect of her job is witnessing the positive difference in her patients’ lives when they follow their diets. “I really enjoy hearing about my patients’ success stories and sharing recipes.”

Maria has two zesty recipes to share that are very popular with her patients in Arizona. The spicy flavor of these dishes is a favorite in the Southwestern area of the U.S. and helps patients understand that the dialysis diet can include tasty foods that are also low in phosphorus and potassium. Give Maria’s Tuna Ceviche and No Tomato Salsa a try. Both are refreshing, tasty and easy to prepare.


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