Dialysis and Nutrition - Essential Dietary Guidelines

Nutrition plays a key role on dialysis. When the kidneys fail, they can no longer regulate minerals, fluid and waste. A suitable diet helps prevent complications, keeps you strong and improves quality of life. Your own targets depend on your blood results and your remaining urine output: always follow the plan from your renal dietitian. The figures below are typical ranges, not personal advice.

Protein

People on haemodialysis usually need more protein than before, because some protein is lost during each session. Good sources include lean meat, poultry, fish and eggs. Plant proteins such as beans and lentils can be included, keeping in mind their phosphorus and potassium content.

Potassium

Potassium helps control muscles and the heart. When the kidneys fail, it can build up to dangerous levels and cause heart rhythm problems. Many patients are asked to limit potassium, often to around 2,000–3,000 mg a day. Foods high in potassium include bananas, oranges, potatoes, tomatoes, avocados and dried fruit. Lower-potassium choices include apples, berries, grapes, cauliflower and green beans. Soaking and boiling some vegetables reduces their potassium.

Phosphorus

Too much phosphorus weakens bones, causes itching and harms blood vessels. Dairy products, nuts, beans, whole grains and dark sodas are high in phosphorus, and phosphate additives in processed foods are absorbed very easily, so read labels. Your doctor may prescribe phosphate binders to take with meals.

Salt and fluid

Less salt means less thirst and better blood pressure. A common target is no more than about 2,000 mg of sodium a day (about 5 g of salt). Fluid is often limited to around 1 litre a day plus the amount of urine you still pass, but your team sets your own limit. Too much fluid between sessions causes breathlessness, high blood pressure and strain on the heart. To manage thirst: ice cubes counted in your allowance, frozen grapes, sugar-free chewing gum, rinsing your mouth without swallowing.

Vitamins and minerals

Dialysis removes some vitamins, and your diet may be limited, so your doctor may prescribe a renal vitamin, vitamin D or iron. Do not take supplements or herbal products without asking your care team: some can build up to harmful levels.

Meal planning tips

• Work with a renal dietitian on a personal plan.
• Keep a food diary.
• Read labels for phosphorus additives and salt.
• Cook at home when you can.
• Share kidney-friendly recipes with other patients.

On holiday, keep to your plan: watch fluids in the heat and ask for grilled dishes with little salt.

Sources

• NIDDK – Eating & Nutrition for Hemodialysis

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