For individuals undergoing hemodialysis, a carefully tailored diet is critical for managing the effects of kidney disease and optimizing overall health. This article provides a detailed overview of hemodialysis diet plan guidelines, drawing upon expert recommendations to offer practical advice for patients and their caregivers.
Introduction to Dialysis Diet
When you first learned that you had chronic kidney disease, you probably made some changes in your diet. Now that you’re on dialysis, your diet needs have changed again. Dialysis takes over some of the work that healthy kidneys would normally do. But dialysis can’t do the job as well as kidneys. Some waste and extra water may still build up in your blood. Over time, that could lead to problems with your heart and bones. Knowing which foods to eat and which foods to limit can help you feel better at this stage of kidney disease.
Dialysis filters out wastes and extra water from your blood. In the process, it also removes proteins. You need to eat plenty of protein to make up for what’s lost. A dialysis diet is designed to help you limit phosphorus and sodium, get the correct amount of potassium, and limit how much fluid you have, as needed.
Understanding the Dialysis Diet
A dialysis diet is a specialized eating plan designed to support individuals undergoing dialysis treatment. Dialysis is a process that filters waste and excess fluids from the blood when the kidneys are unable to perform this function adequately. The diet aims to minimize the buildup of waste products and maintain a balance of essential nutrients in the body.
Individualized Dietary Needs
General nutrition guidelines for patients on dialysis will vary depending on body size. Your diet may be a little stricter if you get hemodialysis 3 times a week. In this type of dialysis, your blood is run through a filter outside your body. When your blood is cleaned this way only 3 times in a week, wastes and water can build up in your blood between treatments. That means you need to be very careful about the foods and drinks you take in. You may need a slightly less strict diet if you do hemodialysis at home every day, or if you get peritoneal dialysis, which uses the lining of your belly to filter blood inside your body. But whatever form of dialysis you get, it’s vital to pay attention to what you eat.
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It’s important to change your diet as needed. Regular lab tests can help you keep tabs on your nutrition. Ask your dietitian to explain how you can use this information to guide your daily food choices. A dietitian who specializes in kidney disease can help you create a personal eating plan.
Benefits and Risks
By limiting how much fluid you have and how much of certain minerals you get, you can help reduce the buildup of waste and extra water-and the health problems it causes.
Your diet needs may change over time. At one point, you might have a low protein level. Later on, your protein level might be fine, but your potassium level might be too high.
Key Components of a Hemodialysis Diet Plan
The next sections below describe the nutrients that need extra attention when you’re on hemodialysis. All nutrients are important, but eating the right amount of these nutrients will help you feel better on hemodialysis.
Protein Intake
People on hemodialysis usually need to eat more protein. Protein helps you keep healthy blood protein levels for overall good health. Protein also helps keep your muscles strong, helps wounds heal faster, and keeps your immune system strong. Include a source of lean protein at every meal. Good options include lean cuts of beef and pork, chicken, fish, eggs, and garbanzo beans.
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As an example, a 155-pound man on dialysis might aim to get 12 to 13 ounces of lean protein per day. A 130-pound woman on dialysis might aim for 10 to 11 ounces. Eat a high protein food (lean meat, poultry, and pork, fish, eggs, or a meat alternative) at every meal, or about 8-10 ounces of high protein foods every day.
The amount of protein that’s needed varies from person to person. Ask your dietitian what’s right for you.
Sodium Management
For people on hemodialysis, sodium intake should be the same as it is for most everyone else. Sodium intake should be less than 2300 milligrams per day, which is equal to one teaspoon of salt. Less sodium in the diet helps prevent fluid from building up between dialysis treatments and helps reduce thirst. Less sodium also helps keep your blood pressure within your goal range.
This means a lot more than not using a saltshaker, but also limiting foods with high levels of sodium listed on their nutrition facts label. Some foods that don’t taste salty can have a surprising amount of sodium when you check their nutrition facts label. Avoid high sodium foods like deli meats and chips.
Potassium Control
Limits on potassium in the diet are based on your specific blood levels. When potassium in the blood is too high or too low this can cause heart problems and even death. Therefore, it’s very important to keep track of your potassium levels.
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People who do frequent hemodialysis at home usually do not need to limit potassium. If you do need to limit potassium, discuss options with your dietitian. The potassium from meat and dairy products is absorbed more easily than from fruits, vegetables, legumes, nuts, and seeds. So a plant-based diet is possible when you’re on hemodialysis. However, you may need to limit portion sizes of certain plant-based foods when your potassium levels are very high. Avoid foods with additives like acesulfame potassium and potassium sorbate, as they are easily absorbed. Do not use salt substitutes that contain potassium.
Potassium binders are medications that can lower your potassium levels, and they may make it possible to add more foods to your diet. Your healthcare team can also adjust the dialysate (the cleansing fluid used during dialysis) to help lower your potassium.
Phosphorus Restriction
Phosphorus levels in the blood can become too high in kidney failure because hemodialysis does not effectively remove phosphorus. This leads to weak bones and phosphorus binding with calcium to settle into blood vessels and the heart. Therefore, you may need to limit phosphorus in your diet, depending on your lab results.
The best way to improve your diet overall and to decrease your phosphorus load is to avoid processed foods. Check labels for additives with PHOS, such as disodium phosphate. Phosphate additives are inorganic and are much more easily absorbed. Plant-based foods with organic phosphates like nuts and seeds are absorbed less. Animal-based foods like meat and dairy products have inorganic phosphates that are more easily absorbed. Therefore, eating more plant-based healthy foods instead of processed foods will decrease the phosphorus load.
Phosphorus binders and phosphorus blockers are medications that also lower your phosphorus levels, and they may make it possible to add more foods to your diet.
Fluid Management
People on in-center hemodialysis usually need a fluid restriction, but the amount depends on how much urine they still make. So, the restriction can range from one to two liters or more per day. Most people on home hemodialysis do not need a fluid restriction. Your healthcare professional or dietitian will help you determine the right amount of fluid to drink each day.
A sudden increase in weight, along with swelling, shortness of breath, or a rise in your blood pressure may be signs that you are drinking too many fluids. Tell your dialysis care team if you are having any of these problems. Check your weight at the beginning of each treatment. Ask your dietitian for creative ways to cut down on the amount of fluid you are drinking.
Fluid is any food or beverage that is liquid at room temperature. Some examples are ice, beverages like coffee, tea, sodas, juices, and water, frozen desserts such as ice cream, sherbet, or popsicles, gelatingravy and soups.
Calorie Intake
Calories give you energy from all the foods you eat and beverages you drink. The number of calories you should have are based on individual needs and your dietitian will work with you to determine the right number for you. Age, weight, height, sex, exercise level, and other factors are considered. An important goal is to get your calories from nutrient-dense foods, which means foods that have a lot of healthy nutrients for the number of calories you take in. For example, you will get a lot of healthy nutrients from a fruit rather than a candy bar, and most likely the candy bar will add more calories that are less healthy because it has more sugar and fat.
Vitamins and Minerals
Vitamin and mineral needs are also specific to each person. Eating a wide variety of foods gives your body the vitamins and minerals it needs each day. In addition to a good diet, your healthcare professional may order special vitamin and mineral supplements. Kidney disease and dialysis change the amounts of vitamins and minerals your body needs. Also, your special diet may limit some food groups that would normally provide important vitamins and minerals. Take only those supplements ordered by your kidney healthcare professional, since certain vitamins and minerals can be harmful if you are on dialysis.
Practical Tips for Following the Diet
Choosing the Right Foods
Along with protein foods, include plenty of vegetables, fruits, and grains. Most people on dialysis should focus on foods that are lower in phosphorus and potassium. Examples of foods low in both include green beans, lettuce, mango, pineapple, cornflakes, pasta, and white bread.
Many people on dialysis need to limit foods high in phosphorus, potassium, and sodium. High-phosphorus foods include beef liver, refried beans, sardines, tuna canned in oil, and bran cereal. Dairy foods such as milk, cheese, and yogurt are also high in this mineral. Limit high-potassium foods in many cases. Examples are bananas, raisins, avocados, cooked spinach, potatoes, tomato paste, and bran cereal. Several kinds of beans, including great northern, navy, and refried beans, also contain a lot of this mineral. Foods high in sodium include salty snacks such as chips and crackers, high-sodium sauces such as steak and soy sauce, and cured meats such as bacon and ham. High levels are also found in many processed foods, including canned soups, hot dogs, and frozen meals.
Choose whole, unprocessed foods when possible. Many processed foods and bottled or canned drinks contain phosphorus additives. They are often high in potassium and sodium, too. Spice up meals without adding salt. Salt is the main source of sodium in the diet. Use herbs, lemon juice, or spices instead. But don't use salt-free seasoning blends that contain potassium.
Meal Planning Suggestions
For breakfast, have scrambled eggs, toast, and a bowl of strawberries. For lunch, have a chicken salad or lean roast beef sandwich and a tangerine. For dinner, have a lean hamburger with lettuce and onion. Add a side of coleslaw.
Reading Food Labels
One of the best things you can do is to limit how much sodium you eat. Use herbs and spices for flavor while cooking. Do not add salt to your food when cooking or eating. Choose fresh or frozen vegetables instead of canned vegetables. If you use canned vegetables, drain and rinse them to remove extra salt. When eating out, ask your server to have the chef not add salt to your dish. Work with your dietitian to find foods that are low in sodium.
Portion Control
Good portion control or watching how much you eat is important in a kidney-friendly eating plan, because you may need to limit how much of certain things you eat and drink. To help control your portion sizes:
Read the nutrition label to learn the serving size and how much of each nutrient is in one serving. Many packages have more than one serving. For example, a 20-ounce bottle of soda is two-and-a-half servings. For foods that do not have nutrition labels, such as fruits and vegetables, ask your dietitian for a list of nutrition facts to measure the right portions.
Eat slowly and stop eating when you are full. It takes about 20 minutes for your stomach to tell your brain that you are full. If you eat too quickly, you may eat more than you need. Avoid eating while doing something else, such as watching TV or driving. When you are distracted, you may not realize how much you have eaten.
Managing Fluid Intake
To limit fluids, you will need to cut back on how much you drink and limit eating some foods that contain a lot of water, such as soups, ice cream, gelatin and many fruits and vegetables.
If you need to limit fluids, here are some tips:
Measure your fluids Drink from small cups to help you keep track of how much you had to drinkLimit sodium (salt) to help you feel less thirstyWhen you feel thirsty:Chew gumRinse your mouth with water and spit it outSuck on a piece of ice, mints or sugar-free hard candy
Kidney-Friendly Eating Plan
When you have kidney disease, it is important to watch what you eat and drink because your kidneys cannot remove waste products as well as they should. A kidney-friendly eating plan can help you stay healthier and slow down damage to your kidneys. This webpage is for people who have Stages 1 to 4 of chronic kidney disease (CKD) and are not on dialysis.
A kidney-friendly eating plan is a way of eating that helps you stay healthy and can slow down damage to your kidneys. It includes foods that are easy on your kidneys and limits other foods and fluids so certain minerals in those foods, like potassium, do not build up to high levels in your body.
Creating a Personalized Plan
Everyone is different and has different nutritional needs. Use this information as a guide. Work with a dietitian to create a kidney-friendly eating plan that is right for you.
Ask your doctor to refer you to a dietitian (someone with special training in food and nutrition to know which foods are right for people with kidney disease). You can talk to a dietitian about the foods you enjoy or any special requirements you have (for example, you are vegetarian or have food allergies) and they will help you create a kidney-friendly eating plan that is right for you and includes the foods you enjoy. Always talk to a dietitian before increasing or decreasing your daily intake of certain foods or nutrients. Medicare and many private insurance plans pay for a certain number of visits with a dietitian each year. Call your insurance company to ask if your plan covers medical nutrition therapy (MNT) with a dietitian. MNT is an approach to treat kidney disease through a tailored nutrition plan. As part of MNT, a dietitian will review your current eating habits, create a healthy eating plan, that includes your preferences, and help you overcome eating challenges.Learn more about working with a dietitian to create and following a kidney-friendly eating plan
Key Nutrients in a Kidney-Friendly Diet
Your kidney-friendly eating plan may change over time but will always give you the right amount of key nutrients.
Protein: One of the nutrients that gives you energy. Your body needs protein to grow, build muscles, heal and stay healthy.
Fat: Fat is another one of the nutrients that gives you energy. Your body needs fat to carry out many jobs, such as using vitamins from your food and keep your body at the right temperature.
Carbohydrates or "carbs": Your body's main source of energy. Your body can more easily convert carbs into energy than protein and fat.
Steps for a Kidney-Friendly Eating Plan
Work with your dietitian to follow the steps below for a kidney-friendly eating plan.
Eat the right amount and the right types of proteinHaving too little protein can cause your skin, hair and nails to be weak. But having too much protein can make your kidneys work harder and cause more damage. This happens because when your body uses protein, it makes waste products that your kidneys must filter. To stay healthy and help you feel your best, you may need to adjust how much protein you eat.
The amount of protein you should eat depends on your body size, activity level and health. Your doctor and dietitian may have you limit protein or change the type of protein you eat. For example, you may need to eat more lean proteins, which are foods that are high in protein and low in fat, such as whole eggs and skinless chicken and turkey. Ask your doctor and dietitian how much protein you should eat and what the best types of protein are for you.
Choose the right types of fatFat gives you energy and helps you use some of the vitamins in your food. You need some fat in your eating plan to stay healthy. Too much fat can lead to weight gain and heart disease. Limit fat in your meal plan, and choose healthier fats when you can, such as olive oil.
Choosing the right types of fat is also part of a heart-healthy eating plan called DASH. Choose whole grain carbohydratesEating too many carbs can lead to weight gain. When you have kidney disease, it is best to choose whole grains and healthy carbs such as fruits and vegetables. Unhealthy carbs include sugar, honey, hard candies, soft drinks and other sugary drinks.
If you have diabetes, you may also need to carefully track how many carbs you take in. Your dietitian can help you learn more about the carbs in your eating plan and how they affect your blood sugar.
The ketogenic diet or "keto diet" is a type of low-carb diet that focuses on eating very low carbs, high fats and moderate protein amounts, so your body uses stored fat for energy instead of carbs. This diet may not be a healthy option for you because it limits your options, and you may miss out on some key nutrients. If you have questions about a specific diet, ask your dietitian.
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