On hemodialysis, diet is crucial. You’ll need to limit fluids and adjust your intake of certain foods. Your dietitian will guide you in balancing protein, calories, and nutrients.

Now that you are beginning hemodialysis, there may be many changes in your daily life. Your doctor has probably told you that you may need to make some changes in your diet. The renal dietitian at your dialysis center will help you plan a diet for your special needs.

Why do I need to be on a special diet?

Because your kidneys are not able to get rid of enough waste products and fluids from your blood and your body now has special needs, you will need to limit fluids and change your intake of certain foods in your diet. How well you feel will depend on:

• eating the right kind and amounts of food from your diet
• having the hemodialysis treatments your doctor orders for you
• taking the medications your doctor orders for you.

Your diet is very important to your care. It is important that you have the right amount of protein, calories, fluids, vitamins and minerals each day. Your dietitian will help you plan your meals to make sure you get the proper balance.

How will I know if I am eating right to keep me healthy?

Because you are on dialysis, you have some very special needs. Eating well helps you stay healthy. Eating poorly can increase your risk of illness. Your dietitian will talk with you about how well you are eating.

Some questions you might be asked:

• Have you noticed a change in the kind or amount of food you eat each day?
• Have you had any problems eating your usual or recommended diet?
• Have you lost weight without trying?
• Have you noticed any changes in your strength or ability to take care of yourself?

Your dietitian or nurse might look at the fat and muscle stores in your face, hands, arms, shoulders, and legs. Your dialysis care team will look for changes in your blood level of proteins, and especially one called albumin. A change in this protein can mean that you are losing body protein.

Some special blood tests that are done each month are called Kt/V (pronounced kay tee over vee) or urea reduction ratio (URR). These tests help your doctor decide if you are getting enough dialysis. Getting the right amount of dialysis is important to help you feel your best.

A change in your fat and muscle stores or any of these blood tests could be a sign that you are not getting enough dialysis. Along with the Kt/V, these tests provide information about your intake of protein or your protein equivalent of nitrogen appearance (PNA). Using the PNA, your albumin and any changes in your appetite, your dietitian will determine if you are eating enough of the right foods. The right amount of dialysis is needed to make sure you are able to enjoy your food while keeping you healthy.

What if I have high cholesterol

Changing your diet may help lower the cholesterol level in your blood. Your dietitian will talk with you about the kinds of fat and animal foods you eat. Also, your doctor may decide you need a special medication to reduce the cholesterol in your blood.

What if I have diabetes

In some cases, you may need to make only a few changes in your diet to fit your needs as a kidney patient. For example, some of the free foods you have been using may need to be limited on your kidney diet. Your dietitian will help develop a meal plan especially for you.

Is there anything else I should know

The following important tips can be helpful with your diet:

• To help you avoid salt, many herbs and spices can be used to make your diet more interesting. Check with your dietitian for a list of these.
• Fresh or plain frozen vegetables contain no added salt. Drain all the cooking fluid before serving.
• Canned fruits usually contain less potassium than fresh fruits. Drain all the fluid before serving.
• Non-dairy creamers often have dipotassium phosphate, which is 100% absorbed. There are many milk alternatives on the market now which are much healthier and don’t contain phosphate additives.
• Labels on food packages will give you information about some of the ingredients that may not be allowed in your diet. Learn to read these labels.

As a patient beginning peritoneal dialysis treatments, you are adjusting to many changes in your daily life. Your healthcare professional has probably told you that some changes in your diet will be necessary.

Why will you have to follow a special diet?

Because your kidneys are not able to get rid of enough waste products and fluids from your body.

It is important that you have the right amounts of protein, calories, vitamins and minerals in your diet. Your dietitian will help you plan your meals to make sure that you get the proper balance. Here are some general guidelines:

Protein

Your body needs protein for growth, building muscles and repairing tissue. After your body uses the protein in the foods you eat, a waste product called urea is left. Since your kidneys are not able to get rid of this urea, you may have too much in your blood. Dialysis and your diet are important to keep the urea level down.

Along with the clearing of urea, your body loses proteins that normally stay in your blood. You will need to eat more protein to replace what is lost. The type of protein you eat is also very important. You should eat high quality protein at each meal. It comes from animal sources such as eggs, fish, chicken and meat. Low quality protein needs to be limited in your diet. It comes from plant sources such as vegetables and grains.

Calories

Calories give your body energy. One source of calories is the food you eat. Another source is the sugar in dialysate solution that can affect you because:

• It takes extra fluid out of the body.
• It is taken in by your body.
• It can cause unwanted weight gain.

Potassium

Potassium is a mineral found naturally in foods that is dangerous to your heart when you have too much or too little. There is a lot of potassium in dried fruits, dried beans and peas, nuts, meat, milk, fruits and vegetables and also in salt substitutes. Since both high and low levels of potassium in your body are dangerous to your heart, your potassium level will be watched closely by your healthcare team.

Fluid and Sodium

Sodium is a mineral that is found naturally in foods and can affect your blood pressure. It is found in large amounts in fast foods, table salt, canned foods, and processed meats (cold cuts, hot dogs, sausage, bacon).

With peritoneal dialysis, you may be able to follow your usual diet. Watching your sodium can help to control your thirst and your weight gain. It may also lower your use of high-sugar solutions. Your doctor will choose the right dialysate for you to control your blood pressure and fluid level.

Phosphorus

Phosphorus is a mineral present in all foods. It is found in large amounts in milk, cheese, nuts, dried beans and peas.

Eating foods high in phosphorus will raise the phosphorus in your blood and this can cause calcium to be pulled from your bones. This will make your bones weak and cause them to break easily. To help control the phosphorus in your blood, you may need to take medicine called a “phosphate binder”. It should be taken with your meals and snacks as ordered by your healthcare professional. Your kidney dietitian can also tell you about protein foods that are lower in phosphorus.

Vitamins and Minerals

The dialysis treatment washes some water-soluble vitamins out of your body. If you are not getting all the vitamins and minerals you need from the foods you eat, vitamin and mineral supplements may be recommended. It is important to take only what is ordered for you. Certain vitamins and minerals can be harmful to people on dialysis..