Nutrition and home dialysis

Eat low foods in sodium (salt)

Eating a lot of sodium (salt) can cause your body to hold on to more fluid. It can also make you thirsty, causing you to drink more fluid. 

Try to eat less than 2,300 milligrams of sodium each day. This is about a quarter teaspoon of salt each day. To lower the amount of sodium you eat, avoid these foods:

• Processed meats such as bacon, sausage, or cold cuts (lunch meats such as sliced ham, turkey, or pepperoni)
• Most canned foods. If you do eat canned foods, rinse the food with water before eating because the liquid has a lot of salt in it.
• Most frozen dinners
• Dehydrated soups such as ramen noodle soup
• Salted snack foods such as chips or crackers
• Most restaurant meals. Ask the waiter if the chef can use less or no salt when you order food.
• Salty seasonings such as soy sauce, teriyaki sauce, garlic salt, or onion salt. Replace salt and salty seasoning with herbs and spices. And avoid salt substitutes with potassium.

Eat foods lower in phosphorus

Dialysis cannot remove all the extra phosphorus from your blood. Too much phosphorus in your blood can cause:

• Weak or brittle bones
• Bone pain
• Organ or heart damage
• Poor blood flow
• Skin infections

To lower the amount of phosphorus you eat, you may need to limit these foods:

• Dairy such as milk, yogurt, cheese, and ice cream.  Ask if milk alternatives such as unfortified almond, oat or soy milk a better choice for you are.
• Nuts and peanut butter
• Beans and peas

Packaged and processed foods often have added phosphorus as preservatives. To tell if foods or drinks have added phosphorus, look at the food label for words containing “phosphate.” Foods that commonly contain phosphorus additives include:

• Non-dairy coffee creamers
• Dark sodas such as Coke or Pepsi
• Foods from fast food restaurants, vending machines and gas stations
• Processed meats such as cold cuts (lunch meats such as sliced ham, turkey, or pepperoni) and cheeses
• Frozen chicken nuggets and pizza

Your doctor may also prescribe these medicines to help lower the amount of phosphorus in your blood:

• A phosphate binder to take with every meal and snack. This lowers the amount of phosphorus your body absorbs from food.
• A specific type of vitamin D to help regulate your phosphorus levels

Eat the right amount of potassium

Potassium helps your muscles and heart work well. However, potassium can build up in your blood between dialysis treatments and become too high. Kidney disease and certain medications can also cause low potassium. Either extreme can be a problem. 

Too much or too little potassium in your blood can cause:

• Tiredness or weakness
• Muscle pains or cramps
• Unusual heart beats

Your doctor will check your potassium levels regularly to make sure you have a healthy amount. Depending on your potassium level, you may need to eat more or less of foods with a lot of potassium, such as:

• Certain fruits and vegetables such as bananas, oranges, potatoes, and tomatoes. Canned fruits (without the liquid) usually have less potassium than fresh fruits.
• Milk and yogurt
• Beans
• Nuts and seeds
• Meats such as beef, chicken, and salmon

Your doctor may also prescribe:

• A potassium supplement if your levels are low
• A potassium binder if your levels are high. This lowers the amount of potassium your body absorbs from food.

Limit the amount of fluid in your body

People on dialysis often urinate (pee) less, so they have more fluid in their body. 

Too much fluid in your body can cause:

• Your eyes, hands, or feet swell or become puffy
• Weight gain
• Shortness of breath
• Strain on your blood vessels, causing high blood pressure, which makes your heart work harder

To limit the amount of fluid in your body:

• Follow your doctor’s guidelines on how much to drink
• Follow your doctor’s guidelines on how much sodium to eat
• Count all foods that melt at room temperature as a fluid, for example ice cream, popsicles, or Jello
• Keep track of how much fluid you use when cooking, for example sauces or broth

Other vitamins and minerals

Dialysis changes your vitamin needs, and your new diet may change what you usually eat. Your doctor or dietitian will let you know if you need more or less of any vitamins or minerals in your diet.

Some vitamins, minerals, and herbal remedies can harm you while you are on dialysis, so:

• Only take supplements that your doctor tells you to take.
• Ask your doctor before you use any herbal remedies.

The special dialysis fluid you will use during your treatments has a sugar called dextrose in it. Dextrose can remove extra fluid from your blood. For many people, this can lead to weight gain. For people with diabetes, this can lead to higher sugar levels.

You may be able to use a dialysis solution with less dextrose, but managing your sodium and fluid intake is important to help control fluid balance. Your healthcare provider can guide you on the best approach for your needs.

If you have high cholesterol

The good news is that following a dialysis-friendly diet may help you lower your blood cholesterol. 

But if you still have high cholesterol, talk with a dietitian about the amount and type of fat and animal foods you eat. These can raise your cholesterol. Your doctor may also prescribe medicine to lower your cholesterol.

If you have diabetes

Recommended changes in your diet and the dextrose you absorb when doing peritoneal dialysis may affect your blood sugar.  Talk with a dietitian to make a meal plan that meets your needs.

If you are vegetarian or vegan

Make sure you eat a variety of plant foods and get enough calories and protein. Talk with a dietitian about which vegetarian or vegan-friendly protein options have a good balance of potassium and phosphorous.

Your dialysis care team will do regular blood tests to check if you are getting enough dialysis and if you have healthy levels of vitamins and minerals such as potassium.

A dietitian may:

• Look at the fat and muscle in your face, hands, arms, shoulders, and legs.
• Ask questions such as how you are following your meal plan, if you’ve lost weight, or are feeling tired or weak.

This can help them know if you are eating enough of the right foods.

• Will I be able to eat a more flexible diet when I am on home dialysis?
• Will I be able to take fewer medicines when I am on home dialysis?
• Can you refer me to a dietitian to help me create a meal plan?
• What are the most important dietary changes I need to make?
• Where can I find kidney-friendly recipes?