Diet and Nutrition on Hemodialysis

Eating the right foods while on hemodialysis is essential for maintaining strength, preventing complications, and improving overall well-being. Since dialysis helps remove waste and extra fluids but does not fully replace kidney function, managing your diet carefully is crucial.

1. Protein: Essential for Strength and Healing

Protein helps build and repair tissues, maintain muscle mass, and prevent infections. Since some protein is lost during dialysis, you need to consume adequate amounts.

• Best Protein Choices (High-quality, low-phosphorus):

• • Lean meats: Skinless chicken, turkey, lean beef, pork
  • Fish: Salmon, tilapia, cod, tuna
  • Eggs and egg whites
  • Dairy alternatives: Rice milk, almond milk (low-phosphorus brands)
  • Plant-based: Tofu, lentils (in moderation), quinoa

• Protein to Avoid (High in phosphorus and sodium):

• • Processed meats: Bacon, sausage, hot dogs, ham
  • Fast food burgers and fried chicken
  • Deli meats

Portion Size: 8-10 ounces per day (roughly two palm-sized portions), depending on individual dialysis needs.

Protein Tip: If phosphorus levels are high, limit dairy-based protein and opt for non-dairy alternatives.

2. Carbohydrates: Energy for Your Body

Carbohydrates provide the main source of energy. They should be chosen wisely to prevent excessive weight gain and high blood sugar levels (especially for diabetic patients).

• Best Carb Choices (Low potassium, moderate phosphorus):

• • White rice, pasta, and white bread (whole grains in moderation)
  • Corn, apples, pears, grapes, berries
  • Non-starchy vegetables: Cabbage, cucumbers, bell peppers, lettuce
  • Starchy vegetables (limit due to potassium): Sweet potatoes, pumpkin, butternut squash

• Carbs to Avoid:

• • High potassium fruits: Bananas, oranges, kiwis, cantaloupe
  • Sugary snacks: Candy, soda, pastries
  • High-phosphorus grains: Bran cereals, oatmeal (unless phosphorus is controlled)

Portion Size: Carbs should make up 50-60% of daily calories.

Carb Tip: If you have diabetes, spread your carb intake evenly throughout the day to prevent blood sugar spikes.

3. Vitamins: Supporting Overall Health

Dialysis removes water-soluble vitamins, so supplementation may be needed.

• Essential Vitamins for Dialysis Patients:
  • Vitamin B complex (for energy and metabolism) – Found in eggs, fish, whole grains
  • Vitamin C (for immune function) – Found in bell peppers, cabbage
  • Vitamin D (for bone health) – Often supplemented
  • Iron (to prevent anemia) – Found in red meat, fortified cereals
  • Folate (for red blood cell production) – Found in leafy greens, beans

Vitamin Tip: Avoid over-the-counter multivitamins without consulting your doctor, as some contain excessive phosphorus or potassium.

4. Ideal Portion Sizes & Caloric Requirements

Each dialysis patient has different calorie needs based on their weight, activity level, and medical conditions.

How to Calculate Caloric Needs:

1. Determine body weight (kg)
2. Multiply by 30-35 kcal/kg per day for most dialysis patients

Example Calculation:

• A 70 kg (154 lbs) patient would need:
  • 70 kg × 30 kcal = 2,100 kcal/day (low activity)
  • 70 kg × 35 kcal = 2,450 kcal/day (more active)

Caloric Breakdown:

• Protein: 15-20% of total calories
• Carbohydrates: 50-60% of total calories
• Fats: 20-30% (focus on healthy fats like olive oil and nuts in moderation)

Caloric Tip: Patients who have diabetes or are underweight may need a modified plan. Work with a dietitian for personalized recommendations.

5. Salt & Fluid Intake: Keeping Balance

• Sodium (Salt): Excess sodium causes fluid retention, high blood pressure, and swelling.

• • Best Choices: Fresh, homemade meals with herbs and spices instead of salt
  • Avoid: Canned foods, processed meats, fast food, frozen meals, chips

• Fluids: Since dialysis patients cannot urinate as much, fluid must be restricted to prevent swelling and high blood pressure.

• • Limit: 32-48 ounces (1-1.5 liters) per day, depending on urine output and dialysis frequency
  • Monitor: Symptoms of excess fluid like swelling, difficulty breathing, and weight gain

Fluid Tip: Manage thirst with ice chips, frozen grapes, or sugar-free gum.

6. Potassium: Maintaining Heart Health

(For full details, visit the Potassium Management section on our website.)

High potassium levels can cause dangerous heart problems, so monitoring intake is crucial.

• Foods High in Potassium (Limit or Avoid):

• • Bananas, oranges, melons
  • Potatoes, tomatoes, spinach
  • Dairy products, chocolate

• Low Potassium Alternatives:

• • Apples, grapes, berries
  • Cabbage, carrots, green beans
  • White rice, pasta, white bread

Potassium Tip: Leach high-potassium vegetables (like potatoes) by soaking them in water before cooking.

7. Phosphorus: Protecting Your Bones

Too much phosphorus weakens bones and increases the risk of heart disease.

• Avoid:

• • Dairy (milk, cheese, yogurt)
  • Dark sodas, processed foods, nuts, seeds
  • Whole wheat products (check with your dietitian)

• Best Choices:

• • Rice milk (phosphorus-free), non-dairy creamers
  • Fresh meats, egg whites, fruits, and vegetables

Phosphorus Tip: Many processed foods contain hidden phosphorus additives. Check labels for ingredients like “phos-.”

8. Special Considerations for Diabetic Dialysis Patients

If you have diabetes, balancing your blood sugar while following a dialysis diet is important.

• Best Foods:
  • Lean proteins, non-starchy vegetables, whole grains in moderation
  • Healthy fats (olive oil, avocado)
• Avoid:
  • Sugary drinks, refined carbs (white bread, pastries)
  • High potassium fruits (bananas, oranges)

Diabetes Tip: Monitor blood sugar levels closely and adjust carbohydrate intake accordingly.

Final Thoughts

A well-balanced diet on hemodialysis helps you feel better, maintain energy, and prevent complications. Work with your healthcare team to create a meal plan tailored to your needs.

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