The diet for patients with end-stage kidney disease who are on dialysis is usually high in protein and low in sodium, potassium, and phosphorus. Fluid intake is also restricted.

The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients who are on dialysis. The special diet is important because dialysis alone does not effectively remove ALL waste products. These waste products can also build up between dialysis treatments.

Most dialysis patients urinate very little or not at all, and therefore fluid restriction between treatments is very important. Without urination, fluid will build up in the body and cause excess fluid in the heart, lungs, and ankles.

Patients on dialysis need to get enough protein and adequate nutrition because they can become malnourished.

This diet will help dialysis patients feel as good as possible.

The dialysis diet controls the intake of fluid, protein, sodium, potassium, and phosphorus. The amounts of these nutrients in the diet are based on your blood levels of sodium, potassium, phosphorus, calcium, albumin, and urea. These levels are measured before and immediately after a dialysis treatment.

Fluid restriction is based on the amount of urine output and weight gain between dialysis treatments.

The following are some general dietary recommendations for dialysis patients.

PROTEIN

Before dialysis, you may be asked to limit protein to slow the progression of kidney disease. At the start of dialysis, you will need much more protein. Patients on peritoneal dialysis need even more protein, because a large amount of protein can be lost in the peritoneal fluid that is discarded.

However, dialysis patients still need to limit salt, potassium, and phosphorous, which makes it a little challenging to get enough protein. Also many dialysis patients have a poor appetite, especially after they just start dialysis.

Every dialysis center has a dietitian who can explain dietary modifications, suggest foods, and prescribe supplements if you need them.

SODIUM

Most patients need to control the sodium (salt) content in their diet. This helps maintain fluid balance in the body to avoid fluid retention and high blood pressure.

POTASSIUM

The daily intake of potassium is also controlled. This helps prevent high potassium levels in the blood (hyperkalemia), a common problem for people on dialysis.

PHOSPHORUS

The mineral phosphorus is also controlled in this diet. Phosphorus is not effectively removed by dialysis treatments, so you need to reduce your intake of dairy products and other foods high in phosphorus.

Your health care provider may prescribe calcium supplements, which bind to phosphorus in food. It is important to take calcium tablets with meals. Or, you may be given a non-calcium phosphorus binder, such as Renagel. How much of the binders you need to take is determined by your blood levels of phosphorus and how many phosphorus-containing foods you eat.

FLUIDS

During kidney failure, the amount of urine produced drops. The urine output usually stops completely once patients have been on dialysis for more than 6 months. Patients on peritoneal dialysis usually continue releasing urine for a longer time and have less restricted fluid intake.

The recommended daily amount of fluid is based on the amount of urine produced in a 24-hour period and the amount of weight gained between dialysis treatments. Other considerations are:

• Amount of fluid retention
• Level of dietary sodium
• Whether you have congestive heart failure

Patients on peritoneal dialysis usually have fewer restrictions on fluid, sodium, and potassium intake because they have dialysis treatments every day. The intake of these substances needs to be individualized in these patients.

OTHER FACTORS

People with kidney disease are more prone to heart disease and often need to follow a low-fat diet. The daily calorie intake needs to maintain proper nutrition and prevent the breakdown of body tissue. Your health care provider should regularly monitor your weight and protein status.

Many patients need to take vitamin supplements. Diet alone can usually meet the requirements for the fat-soluble vitamins (A, D, E, and K). Vitamin D may be supplemented, depending on your calcium, phosphorus, and parathyroid hormone levels. Vitamin D is usually given through a vein during the dialysis treatment.

The intake of water-soluble vitamins is often not enough, because this diet restricts several good food sources of water-soluble vitamins. Water-soluble vitamins are also lost during dialysis treatments. All dialysis patients should receive water-soluble vitamin supplements.

The health care provider will monitor your calcium and iron levels. Whether you get a daily calcium supplement depends on your blood calcium levels. Calcium is also given in the dialysis solution and is adjusted according to the blood calcium levels. Iron supplementation is based on iron studies, which are usually monitored every 3 months. Most dialysis patients do not get enough iron, and must receive iron through a vein during dialysis treatments.

SUPPORT

The Kidney Foundation has chapters in most states. It is an excellent resource for people who are on dialysis, as well as their families.

Tolkoff-Rubin N. Treatment of irreversible renal failure. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 133.

Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 131.