What to Eat (and Avoid) When You’re on Dialysis
Small but mighty, your kidneys are key players in keeping your body humming by filtering wastes and water from your blood. If you have late-stage kidney disease or kidney failure, you already know that, since you’ve lost 85% to 90% of kidney function and are looking at a high-tech dialysis machine to do the job instead.
Following a special diet can help you feel better and make your dialysis treatments more effective. “Diet is truly a life-changing and life-saving element to healthcare for dialysis patients,” says Kristen F. Gradney, R.D., a renal dietician and spokesperson for the Academy of Nutrition and Dietetics. Learn more about what to eat—or skip—when you’re on dialysis.
Say Goodbye to Salt
The problem: “Kidney disease impairs your body’s ability to metabolize and clear micronutrients such as sodium,” says Elizabeth A. Avery, R.D., of Avery Nutrition in Boston who helps patients with chronic kidney disease design healthy eating plans. Skipping high-salt foods can also help you feel less thirsty and ward off fluid retention between treatments. To cut back on sodium, leave the shaker alone and check food labels for sodium—avoid foods with more than 600 milligrams of sodium in an entrée serving or 200 milligrams in a snack or side dishes. Dark sodas which are high in phosphorous, salt, and sugar along with “diet” sodas, have been associated with the worsening of chronic kidney disease.
Get to Know Your Spices
Keep the flavor while lowering the salt content by relying on home-cooked meals over takeout. More than 70% of the sodium we eat comes from processed, prepackaged, and restaurant foods, according to the American Heart Association. At home, replace the salt in your recipes with dried herbs and seasonings such as dill, garlic powder, chili pepper, and oregano. Want even more zing? Flavored vinegars can pack a punch, as can sodium- and potassium-free seasoning mixes.
Skip the Banana
It seems odd to find this nutritional powerhouse on the no-go list, but it’s high in potassium, and when you have kidney failure, that’s not good. In people with healthy kidneys, moderate amounts of the mineral help regulate your heartbeat and fluid balance. But diseased kidneys can allow potassium to build up, even when you’re on dialysis. “Elevated potassium may manifest as heart palpitations, tingling in the extremities, weakness, nausea, heart arrhythmias, and even a heart attack,” Avery says. Limit high-potassium foods such as apricots, avocadoes, bananas, beets, dried fruit, oranges, potatoes, tomatoes, spinach, and lima, kidney, and pinto beans.
Snack on Blueberries
One door closes, another opens. (Hey, you’ve got to find the silver lining somewhere!) While cutting back on high-potassium meals, go ahead and indulge in foods that are low in the mineral but high in other nutrients. Mainly, that’s produce, which you should eat plenty of to help maintain your overall health. Fill your plate with low-potassium apples (full of vitamin C), berries (blueberries, raspberries, and strawberries are great sources of antioxidants) cabbage (high in vitamins A and K), cauliflower, cucumber, eggplant (shown to help lower LDL cholesterol and triglyceride levels), lettuce, pineapple (provides 131% of the RDA for vitamin C), plums, and peppers.
Limit High-Phosphorous Foods
The mineral phosphorus helps maintain bone health and affects how your body uses calcium. A little is good, but a lot spells trouble. “Excessive dietary phosphorus leaches calcium from bones and weakens them,” Avery says. “Elevated phosphorus may result in calcium-like deposits in soft tissues and impede blood flow, which could increase your risk of heart disease.” Healthy kidneys help keep the mineral's levels in check; while dialysis removes some phosphorus from your blood, you can lower your risk of buildup problems between dialysis treatments by avoiding high-phosphorus foods including processed meats, dairy, bran cereals, nuts, dried beans, tea, and cola.
Here’s the good news about phosphorus: Most fruits and vegetables have little or none of this kidney-stressing mineral. Just be sure to choose ones that are also low in potassium (see previous list). Fresh is almost always best when available; if you’re choosing frozen or canned make sure they are packaged without additional sodium. And because everyone could use a little extra help from time to time, your doctor may recommend medications known as phosphorus binders that help remove phosphorus from your body. “Patients often take phosphorus binders that attach to and excrete the phosphorus in any foods,” Gradney says.
Find a Friend in Fish
Your body uses protein for many important processes, such as keeping muscles strong, fighting infection, healing wounds, and manufacturing hormones. When you’re having dialysis, protein plays a big role in helping you maintain your overall health. “Animal sources are best because they provide high-quality protein that your body can more easily and effectively use,” says Gradney. To get the amount and type protein you need, aim for a total of 8-10 ounces of poultry, fish, lean meat, and eggs every day. But limit ham, hotdogs, sausages, and other processed meats that tend to contain significant quantities of sodium and phosphorus.
Limit Plant Proteins
There are a lot of great things about plant-based proteins. But if you’re on dialysis, these foods can put an additional strain on your kidneys due to their high phosphorus and potassium content, raising your risk of problems. This includes plant-based proteins such as nuts and nut butters, seeds, dried beans (such as lima, black, white, and baked beans), peas, and lentils.
Swap Rice Milk for Cow Milk
Because of its high potassium and phosphorus content (you’re detecting a theme by now!), dairy is not helpful when you’re on dialysis. That means milk, cheese, ice cream, and puddings made with milk are off the menu. What to try instead? Swap in unenriched rice milk for cow’s milk and low-sodium vegan cheese for your usual slices of American. Sherbet and popsicles are a handy substitute for ice cream. Look, no one’s going to pretend that an orange ice is anywhere near as satisfying as a bowl of mint chocolate chip, but it’s better than no dessert at all!
Go Light on Fluids
Because your body is no longer able to effectively eliminate water by peeing, it’s super important to limit the amount you drink. Extra fluid in your system can lead to bloating, blood pressure changes, and swelling that might strain your heart or lungs. “Most people on dialysis will have a fluid restriction based on how much urine they make,” Gradney says. “It’s usually extremely low, around one liter.” Ask your doc about the best beverages (skip high-phosphorus drinks like cocoa, milk, cola, and beer). Apple juice, lemon-lime soda, lemonade from a powdered mix, and good old water are solid picks.
Dialysis and nutrition: National Institute of Diabetes and Digestive and Kidney Diseases. (n/d) “Eating & Nutrition for Hemodialysis.” niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis/eating-nutrition
Chronic kidney disease and nutrition: National Institute of Diabetes and Digestive and Kidney Diseases. (n/d) “Nutrition for Advanced Chronic Kidney Disease in Adults.” niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition/nutrition-advanced-chronic-kidney-disease-adults
Dialysis and nutrition: National Kidney Foundation. (n/d) “Dietary Guidelines for Adults Starting on Hemodialysis.” kidney.org/atoz/content/dietary_hemodialysis
Chronic kidney disease and nutrition: National Institute of Diabetes and Digestive and Kidney Diseases. “Eating Right for Chronic Kidney Disease.” niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition#potassium
Salt in food: American Heart Association. (n/d) “Sodium Sources: Where Does All That Sodium Come From?” heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sodium-sources
Milligrams of sodium limit: National Kidney Foundation. (n/d) “Sodium and Your CKD Diet: How to Spice Up Your Cooking.” kidney.org/atoz/content/sodiumckd