Nutrition and Kidney Failure (Dialysis)

Find out how to get the nutrients your body needs when you have kidney failure.

Eating healthy is important if you have kidney failure. Good nutrition gives you energy to do your daily tasks, prevent infection, build and keep muscle, and help you stay at a healthy body weight.

Basics of good nutrition

A healthy eating plan gives you the right amount of:

protein
calories
vitamins
minerals

Your dietitian may ask what you eat and may also ask you to keep a diary of everything you eat each day. This will show if you are eating the right amount of protein, calories, vitamins and minerals. Your dietitian can help you plan meals that give you the right amount of these nutrients each day.

Protein

Your body needs protein to help build muscle, repair wounds, and fight infection. Now that you have begun dialysis, your diet may include more protein. You get protein from:

eggs, egg whites
meats (beef, veal, lamb, pork)
poultry (such as chicken and turkey)
fish and other seafood
vegetables and grains

(This food list is not complete.)

Calories

Calories are like fuel—they provide your body with the energy you need to live. They are important because they:

help you stay at a healthy body weight
give you energy to do your daily tasks and stay active
help your body use the protein in food to build muscles.

If you are not getting enough calories from your diet, you may need to eat extra sweets like sugar, jam, jelly, hard candy, honey, or syrup; unless you also have diabetes. Other good sources of calories come from fats such as soft (tub) margarine, and oils like canola or olive oil.

Vitamins and Minerals

Kidney disease and dialysis change the amounts of vitamins and minerals your body needs. Also, your kidney diet may limit some food choices that would normally give you important vitamins and minerals. Instead, you may need to take special vitamin or mineral supplements. Be sure to:

Take only the vitamins and minerals your health care professional recommends, because some vitamins and minerals may be harmful to people with kidney failure.
Avoid herbal supplements.

What to do if you don’t feel hungry

As a person on dialysis, it may be difficult to get enough nutrients from food, especially if you don’t feel hungry. Nutritional supplements can help you get the calories and nutrients you need. Supplements can come in the form of liquid drinks, shakes, juices, bars, soups, cookies, puddings, and more. There are some nutritional supplements made just for people with diabetes and/or kidney failure. Before starting a nutritional supplement ask your dietitian which one is best for you.

Without enough dialysis, you may not eat well. Tests called urea reduction ratio (URR) and Kt/V (pronounced “kay tee over vee”) will measure how much dialysis you are getting. Ask your dialysis team about these tests to see if you are getting enough dialysis.

How to control other nutrients

You may need to control your intake of these nutrients:

sodium
potassium
phosphorus
calcium
fluid

Sodium

Sodium affects blood pressure and water balance in your body. Sodium is found in large amounts in table salt and in foods that have added salt such as:

seasonings like soy sauce, sea salt, teriyaki sauce, garlic salt, or onion salt
most canned foods and frozen dinners (unless they say “low sodium”)
processed meats like ham, bacon, hot dogs, sausage, and deli meats
salted snack foods like chips and crackers
canned or dehydrated soups (like packaged noodle soup)
most restaurant foods, take-out foods, and fast foods

(This food list is not complete.)

Reading food labels can help you choose foods with less sodium. Do NOT use salt substitutes containing potassium unless approved by your healthcare professional.

Potassium

Potassium helps your muscles and heart work properly. Large amounts of potassium are found in:

certain fruits and vegetables (like bananas, oranges, potatoes, tomatoes)
milk and yogurt
dried beans and peas
most salt substitutes

(This food list is not complete.)

Too much or too little potassium in the blood can be dangerous. A simple blood test can check your potassium level. If it is not normal, you may need to:

work with your dietitian to eat less high potassium foods
take a special medicine to help get rid of too much potassium

Phosphorus

Phosphorus is a mineral that is important for bone health. Large amounts of phosphorus are found in:

dairy products, such as milk, cheese, yogurt, ice cream and pudding
nuts and nut butters
dried beans and peas, such as kidney beans, split peas, and lentils
beverages, such as cocoa, beer, and dark cola drinks
bran breads and bran cereals
packaged foods that have phosphate additives, (look for any word in the ingredient list that begins with “PHOS”).

(This food list is not complete.)

A high level of phosphorus in your blood can cause bone disease and heart disease. To keep phosphorus at safe levels in your blood, you may need to limit phosphorus-rich foods. Your healthcare professional may also tell you to take a type of medicine called a phosphate binder with your meals and snacks.

Calcium

Calcium is a mineral that is important for building strong bones. The best way to prevent loss of calcium from your bones is to control your blood phosphorus level.

Since your kidneys can no longer remove calcium from your body, calcium may build up in your blood vessels, heart, joints, muscles, and skin where it doesn’t belong.

To prevent calcium from building up in your body avoid eating calcium-fortified foods. Reading food labels can help you check for “added” nutrients, such as calcium. Also ask your healthcare professional about phosphate binders that do not have calcium.

Your healthcare professional may have you take a special form of vitamin D to help keep calcium levels in balance and to prevent bone disease. Do not take over-the-counter vitamin D or calcium supplements unless recommended by your healthcare professional.

Fluid

Fluid is any food or beverage that turns to liquid at room temperature. Some examples are:

ice
beverages like coffee, tea, sodas, juices, and water
desserts like gelatin, ice cream, sherbet, or popsicles
gravy and soup

(This food list is not complete.)

If you have kidney failure, you may need to limit your fluid intake. You may be drinking too much fluid if you have:

a sudden increase in weight
swelling or puffiness around the eyes, hands, or feet
shortness of breath
a rise in blood pressure

Tell your dialysis care team if you are having any of these problems.

Your dialysis team will let you know if you are gaining too much fluid weight. Ask your dietitian for helpful ways to cut down on the amount of fluid you are drinking

Nutrition tips for peritoneal dialysis

If you are on peritoneal dialysis you may gain unwanted weight over time. This happens because the dialysis fluid you use for exchanges contains a sugar called dextrose.

Solutions that have more dextrose help to remove extra fluid from your blood. However, dextrose has calories, which can lead to unwanted weight gain. And if you have diabetes, the extra sugar from your dialysis solution can cause your blood sugar to rise. To help prevent unwanted weight gain or high blood sugar you should:

Ask your dietitian for help planning meals that will prevent extra weight gain and high blood sugar.
Limit sodium and fluid, this can help stop the need for higher sugar solutions in your dialysis fluid.
Ask your healthcare professional if you need to change your medications to help control blood sugar.
Ask your healthcare professional if you need to change the type of dialysis fluid you use for your exchanges.

How to check nutritional health

Ask which tests your healthcare professional and dietitian will use to check your nutritional health and ask to discuss the results. Some tests are

Subjective Global Assessment
Blood tests

Subjective Global Assessment (SGA)

Subjective Global Assessment is an exam your dietitian may give you to check your body for signs of nutrition problems. Your dietitian asks you questions about your food intake and checks the fat and muscle stores in your body. The dietitian looks at:

changes in your weight
changes in the tissues around your face, arms, hands, shoulders, and legs
food intake
your activity and energy levels
problems that might keep you from eating

Blood Tests

Albumin is a type of protein in your blood. If the level of albumin is too low, it may mean you are not eating enough protein or calories.
nPNA (normalized protein equivalent of nitrogen appearance) estimates how much protein you are eating. It helps your healthcare professional and dietitian check to see if you are eating the right amount of protein.