Transitioning to end stage renal disease and dialysis can be daunting and overwhelming. Starting dialysis is a big life change, and changing your diet is a major part of it all. Your kidneys may not be able to filter out certain nutrients on their own at this point, so changing your diet may help maintain your overall health and ease some stress on your kidneys. However there’s no need to fear!
Every dialysis center has a registered dietitian on staff who is there to help you navigate the new changes and to help tailor your diet to your monthly lab values. You will not be on your own as you start this journey in terms of what to eat. If you start dialysis and haven’t met your dietitian within the first few weeks, be sure to seek them out. In the meantime, below are some of the key diet changes you will need to keep in mind when you first begin dialysis:
Protein
You may have been told to restrict your protein to help preserve kidney function prior to starting dialysis, however now that you are on dialysis it is extremely important to eat as much protein as possible. Dialysis actively pulls protein out of your blood, and it’s important to eat enough high-quality protein to replace what is lost, and to help support all of your bodily functions and maintain muscle. High quality protein includes animal proteins, such as chicken, turkey, eggs, pork, beef, and fish.
Try to incorporate animal protein with every meal, if possible.
If you are a vegetarian or vegan, you can get your protein from plant sources such as beans/legumes, nuts, lentils, and soy.
It is very common to need to take protein supplements to help increase your protein levels in your blood, like Prostat, Liquicel, Nepro, or protein bars. Your dietitian will let you know if these are available to you at your dialysis center and if you need them.
Salt
Consuming a low sodium diet will help keep your blood pressure in check, and will also help prevent excess swelling.
Check your food labels, and try to select foods that have less than 200 mg of sodium per serving.
Avoid adding salt while you’re cooking or at the dinner table.
You can boost the flavor of your food by adding lemon juice, vinegars, and salt free spices and herbs like garlic powder, onion powder, paprika, chili powder, curry powder, thyme, rosemary, etc.
Be careful with seasoning blends that contain salt, like adobo.
Foods that are high in sodium that should be limited as much as possible include cold cuts; processed meats like hot dogs and jerkies; canned soups and entrees; canned beans; aged or processed cheeses; bottled salad dressings; some bread products like tortillas, wraps, and bagels; pre-flavored rices; and pickles/pickled vegetables.
When dining out, ask the waiter for “no added salt,” and avoid dishes with heavy sauces and cheeses.
Potassium
Potassium is an electrolyte that is filtered by your kidneys. When your kidneys aren’t working properly, potassium can build up in your blood and lead to dangerous conditions like an irregular heartbeat or a heart attack. Your potassium will be closely monitored while on dialysis. Potassium is found in a lot of healthy foods, fruits and vegetables, but monitoring your portion sizes of foods that contain potassium and avoiding foods that are the highest in potassium will go a long way until your first lab report.
Foods high in potassium include bananas, tomatoes, avocados, and potatoes.
Avoid at first dark leafy greens, pumpkin, butternut squash, cooked broccoli, tomato sauces, dried fruits, mango, papaya, oranges, and coconut/coconut water.
Ask your dietitian if there are ways you can enjoy some of these foods above.
Example: Double boiling potatoes prior to eating them can actually lower the potassium content.
Lower potassium fruits and vegetables that may be safe to eat include berries, carrots, cucumbers, eggplant, zucchini, lighter green lettuce, peppers, mushrooms, onions, peas, apples, grapes, pears, and plums.
Phosphorus
Like potassium, phosphorus can also build up between dialysis sessions, and if high for a long time, can lead to hardening in the arteries and organs and weakening of the bones. The main source of phosphorus in our diet is typically grains, dairy, meats, and preservative additives.
Dark sodas, like Coca Cola, and chocolate are also high in phosphorus. Grains, dairy, and meats are important parts of the diet as they provide protein, fiber, vitamins and minerals, and should not be completely cut out.
To lower phosphorus intake:
Stick to 1 serving of dairy per day (milk, yogurt, or low sodium cheese).
Phosphorus in grains is typically not well absorbed by the body, however phosphorus from additives and preservatives are.
Be vigilant with your food labels, and scan the ingredients list in your foods for any ingredients that contain the word “PHOS” (for instance “phosphoric acid,” “sodium polyphosphate,” and “trisodium phosphate,” to name a few). These are often found in powdered drinks, sodas, and processed foods. If you are prescribed phosphate binders, be sure to take them with every meal and snack to help lower your phosphorus levels.
Fluid
Fluid can often build up in your body between dialysis sessions since your kidneys are not removing excess fluid on their own, and can lead to swelling, elevated blood pressure, and shortness of breath. Dialysis can definitely help with fluid build up, but there is a limit to how much can be safely removed without causing cramping and electrolyte imbalances, so adhering to a fluid restriction is important if your nephrologist prescribed one to you.
Fluid isn’t consumed exclusively through beverages, it can also be consumed through food, so be careful with very high fluid foods like soups, jello, gravies, and ice cream.
Try to minimize foods that may cause thirst, like salty and spicy foods.
If you’re thirsty, try chewing on ice first to keep your fluid intake low.
Again, starting dialysis may be stressful, but navigating your diet changes doesn’t have to be. Befriend your dialysis dietitian and be sure to review your monthly lab values so you can see if you can liberalize your diet in any way. Your dietitian can also give you good snack and meal ideas, diet education and resources, label reading tips, and answer any other questions you may have. You got this!
Resources
Dietary Guidelines for Adults Starting on Hemodialysis. National Kidney Foundation.
Eating Well on a Dialysis Diet. Fresenius Kidney Care.
Sodium-Controlled Diet. Cleveland Clinic.
Potassium and Your CKD Diet. National Kidney Foundation.
Phosphorus and Your Diet. National Kidney Foundation.
Fluid Control for Kidney Disease Patients on Dialysis. Davita Kidney Care.
