Nutrition and Dialysis

Your doctor has told that you will need to start dialysis. This procedure will take over part of the function of the kidney by getting rid of waste products that accumulate in your system, essentially “cleaning” your blood. Dialysis nutrition services are an important part of the comprehensive care you will receive at The Rogosin Institute. The diet that you will need to follow will depend on the method or “modality” of dialysis that you and your doctor decide is best for you. When you start dialysis you will meet with a dietitian to discuss your diet and learn which foods are acceptable and which foods you must limit or avoid. Your dietitian will monitor your progress every month by evaluating your monthly blood tests. By looking at your monthly blood reports you and your dietitian and other members of your health care team can determine whether the diet and medications are doing the best job for maintaining your health. Sometimes the diet and meds need to be fine-tuned to keep you feeling your best.

Dietitians expert in dialysis nutrition services provide counseling for all patients at The Rogosin Kidney Center.

Nutrition and Hemodialysis

Most patients on hemodialysis receive treatment 3 times per week. On “off” days, when you are not receiving treatment, the excess potassium, phosphorus and fluid will accumulate, so it is important to limit these in your diet. You will receive detailed lists of the types and amounts of food you can eat.

Protein
If you have been restricting your protein intake prior to starting dialysis, you will be happy to find out that that you will be encouraged to increase the amount of protein in your diet, usually 8 ounces per day or more. The best sources of protein are meat, poultry, fish and eggs or egg-whites.

Potassium
You will need to avoid foods that are highest in potassium. These include bananas, potatoes, tropical fruits such as mango and papaya, raisins and other dried fruit, nuts, chocolate, spinach and limit tomato products such as tomato sauce, paste or soup.

Phosphorus
The main source of phosphorus is dairy products such as milk, cheese, yogurt and ice cream. You will be able to use a small amount of milk in cereal or coffee. Nuts, peanut butter, cola sodas and some other foods will be restricted. Your doctor may also prescribe a medication called a phosphate binder to help your body get rid of excess phosphorus in food. Controlling phosphorus is very important because an excess of phosphorus in your blood over time can cause weakening of your bones and other medical complications such as mineral deposits in your tissues and blood vessels.

Fluid
Because you don’t dialyze every day, and your kidneys don’t excrete fluid normally, your body cannot get rid of fluid on off days causing fluid to accumulate in your body. This can cause high blood pressure, difficulty breathing, and other problems. Most patients on hemodialysis must limit all fluid to about 1 quart per day. Your doctor will determine how much fluid you can take daily.

Sodium
You will most likely need to restrict sodium. Excess sodium in your diet can be harmful because it causes your body to retain fluid and raise blood pressure. Eating foods high in sodium can make you thirstier, causing you to drink too much fluid. By avoiding the salt shaker as well as canned or processed foods you can limit your sodium intake. Herbs and spices can make your food tasty without adding sodium.

Nutrition and Peritoneal Dialysis

If you are doing peritoneal dialysis you are dialyzing daily, which closely mimics what your healthy kidney had been doing. Therefore the diet for this modality is less strict than the diet for hemodialysis.

Protein
Daily dialysis via this method causes the body to lose protein on a daily basis, so you will need to replace it by eating a high protein diet, usually 10 ounces per day or more, mainly from meat, poultry, fish, eggs or egg-whites. If you have difficulty taking in this amount of protein your dietitian may recommend a protein supplement, either in powder or drink form to provide extra protein.

Potassium
This mineral is usually not restricted because dialyzing every day efficiently gets rid of potassium. Occasionally too much potassium is excreted and your dietitian may recommend eating some high potassium foods such as banana or potato.

Phosphorus
Since phosphorus is difficult to dialyze, even with peritoneal dialysis, you will probably have to restrict dairy products- milk, cheese, yogurt and ice cream, beans, nuts and cola sodas.

Fluid
Since you are dialyzing daily the fluid requirement is less strict than with hemodialysis. Usually 1 ½ to 2 quarts per day is the limit.

Sodium
You may or may not have to restrict sodium, depending on whether your blood pressure is well- controlled. Your dietitian will discuss this with you.

Nutrition and Nocturnal Hemodialysis

This is a special program available at Rogosin, in which patients perform hemodialysis on a daily basis at home. Most patients on this program do not need to restrict their diet and fluid intake. Your diet will be determined based on your individual needs.

For more information on dialysis nutrition services at The Rogosin Institute contact:
Diane Lieberman, R.D. Ph.D.
212-746-1577