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When kidneys do not work well, waste and fluid can build up in your blood, making you feel sick. Hemodialysis (HD) can clear some waste and fluid. Eating right can reduce waste in your blood, which makes you feel better and keeps you healthier. When on dialysis you need to monitor protein, sodium, phosphorus, potassium, and fluid intake.
Protein
You need protein to build and repair muscle. Protein also helps you fight off infections. Eating enough protein can help you live longer on HD. You need to eat more protein because you lose some protein during the dialysis process.
How much protein can I eat?
On dialysis, you need 7-10 ounces of good protein sources daily. These count as one ounce of protein:
1 ounce beef, chicken, lamb, pork, fish
¼ cup salmon, tuna, crab, lobster, clams
¼ cup cottage cheese
1 ounce or 5 medium shrimp
1 egg
¼ cup egg substitute
4 ounces tofu
*2 tablespoons peanut butter
*½ cup cooked beans, peas, or lentils
*1 ounce natural cheese (Swiss, Cheddar, etc)
*Choices higher in phosphorus and/or potassium
Milk is a protein source, but you should limit it to less than 1 cup or 8 ounces daily. It is high in potassium and phosphorus. Each choice has 8 grams of protein. Each of these is equal to one choice:
1 cup milk
1 cup yogurt
½ cup Greek yogurt
¾ cup custard
1 cup (milk based) soup
½ cup ice cream
1 cup milk-based pudding
Sodium
Eating too much sodium (salt) can make you thirsty. The more fluid you drink, the more your heart works to pump the fluid through your body. Over time, this can cause heart failure. Limit sodium to less than 2000 mg per day. To limit sodium, avoid using highly processed foods, canned goods, and salty seasonings. Restaurant food is very salty. To limit salt, prepare more foods from fresh ingredients at home.
High Sodium Foods
Salted or smoked meat/fish (bacon, brats, hot dogs, corned beef, smoked fish, sardines, ham, lunchmeat, smoked sausage)
Breads and rolls with salt toppings
Cheeses (especially processed cheese such as Velveeta® or American®)
Store-bought, ready-made and processed foods (frozen dinners, soup, pot pies, packaged entrees or noodle mixes, gravy, sauce mixes, pickles, olives, relish, salty snacks like chips, canned tomato products like spaghetti sauce)
Be careful with seasonings! Stay away from items with sodium such as MSG, salts like garlic salt, sauces like BBQ, chili, soy, Worcestershire.
Avoid
Don’t use salt substitutes that have large amounts of potassium such as:
Morton’s Salt Substitute®
No Salt®
Diamond Crystal®
Morton’s Lite Salt®
Choose
Herbs like garlic, parsley, pepper, or oregano
Lemon juice
Pleasoning® Mini Mini Salt
Herbal Bouquet®
Lawry’s Seasoned Pepper®
Mrs. Dash® (all types)
Spike® salt-free
Tabasco® sauce
Veg-it®
Fluid
Most people on dialysis need to limit their fluid intake to 1-1.5 liters per day, which is the same as 4-6 cups, or 32-48 ounces. This is usually based on urine output.
If you drink too much fluid between hemodialysis sessions, you may feel short of breath and your heart will have to work harder. Your blood pressure may be high. You may gain weight or get edema or swelling.
Fluids are anything you drink, or food you eat that becomes liquid at room temperature, such as soup, ice, Jello®, popsicles, yogurt, or ice cream.
Potassium
Potassium is a mineral that can build up in your blood between treatments. It is very important to keep potassium levels under control. Too much or too little potassium in your blood can cause muscle cramps or stop your heart.
See our list of fruits and vegetables that contain low, medium and high amounts of potassium for a single serving. A serving size is 1 cup raw or ½ cup cooked, or one medium-sized fruit.
Low Potassium Group
Choose most of your fruits and vegetables from this group.
Fruit
Apple juice, applesauce, or apple without skin
Blackberries, blueberries, boysenberries, raspberries, or gooseberries
Canned apricots, figs, fruit cocktail, grapes, Mandarin oranges, peaches, pears, pineapple, or plums
Cranberries, cranberry sauce, or cranberry juice
Fresh grapes, lemon, limes, pears, pineapple, raspberries, rhubarb, strawberries, or tangerines
Nectars: peach, pear, or apricot
Vegetables
Bamboo shoots, canned
Beans – green or waxed
Broccoli and cauliflower, fresh or boiled
Cabbage, 1 stalk of celery, or cucumber
Eggplant
Greens (raw or cooked): collards, dandelion, kale, mustard, or turnip
Hominy
Raw spinach
Leeks or onion: green, red, yellow or white
Lettuce, cos, romaine, iceberg, leaf, endive, or watercress
Mushrooms
Peppers: sweet or hot
Double-cooked* potatoes
Squash: summer or spaghetti
Radishes, turnips, and water chestnuts
*See double-cooked potatoes recipe
Medium Potassium Group
Limit these foods to 1-2 servings daily.
Fruit
Apple, with skin
Canned cherries
Fresh apricots, cubed casaba, 15 cherries, 2 figs, ½ of a grapefruit, orange, peach, 2 plums, or cubed watermelon
Juice: grape, grapefruit, or pineapple juice
Vegetables
Asparagus, frozen or cooked
Artichoke heart, boiled
Brussels sprouts
Carrots
Corn, canned or 1 small ear
Garbanzo beans
Greens, frozen, cooked: kale or turnip
Mixed vegetables
Okra, frozen or cooked
Peas, green
Summer squash: yellow, crookneck, or white scallop
High Potassium Group
Limit these foods to 1-2 times a week.
Fruit
½ of an avocado, banana, honeydew, or cantaloupe melon
Dried fruits: apricots, dates, figs, prunes, or raisins
Kiwi fruit
Mango
Nectarine
Prune or orange juice
Tangelo
Vegetables
Artichoke
Beets and beet greens
Dried beans and peas: kidney, lima, navy, pinto, black-eyed peas, or split peas
Kohlrabi
Potato: baked, boiled, fried, not double-cooked
Pumpkin
Rutabaga, cooked
Cooked Spinach
Sweet potato or yams
Tomato, fresh or canned
Unsalted tomato or vegetable juice
Winter squash: acorn, butternut, or hubbard
Double Cooked Potatoes Recipe
Double-cooking potatoes can decrease the potassium content of potatoes by about half. Avoid Yukon gold potatoes as they will still be high in potassium after double-cooking.
Wash and peel the potato.
Slice into thin slices.
Place the sliced potato in room temperature water. Use twice the amount of water to the amount of potato.
Bring to a boil.
Drain the water and add twice the amount of fresh room temperature water to the amount of potato again.
Boil again and cook until soft and tender.
Phosphorus
Phosphorus is another mineral that builds in your blood. This pulls calcium from your bones, causing them to become weak. Calcium and phosphorus can settle in your soft tissues, your blood vessels and your heart, causing damage.
Phosphorus Binders
Because protein foods contain phosphorus and you do need plenty of protein, your doctor may also ask you to take a medicine with meals to bind phosphorus from the food you eat. When the phosphorus is bound with the binder medicine, it will be excreted in the stool. Examples of binder medicines include: Renagel®, Renvela®, Phoslo®, Tums®, Auryxia®, Velphoro®, or Fosrenol®.
High Phosphorus Foods
Dairy products like milk, cheese, yogurt, custard, pudding, ice cream
Some grain products like bran, oats, cornbread, wheat germ, and boxed cake/bread mixes
Chocolate, cocoa, caramel, beer, cola, molasses, pizza
Meat, liver, fish, and eggs
Nuts, peanut butter, beans, lentils, and seeds
Phosphorus Additives
Many processed food items contain phosphorus additives, which binders will not help much with. The more you prepare fresh food at home, the less you will be exposed to these additives. You can find these additives on the ingredients list on the food label.
Always read the ingredients list of packaged foods for “phos” foods, such as:
Phosphoric acid
Hexametaphosphate
Tricalcium phosphate
Phosphorus additives are found in:
Fast food
Bottled drinks and drink mixes (like Coke®, Pepsi®, Dr. Pepper®, Koolaid®, Gatorade® and other sports drinks, and iced teas)
Processed meats (like lunchmeat, breakfast sausage, hot dogs)
Boxed baking items (like cake, cornbread, or cookie mix)
Resources
Websites
Cookbooks
There are many cookbooks for people with kidney failure. These may help add variety to your diet.
Creative Kidney Cooking for the Whole Family by Rebekah Engum, RD. Expert Publishing. 2012.
National Kidney Foundation list of Cookbooks for Kidney Patients:
https://www.kidney.org/atoz/content/list-cookbooks-kidney-patients
Who to Call
If you are a UW Health patient and have more questions, please contact UW Health at one of the phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.
Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital (AFCH) can be reached at: (608) 890-5500.
Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.
If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.
