Eat Right to Feel Right on Hemodialysis
On this page:
How to Use This Publication
When you start hemodialysis, you must make many changes in your life. Watching the foods you eat will make you healthier. This publication will help you choose the right foods.
Print this publication and use it with a dietitian to help you learn how to eat right to feel right on hemodialysis. Read one section at a time. Then go through the exercise with your dietitian.
Once you have completed every exercise, keep a copy of this publication
to remind yourself of foods you can eat and foods you need to avoid.
My dietitian's name is _____________________________
Phone ___________________
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How does food affect my hemodialysis?
Food gives you energy and helps your body repair itself. Food is broken down in your stomach and intestines. Your blood picks up nutrients from the digested food and carries them to all your body cells. These cells take nutrients from your blood and put waste products back into the bloodstream. When your kidneys were healthy, they worked around the clock to remove wastes from your blood. The wastes left your body when you urinated. Other wastes are removed in bowel movements.
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Talk to a dietitian to learn how to eat right on hemodialysis. |
Now your kidneys have stopped working. Hemodialysis removes wastes from your blood. But between sessions, wastes can build up in your blood and make you sick. You can reduce the amount of wastes by watching what you eat and drink. A good meal plan can improve your dialysis and your health.
Your clinic has a dietitian to help you plan meals.
A dietitian specializes in food and nutrition. A dietitian with special training in care for kidney health is called a renal dietitian.
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What do I need to know about fluids?
You already know you need to watch how much you drink. Any food that
is liquid at room temperature also contains water. These foods include
soup, Jell-O, and ice cream. Many fruits and vegetables contain lots of
water, too. They include melons, grapes, apples, oranges, tomatoes, lettuce,
and celery. All these foods add to your fluid intake.
Fluid can build up between dialysis sessions, causing swelling and weight gain. The extra fluid affects your blood pressure and can make your heart work harder. You could get serious heart trouble from overloading your system with fluid.
Control Your Thirst
You can keep your fluids down by drinking from smaller cups or
glasses. Freeze juice in an ice cube tray and eat it like a popsicle.
(Remember to count the popsicle in your fluid allowance!) The dietitian
will be able to give you other tips for managing your thirst.
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Your dry weight is your weight after a dialysis session when all of the extra
fluid in your body has been removed. If you let too much fluid build up
between sessions, it is harder to get down to your proper dry weight.
Your dry weight may change over a period of 3 to 6 weeks. Talk to your
doctor regularly about what your dry weight should be.
My dry weight should be _____________.
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Many foods contain water.
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Talk to a Dietitian
Even though you are on hemodialysis, your kidneys may still be able to remove some fluid. Or your kidneys may not remove any fluid at all. That is why every patient has a different daily allowance for fluid. Talk to your dietitian about how much fluid you can have each day.
I can have _____ ounces of fluid each day.
Plan 1 day of fluid servings:
I can have _____ ounce(s) of ______________
with breakfast.
I can have _____ ounce(s) of ______________
in the morning.
I can have _____ ounce(s) of ______________ with lunch.
I can have _____ ounce(s) of ______________
in the afternoon.
I can have _____ ounce(s) of ______________
with supper.
I can have _____ ounce(s) of ______________
in the evening.
TOTAL _______ ounces (should equal the allowance written above) |
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Be careful to keep track of your fluids and other foods. |
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What do I need to know about potassium?
Potassium is a mineral found in many foods, especially milk, fruits, and vegetables. It affects how steadily your heart beats. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Potassium levels
can rise between dialysis sessions and affect your heartbeat. Eating too much potassium can be very dangerous to your heart. It may even cause death.
You can remove some potassium from potatoes by soaking them in water.
To control potassium levels in your blood, avoid foods like avocados, bananas, kiwis, and dried fruit, which are very high in potassium. Also, eat smaller portions of other high-potassium foods. For example, eat half a pear instead of a whole pear. Eat only very small portions of oranges and melons.
Dialyzing Potatoes and Other Vegetables
You can remove some of the potassium from potatoes and other vegetables
by peeling them, then soaking them in a large amount of water for several
hours. Drain and rinse before cooking. Your dietitian will give you more
specific information about the potassium content of foods.
Talk to a Dietitian
Make a food plan that reduces the potassium in your diet.
Start by noting the high-potassium foods (below) that you
now eat. A dietitian can help you add other foods to the
list.
High-Potassium Foods:
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apricots avocados bananas beets brussel sprouts
cantaloupe clams dates figs
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kiwi fruit lima beans melons milk nectarines orange juice oranges
peanuts pears (fresh)
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potatoes prune juice prunes raisins sardines spinach
tomatoes winter squash yogurt
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Others:______________________________________
Changes:
Talk to a dietitian about foods you can eat instead of high-potassium foods.
Instead of _________, I will eat _________.
Instead of _________, I will eat _________.
Instead of _________, I will eat _________.
Instead of _________, I will eat _________.
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What do I need to know about phosphorus?
Phosphorus is a mineral found in many foods. If you have too much phosphorus in your blood, it pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Also, too much phosphorus may make your skin itch. Foods like milk and cheese, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus. Usually, people on dialysis are limited to 1/2 cup of milk per day. The renal dietitian will give you more specific information regarding phosphorus.
You probably will need to take a phosphate binder like Renagel, PhosLo,
Tums, or calcium carbonate to control the phosphorus in your blood between
dialysis sessions. These medications act like sponges to soak up, or bind,
phosphorus while it is in the stomach. Because it is bound, the phosphorus
does not get into the blood. Instead, it is passed out of the body in
the stool.
Taking a phosphate binder helps control phosphorus in your blood.
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What do I need to know about protein?
Before you were on dialysis, your doctor may have told you to follow
a low-protein diet. Being on dialysis changes this. Most people on dialysis
are encouraged to eat as much high-quality protein as they can. The better
nourished you are, the healthier you will be. You will also have greater
resistance to infection and recover from surgery more quickly.
Protein helps you keep muscle and repair tissue. In your body, protein breaks down into a waste product called urea. If urea builds up in your blood, you can become very sick. Some sources of protein produce less waste than others. These are called high-quality proteins. High-quality proteins come from meat, fish, poultry, and eggs (especially egg whites). Getting most of your protein from these sources can reduce the amount of urea in your blood.
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Poultry and fish, like broiled flounder, are a good source of high-quality protein. |
Talk to a Dietitian
Meat, fish, and chicken are good sources of protein. Talk to a dietitian about the meats you eat.
I will eat ______ servings of meat each day. A regular serving size is 3 ounces. This is about the size of the palm of your hand or a deck of cards.
Try to choose lean (low-fat) meats that are also low in phosphorus.
If you are a vegetarian, ask about other ways to get your protein.
Low-fat milk is a good source of protein. But milk is high in phosphorus and potassium. And milk adds to your fluid intake. Talk to a dietitian to see if milk fits into your food plan.
I (will) (will not) drink milk. I will drink ______ cup(s) of milk
a day.
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What do I need to know about sodium?
Sodium is found in salt and other foods. Most canned foods and frozen
dinners contain large amounts of sodium. Too much sodium makes you thirsty.
But if you drink more fluid, your heart has to work harder to pump the
fluid through your body. Over time, this can cause high blood pressure
and congestive heart failure.
Try to eat fresh foods that are naturally low in sodium. Look for products labeled low sodium.
Do not use salt substitutes because they contain potassium. Talk to a
dietitian about spices you can use to flavor your food. The dietitian
can help you find spice blends without sodium or potassium.
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Find new ways to spice up your food. |
Talk to a Dietitian
Talk to a dietitian about spices and other healthy foods you can use to flavor your diet. List them on the lines below.
Spice: _____________________________
Spice: _____________________________
Spice: _____________________________
Food: _____________________________
Food: _____________________________
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What do I need to know about calories?
Calories provide energy for your body. If your doctor recommends it, you may
need to cut down on the calories you eat. A dietitian can help you plan
ways to cut calories in the best possible way.
But some people on dialysis need to gain weight. You may need to find ways to add calories to your diet. Vegetable oils--like olive oil, canola oil, and safflower oil--are good sources of calories. Use them generously on breads, rice, and noodles.
Butter and margarines are rich in calories. But these fatty foods can
also clog your arteries. Use them less often. Soft margarine that comes
in tubs is better than stick margarine. Vegetable oils are the healthiest
way to add fat to your diet if you need to gain weight.
Hard candy, sugar, honey, jam, and jelly provide calories and energy
without clogging arteries or adding other things that your body does not
need. If you have diabetes, be very careful about eating sweets. A
dietitian's guidance is very important for people with diabetes.
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If you need to get extra calories, vegetable oils like these are a good choice. |
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Should I take vitamins and minerals?
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Take only the vitamins your doctor prescribes. |
Vitamins and minerals may be missing from your diet because you have to avoid so many foods. Your doctor may prescribe a vitamin and mineral supplement like Nephrocaps.
Warning:
Do not take vitamins that you can buy off the store shelf. They may contain
vitamins or minerals that are harmful to you.
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Resources
Books
Bowes and Church's Food Values of Portions Commonly Used. Seventeenth Edition.
Jean A. T. Pennington. J.P. Lippincott Co. 1997.
ISBN: 0-397-55435-4.
The Complete Book of Food Counts. Fourth Edition.
Corinne T. Netzer. Dell Publishing Co. 1997.
ISBN: 0-440-22110-2.
Brochures
Nutrition and Hemodialysis.
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
How to Increase Calories in Your Renal Diet.
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Charts and Posters
Kidney HELPER Phosphorus Guide. (Chart or poster)
Kidney HELPER Potassium Guide. (Chart or poster)
Available from Consumer MedHelp
94 New Salem Street, Suite 104
Wakefield, MA 01880-1906
Phone: 1-800-556-7117 or (781) 246-7700
Fax: (781) 246-3086
Email: info@consumermedhelp.com
Internet: www.consumermedhelp.com
Picture Renal Diet. (Poster)
Available from University Hospital, Food and Nutrition Services
619 South 19th Street
Birmingham, AL 35233
Phone: (205) 934-8055
Cookbooks
These cookbooks provide recipes for people
on dialysis:
The Renal Gourmet. Mardy Peters
ISBN: 0-9641730-0-X
Emenar Inc.
320 Charmille Lane
Wood Dale, IL 60191
Phone: 1-800-445-5653
Southwest Cookbook for People on Dialysis
Developed by the El Paso Chapter Council on Renal Nutrition and the National Kidney Foundation of Texas, Inc.
Published by a grant from Amgen Inc.
Available from the
National Kidney Foundation of Texas
13500 Midway Road, Suite 101
Dallas, TX 75244
Phone: (972) 934-8057
Creative Cooking for Renal Diets
Cleveland Clinic Foundation
ISBN: 0-941511-00-6
Senay Publishing
P.O. Box 397
Chesterland, OH 44026
Phone: (440) 256-4435
Creative Cooking for Renal Diabetic Diets
Cleveland Clinic Foundation
ISBN: 0-941511-01-4
Senay Publishing
P.O. Box 397
Chesterland, OH 44026
Phone: (440) 256-4435
More Online Information
The American Association of Kidney Patients provides an online sodium-potassium-phosphorus counter at
aakp.org/na-k-pho.htm on the Internet.
The National Kidney Foundation offers many fact sheets for patients with kidney disease at www.kidney.org on the Internet.
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Acknowledgments
The individuals listed here provided editorial guidance or facilitated field testing for this publication. The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) would like to thank them for their contribution.
Lawrence Y. Agodoa, M.D.
End-Stage Renal Disease Program
NIDDK, National Institutes of Health
Bethesda, MD
Kim Bayer, M.A., R.D., L.D.
BMA Dialysis
Bethesda, MD
Josephine P. Briggs, M.D.
Director, Division of Kidney, Urologic, and Hematologic Diseases
NIDDK, National Institutes of Health
Bethesda, MD
Shirley Cox, R.D., L.D.
Amarillo High Plains Dialysis Center
Amarillo, TX
Sana Dicey, R.D.
Department of Chronic Dialysis Programs
Shore Memorial Hospital
Somers Point, NJ
Laura Byham Gray, M.S., R.D., C.N.S.D.
Department of Nutrition Services
Shore Memorial Hospital
Somers Point, NJ
Linda Hager, M.S., R.D.
Total Renal Care
Minneapolis Dialysis Unit
Minneapolis, MN
Melissa Hildebrand, R.D., L.D.
Total Renal Care
Minneapolis Dialysis Unit
Minneapolis, MN
Lisa Hill, R.D., C.D.E.
Dialysis Clinic, Inc.
Nashville, TN
Jean King, R.D., C.D.E.
Pikes Peak Dialysis Center, Inc.
Colorado Springs, CO
Wanda Knopik
Facility Administrator
Total Renal Care
Minneapolis Dialysis Unit
Minneapolis, MN
Susan Lindsey-Goldman, R.D.
Kessler Dialysis
Hammonton, NJ
Betty Murray, R.N.
Dialysis Clinic, Inc.
Nashville, TN
Jean Pennington, Ph.D., R.D.
Research Nutritionist,
Division of Nutrition Research Coordination
NIDDK, National Institutes of Health
Bethesda, MD
Gail Radosevich, R.D., L.D.
Total Renal Care
Minneapolis Dialysis Unit
Minneapolis, MN
Susan Schommer, R.D., L.D.
Total Renal Care
Minneapolis Dialysis Unit
Minneapolis, MN
Charlotte Stall, M.A., R.D.
The Children's Hospital
Denver, CO
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The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.
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About the Kidney Failure Series
You and your doctor will work together to choose a treatment that's best for you.
The publications of the NIDDK Kidney Failure Series can help you learn about
the specific issues you will face.
Booklets
Fact Sheets
Learning as much as you can about your treatment will help make you an important member of your health care team.
NIDDK will develop additional materials for this series as needed. Please address
any comments about this series and requests for copies to the National
Kidney and Urologic Diseases Information Clearinghouse. Descriptions of the publications in this series are available at http://kidney.niddk.nih.gov/kudiseases/pubs/kidneyfailure/index.htm on the Internet.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Email: nkudic@info.niddk.nih.gov
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
NIH Publication No. 03-4274
April 2003
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