Diet and Nutrition Q&A by Betty Kovacs

I'm a dialysis patient. Are there any foods that I should avoid? Is there a special diet for people like me?

Answer:

Let me begin by saying that it is imperative that you work with a qualified health-care professional to determine your dietary needs each week when you are on dialysis. The dietary requirements vary from individual to individual. Dialysis patients have very specific dietary needs that can be difficult to understand and can even vary each time you are dialyzed. Most dialysis centers have someone to provide these instructions. If yours does not, you can find a registered dietitian in your area by going to http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_4874_ENU_HTML.htm. You can also ask your center if there is someone whom they recommend.

I think that it is great that you are trying to find out what you can do for yourself. The more that you know ahead of time the better you will be able to understand the instructions that you are provided by your health-care professional. The frequency of your appointments, type of dialysis, your medical history, your urine output, your weight, and your blood levels will all help to determine what your particular dietary requirements will be. Here is an overview of how your diet can be affected by dialysis:

    1. Fluids: Allowance is based primarily on the type of dialysis and urine output. If you have any edema, are taking a diuretic, and/or have congestive heart failure, your allowance will be adjusted.
    2. Sodium: This will be modified to maintain blood pressure and fluid control and to help prevent congestive heart failure and pulmonary edema.
    3. Potassium: Your intake of this will be adjusted to prevent your blood levels from going too high or too low.
    4. Phosphorus: The majority of dialysis patients require phosphate binders and dietary restrictions in order to control their blood phosphorus levels.
    5. Protein: Adequate protein is necessary to maintain and replenish your stores. You may be instructed on increasing your intake now that you are on dialysis.
    6. Fiber: There is a chance that constipation may be a problem due to fluid restrictions and phosphate binders, so it's important to keep fiber intake up. You will need guidance on this because many foods that are high in fiber are also high in potassium.
    7. Fat: Depending on your blood cholesterol levels, you may need to decrease your intake of trans fat, saturated fat, and cholesterol.
    8. Calories: If you are over or underweight, you will be instructed on adjusting the amount of calories that you take in each day.
    9. Calcium: Most foods that contain calcium also contain phosphorus. Due to your phosphorus restrictions, you will need guidance on how to get enough calcium while limiting your intake of phosphorus.

There are other vitamins and minerals that you may need to supplement and this will be determined by your health-care professional. For more detailed information, I recommend reading the guidelines for dialysis at http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm.

As you can see, this is not an easy diet to follow. I have never had anyone on dialysis figure out how to do this on their own. This will take time to get used to, but with the proper guidance, you will begin to understand how it all fits together.

Thank you for your question.


Last Editorial Review: 12/11/2006