Hemodialysis, Peritoneal Dialysis, and Diet
- Brandy Winfree Root, RDN, CSR, LDN
- Mar 31
- 5 min read
The goal of treating kidney disease is usually to prolong the life of the kidneys (or for some, just one kidney), but eventually your doctor may discuss dialysis with you. Dialysis is typically saved for when a person is at or near kidney failure or End-Stage Renal Disease (ESRD). ESRD is just another name for Stage 5 chronic kidney disease (CKD).
Kidney failure or ESRD is treated with Hemodialysis (HD), Peritoneal Dialysis (PD), or palliative care. It’s important to know that diet is very individualized on dialysis. This is because each person will have a different dialysis prescription, different medications, and different levels of residual kidney function.
Residual kidney function is the little bit of function that the kidneys have even in End Stage Kidney Disease. Think of the kidneys as little kids helping with groceries. They can’t carry a whole gallon of milk on their own, so they need a grown up to help them. But, they can carry a container of blueberries or a box of popcorn!
So, even though the kidneys aren’t strong enough to keep all of the blood in the body clean anymore, they can still help a little bit! That’s called “residual kidney function” and it plays a big role in determining the changes needed to your diet, medication, and dialysis needs.
If you have questions about your specific nutrition needs, you should consult with your doctor or dietitian.
Hemodialysis and Diet
Hemodialysis is a specialized treatment in which waste and water are filtered from the blood using a dialysis machine. Small amounts of blood are taken into the machine and run through a special filter before being sent back into the vascular system. This process usually takes 2.5 to 4 hours to complete. Though this time can can be affected by weight — larger bodies have more blood to clean — and prescription — the doctor will order a dialysis prescription that is tailored to your needs.
Protein
Unfortunately, hemodialysis pulls a lot of protein out of the blood when it’s cleaning it. That’s why protein needs are so high on dialysis. In general, it is recommended that patients undergoing hemodialysis consume at least 1.2 grams of protein per kilogram of body weight. That comes out to about 99 grams of protein for a person weighing about 180 pounds. Truthfully, though, if you have any other health concerns — like a wound, diabetes, or cancer, — your needs may be much higher than that.
Potassium
Potassium can be scary for people on dialysis because it tends to be in a lot of foods that we think of as being “healthy”. Foods like bananas, avocadoes, and sweet potatoes are high in potassium and too much potassium can cause big problems when you have advanced kidney disease — like heart palpitations or even cardiac arrest. That’s why it’s important to talk to your provider about how much potassium is safe for you.
Calcium and Phosphorus
Your providers may talk to you about calcium and phosphorus because they are two important bone minerals that may be affected by your dialysis treatments. You may have to limit calcium-rich foods, like milk, yogurt, or cheese, and calcium containing medicine such as phosphate binders. Or your team may tell you to eat more of these things because your calcium is low!
Phosphate binders can help decrease phosphorus by binding to phosphorus in food — once the phosphorus in food is bound to the phosphorus binder it passes into the stool and thus, doesn’t get absorbed by the body. Phosphorus absorption may vary depending on the type of phosphorus eaten as well. Plant sources of phosphorus (like beans and nuts) aren’t as well absorbed as phosphorus from highly processed foods (like dark colas and some snack foods). Phosphorus is complex and you can learn more about sticking to a low phosphorus diet here.
Fluid and Blood Pressure
Because the kidneys are unable to adequately remove excess fluid, hemodialysis patients may have to limit fluid intake to 32 ounces (or about 1 quart) daily. Sticking to your doctor’s fluid recommendations help to lower blood pressure, prevent muscle cramping, and minimize stress on the heart.
Some strategies to keeping your fluid intake under your doctor’s limit include:
Tracking water intake using a 32 ounce water bottle
Sucking on sugar free candies, ice chips, or frozen fruits, like blueberries!
Asking your dialysis team for lemon sticks during treatment
Sodium may also have to be limited to less than 2 grams or 2000 milligrams per day to keep fluid from building up. The single best thing that any person that I have worked with has done to limit their sodium intake is to limit highly processed foods. In the US, about 70% of our sodium intake comes from processed food!
Peritoneal Dialysis
Peritoneal dialysis (PD) cleans the blood just list hemodialysis, but it uses the peritoneum, the thin lining of the abdomen, to filter out waste and excess fluid from the blood. A person can do this type of dialysis themselves by connecting a catheter in their belly to a special fluid called dialysate that helps to pull waster products from the blood. This It sounds bananas, but it's actually pretty amazing. And don't worry, anyone who chooses to do PD is trained by a special nurse and always has access to a PD nurse that they can call anytime (day or night!) if they they have questions or concerns.
Protein Needs
Peritoneal dialysis also requires a high protein intake of at least 1.2 to 1.3 grams of protein per kilogram of body weight. This is slightly higher than the protein requirements for hemodialysis patients because additional protein is lost every time dialysate is drained from the abdomen.
Potassium Restrictions
Poeple on PD can usually eat a near normal amount of potassium-rich foods because potassium is lost when the dialysate is drained from the abdomen. Potassium labs are drawn regularly and some people may have to restrict potassium, but it often less restricted in people on PD.
Bone Health and Blood Pressure
The calcium, phosphorus, fluid , and sodium recommendations for people on PD are the same as they are for people on HD. All recommendations should be made by your healthcare team and they may change over time as your medications, dialysis prescription, residual kidney function, and lifestyle changes.
Blood sugar
The dialyate fluid used in PD has a sugar called dextrose in it. This can sometimes cause blood sugar to increase to those on PD. This can be managed with medication, exercise, and a low carbohydrate diet. Your dietitian can help with this!
This is just a bit about the differences between hemodialysis and peritoneal dialysis. You can check out the National Kidney Foundation or ask your doctor for more information so that you can figure out together what type of dialysis may work for you. Just know that regardless of which one you choose, you'll have a whole team of doctors, nurses, dietitians, and social workers to help you navigate it.
This post was a special one because it was brought to you with the help of a friend of mine. Ava Matt is a student at Texas A&M University! She is working on her BS in Nutrition and Dietetics and when she isn't delving into the world of renal nutrition, she enjoys cooking, baking, hiking, and yoga!
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