Best Foods to Eat when You’re on Dialysis

Every second of every day, our kidneys help keep us healthy by filtering our blood.

If the kidneys are not working well, toxins and extra fluids build up in our bodies, causing symptoms like fatigue, swelling, nausea, and changes in urine production. Chronic kidney disease is common in the United States, and dietary factors may influence how fast it progresses. Some patients develop kidney failure, which requires closer medical care and can be life-threatening.

Depending on symptoms, one treatment for kidney failure is hemodialysis, which uses a specialized device to perform the work of the kidneys. Whether a patient undergoes dialysis at home or in a clinic, it is important to adhere to a regular dialysis schedule.

“People undergoing dialysis need to pay attention to what they eat and how much they drink,” says Rosemary Sampogna, MD, PhD, a Columbia nephrologist (a doctor who specializes in kidney disease). Overnutrition, she explains, can cause the buildup of sodium, potassium, phosphorus, waste from protein degradation, and fluids in the body. On the other hand, poor nutrition in dialysis patients is linked to worse outcomes and a higher risk of death.

Dr. Sampogna explains how diet can complement your dialysis treatment, which nutrients to focus on, and what foods to avoid.

Why should someone undergoing dialysis be careful about what they eat?

Dialysis serves as a substitute for kidney function, but it is not perfect. It can only replace a fraction of what kidneys normally do: cleanse the blood continually.

Following a diet of foods and nutrients that closely match what the body needs for metabolism will help limit the harmful buildup of fluids, toxins, and minerals.

What is a good dialysis diet?

Every dialysis patient will have different dietary needs. Work with your healthcare provider and a kidney dietitian to develop a diet plan that’s best for you. This plan will include specifics, such as the amount of protein needed to maintain strong muscles and a robust immune system.

Your nephrologist will likely also prescribe a daily vitamin to supply nutrients, vitamins, and minerals you need.

Dialysis patients can enjoy the following kidney-healthy foods:

• Fruits and vegetables like green beans, kale, and apples
• Proteins like poultry, eggs, and fish. Some patients benefit from drinking a special supplement with extra protein and calories.
• Grains like pasta, bread, and bagels
• Some dairy products, like one serving of nonfat Greek yogurt and a small glass of milk

Usually, dialysis patients need to limit:

• Fluids: Depending on symptoms, some patients may need to restrict their daily intake of liquids, including beverages, soups, and gravies.
• Salt: Patients need to follow a low-sodium diet: Aim for less than one teaspoon of salt per day, including the sodium added to processed foods. This also helps you limit fluid intake (because salt makes you thirsty).
• Potassium: Cut down on high-potassium foods, like avocados, bananas, melons, mangos, oranges, dried beans, squash, potatoes, and tomatoes. Also read labels; many salt substitutes contain potassium.
• Phosphorus: Reduce phosphorus-rich foods, like dairy, nuts, dried beans, and chocolate. Dialysis does not effectively remove phosphorus, so patients also need to take phosphorus-binding medications with meals to help maintain normal levels.

Does everyone on dialysis follow the same diet?

No, which is why working with a kidney dietician is essential. Although most dialysis patients need to limit certain foods and take phosphorus-binding medicines, everyone’s body is different.

Can you dine out if you are on dialysis?

Dining out can be a challenge while on dialysis, but it is possible. Take time to read the menu and ask your server questions, if necessary, to make sure your order adheres to the guidelines above.

Rosemary Sampogna, MD, PhD, is an associate professor of medicine and a board-certified nephrologist.