American

Kidney Fund

reaching out

giving hope

improving lives

Healthy Eating for People on Hemodialysis

reaching out

giving hope

improving lives

You need a “kidney-friendly” diet when you are on

dialysis. Watching what you eat and drink will help

you stay healthier. This brochure is for people who have

kidney failure and are on hemodialysis. It will describe a

kidney-friendly diet and why it is important.

This brochure will teach you about:

• The basics of a healthy diet

• What makes the kidney-friendly diet different

• Special steps for people with diabetes

• Where to find more information

Keep this in mind…

This guide gives only general information. Diet needs

vary from person to person depending on size, activity,

and other health concerns. Talk to a renal dietitian,

someone who specializes in the kidney-friendly diet, to

find a meal plan that meets your needs. Your dialysis

center will have a dietitian that you can meet with, and

Medicare will cover this service.

Healthy Eating

for People on

Hemodialysis

1

All diets, including the kidney-friendly diet, need to take

into account some of the same things, like:

• Calories

• Carbohydrates

• Protein

• Fat

• Portions

In this section, we’ll review each of these. We’ll also take a

look at the nutrition facts label and explain how you can use

this tool to help you have a healthy diet.

What you eat affects your

health. Maintaining a healthy

weight and following a diet that is

low in salt can help you control

your blood pressure. If you have

diabetes, your diet is also

important in helping to control your

blood sugar. This can help you

prevent other health problems.

A kidney-friendly diet goes a step

further. It limits certain minerals in the foods you eat. This

helps keep waste from building up in your blood and may

help prevent some common problems caused by kidney

failure.

We’ll start by reviewing the basics of a healthy diet. Then,

we’ll take a look at the kidney-friendly diet and some

helpful kidney-friendly diet resources.

Why is diet important? Healthy Diet Basics

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Your body gets energy from the calories you eat and

drink. Calories come from the carbohydrates, protein,

and fat in your diet. How many calories you need depends

on your age, sex, size and activity level. You may also

need to adjust how many calories you eat based on your

weight goals.

Some people will need to limit the calories they eat.

Others may need to have more calories. Your dietitian can

help you figure out how many calories you should have

each day. Work with your dietitian to make a meal plan

that helps you get the right amount of calories, and keep in

close contact for more advice and follow up.

Carbohydrates

Carbohydrates (“carbs”) are the easiest kind of energy for

your body to use. Healthy sources of carbohydrates

include whole grains, fruits and vegetables. Other

unhealthy sources of carbohydrates include sugar, honey,

hard candies, soft drinks and other sugary drinks.

Some carbohydrates are high in potassium and

phosphorus, which you may need to limit. We’ll talk about

this in more detail a little later. You may also need to watch

your carbohydrates carefully if you have diabetes. Your

dietitian can help you learn more about the carbohydrates

in your diet and how they affect your blood sugar.

Calories

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Protein

Protein is one of the building

blocks of your body. Your body

needs protein to grow, heal and

stay healthy. Before you started

dialysis, your doctor or dietitian

may have told you to limit the

protein in your diet. Now that you are on dialysis, you may

need to eat more protein. This will help replace protein that

is lost during your treatments.

Talk to your dietitian to find out how much protein you should

have each day. Your dietitian can help you make a meal

plan that helps you get the protein you need.

Use the table below to learn which foods are low or high in

protein.

Fat

You need some fat in your diet to stay healthy. Fat gives

you energy, keeps you warm, and helps you use some of

the vitamins in your food. But too much fat can lead to

weight gain and heart disease. Try to limit fat in your diet,

and choose healthier fat when you can.

Healthier fat or “good” fat is called unsaturated fat.

Examples of unsaturated fat include:

• Olive oil

• Vegetable oils

Unsaturated fat can help reduce cholesterol. If you need

to gain weight, try to eat more unsaturated fat. If you need

to lose weight, limit the unsaturated fat in your diet. As

always, moderation is the key. Too much “good” fat can

also cause problems.

Saturated fat, also known as “bad” fat can raise your

cholesterol and put you at risk for heart disease.

Examples of foods that have saturated fat include:

• Butter

• Lard

• Shortening

• Meat

Limit these in your diet. Choose healthier, unsaturated fat

instead. Trimming the fat from meat and removing the skin

from chicken or turkey can also help limit saturated fat.

Lower-protein foods Higher-protein foods

98

Sodium (salt) is a mineral found in almost all foods. Too much

sodium can raise your blood pressure and make your heart

work harder. Too much sodium can also make you thirsty.

One of the best things that you can do to stay healthy is to

limit how much sodium you eat. A dialysis diet should have

less than 2,000 milligrams (mg) of sodium per day. To

limit sodium in your diet:

• Do not add salt to your food when cooking or at the

table. Try cooking with fresh herbs, lemon juice or other

salt-free spices.

• Choose fresh or frozen vegetables instead of canned

vegetables. If you do use canned vegetables, rinse

them to remove extra salt before cooking or eating them.

• Avoid processed meats like ham, bacon, sausage and

lunch meats.

• Munch on fresh fruits and vegetables rather than

crackers or other salty snacks.

• Avoid canned soups and frozen dinners that are high in

sodium.

• Avoid pickled foods, like olives and pickles.

• Limit high-sodium condiments like soy sauce, BBQ sauce

and ketchup.

Sodium

Warning! Be careful with salt substitutes and “reduced

sodium” foods. Many salt substitutes are high in potassium.

Too much potassium can be dangerous for someone with

kidney failure. Work with your dietitian to find low-sodium

foods that are also low in potassium.

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Use nutrition facts labels to learn more about what is in the

foods you eat. The nutrition facts label will tell you how much

carbohydrates, protein, fat and sodium are in each serving of a

food. This can help you pick foods that are high in the nutrients

you need and low in the nutrients you should limit.

Use the diagram on page 11 to find key areas of the

nutrition facts label that will give you the information you

need.

The Nutrition Facts Label

Serving SizeThis part of the label tells you how much of the food is equal to one

serving. Many packages contain more than one serving, but the

information on the label is for just one serving. Using the example

below, if you have one cup of this food, you will get 50 calories. If you

have two cups of this food, you will get 100 calories. If you have half a

cup of this food, you will get 25 calories. This same idea applies to all of

the other nutrients listed.

CaloriesThis part of the label tells you how

many calories are in each serving

of the food. An average adult will

need about 2,000 calories per day,

but this might vary based on age,

sex, size, activity level and health

concerns. Ask your doctor or

dietitian how many calories you

should have each day.

NutrientsLook here to see how much fat,

sodium, carbohydrate and

protein are in each serving.

Note: People with kidney disease may also need to

watch the amount of potassium and phosphorus

they get. These do not have to be listed on the

nutrition facts label. Be careful! Even if they aren’t

listed, the food may be high in these. Check the

package ingredients list for other clues.

• Foods high in potassium might list the ingredient

potassium chloride or KCl.

• Foods high in phosphorus might have the words

phosphate or phosphoric somewhere in the

ingredients list.

See pages 14 and 15 to learn more. Your dietitian

can also help you learn which foods are high in

potassium and phosphorus.

% Daily Value (%DV)This part of the label tells you how much of your daily needs of a

nutrient are met with one serving of the food. This number is not exact,

as each person’s needs may be a little different. As a general rule,

when the %DV is less than 5%, the food is low in that nutrient. When

the %DV is more than 20%, the food is high in that nutrient.

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Portions

Choosing healthy foods is a great start, but eating too

much of even healthy foods can be a problem. The

other part of a healthy diet is portion control, or watching

how much you eat.

To help control your portions:

• Eat slowly, and stop eating when you are not hungry

any more. It takes about 20 minutes for your

stomach to tell your brain that you are full. If you eat

too quickly, you may eat more than you need.

• Check the nutrition facts label to learn the true

serving size of a food. Many packages have more

than one serving. For example, a 20-ounce bottle of

soda is really two-and-a-half servings.

• Do not eat directly from the package the food came

in. Instead, take out one serving of food, and put the

bag or box away.

• Avoid eating when watching TV or driving. When you

are distracted you may not realize how much you

have eaten.

Good portion control is an important part of any diet. It is

even more important in a kidney-friendly diet, because

you may need to limit how much of certain foods you eat.

Keep reading to learn more!

How is a kidney-friendly diet different?

Dialysis helps to replace the work of your kidneys, but it

does not work as well as healthy kidneys. Some waste and

fluid still build up in your body. Over time, the waste and

extra fluid can cause heart, bone and other health

problems. A kidney-friendly diet limits how much of certain

minerals and fluid you take in. This can help keep the

waste and fluid from building up and causing problems.

Exactly how strict your diet should be depends on your

treatment plan and other health concerns. Still, most people

on dialysis will need to limit:

• Potassium

• Phosphorus

• Fluids

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Potassium

Potassium is a mineral found in almost all foods. Your body

needs some potassium to make your muscles work, but too

much potassium can be dangerous. When you are on

dialysis, your potassium level may be too high or too low.

Having too much or too little potassium can cause muscle

cramps, irregular heartbeat and muscle weakness.

Most people on dialysis will need to limit potassium to

2,000 to 4,000 mg per day. Ask your dietitian how much

potassium you should have each day.

Use the table below to learn which foods are low or high in

potassium. Your dietitian can also help you work in some

higher potassium foods in small amounts.

Phosphorus

Phosphorus is a mineral found in many foods. It works with

calcium and vitamin D to keep your bones healthy. Healthy

kidneys help keep the right balance of phosphorous in your

body. When you are on dialysis, phosphorus can build up in

your blood. Too much phosphorus in your blood can lead to

weak bones that break easily.

Most people on dialysis will need to limit phosphorus to

about 1,000 mg per day. Ask your dietitian how much

phosphorus you should have each day.

Use the table below to learn which foods are low or high in

phosphorus.

To help control your phosphorus, your doctor may also

prescribe a medicine called a phosphate binder. This helps to

keep phosphorus from building up in your blood. A phosphate

binder can be helpful, but you will still need to watch how much

phosphorus you eat. Ask your doctor if a phosphate binder is

right for you.

Eat this… (lower-phosphorus foods)

Rather than… (higher-phosphorus foods) Eat this…

(lower-potassium foods) Rather than… (higher-potassium foods)

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Fluids

You need water to live, but when you are on dialysis, you

may not need as much. This is because fluid may build up

in your body between treatments. Too much fluid in your

body can be dangerous. It can cause high blood pressure,

swelling, heart failure and trouble breathing. Extra fluid

can also make your dialysis treatments more difficult.

Most people on dialysis will need to limit fluids. Ask your

dietitian how much fluid you should have each day.

If you need to limit fluids, you will need to cut back on how

much you drink. You may also need to cut back on some

foods that contain a lot of water. Soups or foods that melt,

like ice, ice cream and gelatin, have a lot of water. Many

fruits and vegetables are high in water, too.

When you limit your fluids, you may feel thirsty. To help

quench your thirst, you might try to:

• Chew gum

• Drink from small cups

• Rinse your mouth

• Suck on a piece of ice, mints or hard candy

(Remember to pick sugar-free candy if you have diabetes.)

Other diet concerns

Vitamins

A kidney-friendly diet may make it hard to get all of the

vitamins and minerals you need. To help you get the right

balance of vitamins and minerals, your dietitian may

suggest a special supplement made for people with kidney

failure.

Your dietitian might also suggest a special kind of vitamin

D, folic acid or iron pill, to help avoid some common side

effects of kidney failure, like bone disease and anemia.

Regular multi-vitamins may not be healthy for you if you

have kidney failure. They may have too much of some

vitamins and not enough of others. Talk to your dietitian

to find vitamins that are right for you.

Important! Tell your

doctor and dietitian about

any vitamins, supplements

or over-the-counter

medicines you are taking.

Some may be harmless,

but others can cause

problems.

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My Diet

Following the kidney-friendly diet can be difficult. Your dietitian

can help you learn how much of each nutrient you should have

each day. Next time you meet with your dietitian, take this

worksheet. Ask your dietitian to help you fill in the blanks.

Your dietitian can also help you learn what foods to limit

and other foods you might try instead. Work with your

dietitian to find a meal plan that works for you.

Other diet concerns

What if I have diabetes?

Diabetes is the leading cause of kidney failure. Diabetes

can also damage other parts of your body, like your eyes

and heart. If you have diabetes, you will need to watch

your blood sugar and diet to stay healthy. Work with your

dietitian to make a kidney-friendly meal plan that helps you

keep your blood sugar in control.

A diabetes educator can also help you learn how to control

your blood sugar. Ask your doctor to refer you to a

diabetes educator in your area. You can also get a list of

diabetes educators from the American Association of

Diabetes Educators at www.diabeteseducator.org or

1.800.338.3633. Medicare and many insurance

companies may help pay for sessions with a diabetes

educator.

Summary

A well-balanced diet is important for good health. It is even

more important for people with on dialysis, because it may

help prevent other problems. Work with the dietitian at

your dialysis center to make a meal plan that helps you get

the right amount of calories, carbohydrates, protein, fat and

sodium. Your dietitian can also help you limit your

potassium, phosphorus and fluids.

Nutrient How Much I Should Have Each Day

Protein

Sodium

Potassium

Phosphorus

Fluid

Foods To Limit Because They’reHigh In…

What to Try Instead

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Kidney-Friendly Cookbooks

Brilliant Eats: Simple and Delicious Recipes for

Anyone Who Wants to be Kidney Wise

Kelly L. Welsh, RD, CD

www.brillianteats.com

1.866.524.6732

Calabash Cookbook for Kidney Health

National Kidney Foundation of Hawaii

www.kidneyhi.org

1.800.488.2277

Carbohydrate & Sodium Controlled Recipes

CRN No. California/No. Nevada

www.crn-norcal.org

415.353.7725

Chinese Renal Kitchen

BC Chinese Nutrition Consultants

604.806.8141

Cooking for David: A Culinary Dialysis Cookbook

Sara Colman, RD, CDE and Dorothy Gordon, BS, RN

www.culinarykidneycooks.com

714.842.4684

Cooking the Renal Way

Oregon Council on Renal Nutrition

503.371.8047

Creative Cooking for Renal Diabetic Diets

Creative Cooking for Renal Diets

Cleveland Clinic Foundation

www.patientsupport.net

1.800.247.6553

The Gourmet Renal Cookbook

Sharon Stall, RD

212.434.3266

The Kidney Helper Cookbook

Bob and Natalie Lufty with Mary Pinto, RD

www.consumermedhelp.com

1.877.248.2331

Kidney Kids’ Cookbook

Kay Anderson, Frances Buchanan, Linda Tyler

Edited by Betsy Watson

1.800.282.0190

Now You’re Cooking: A Resource for People with

Kidney Disease

Council on Renal Nutrition of New England

www.kidneyhealth.org

1.800.542.4001

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Renal Lifestyles Manual

Peggy Harum, RD, LD

Available in bookstores.

The Renal Patient’s

Guide to Good Eating

Judith Curtis

www.ccthomas.com

1.800.258.8980

Southern Comforts of Mississippi

National Kidney Foundation of Mississippi

www.kidneyms.org

1.800.232.1592

The Vegetarian Diet for Kidney Disease Treatment

Joan Brookhyser, RD, CSR, CD

Available in bookstores.

Online Recipes

DaVita

www.davita.com/recipes

Kidney Kitchen

National Kidney Foundation

www.kidney.org/patients/kidneykitchen

Kidney Times

Renal Support Network

www.kidneytimes.com

Northwest Kidney Centers

www.nwkidney.org

Notes:Helpful Kidney Disease Resources

American Kidney Fund

www.kidneyfund.org

1.800.638.8299

American Association of Kidney Patients

www.aakp.org

1.800.749.2257

American Dietetic Association

www.eatright.org

1.800.877.1600

National Institute of Diabetes and Digestive and

Kidney Diseases

www.niddk.nih.gov

1.800.891.5390

Acknowledgements

Our sincere thanks to Rebecca Brosch, RD, LD for her

continued support of the American Kidney Fund and for

her input on this brochure.

The American Kidney Fund is the leading national

voluntary health organization serving people with and at

risk for kidney disease through direct financial assistance,

comprehensive education, clinical research, and

community service programs.

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American Kidney Fund

6110 Executive Boulevard

Suite 1010

Rockville, MD 20852

Phone: 301.881.3052

Fax: 301.881.0898

Toll-Free: 800.638.8299

HelpLine: 866.300.2900

helpline@kidneyfund.org

http://www.kidneyfund.org

Se habla español.

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© Copyright 2010 by American Kidney Fund, Inc. All rights reserved.