Hemodialysis Diet Guidelines from a Veteran Nurse

I would like to introduce to you once again, registered nurse, Lynda Lampert. Lynda’s article The Definitive Guide To Dialysis: Types Of Dialysis, Indications, Side-Effects And More got a great response, so I have asked her back to continue where she left off. I have asked her talk to about the guidelines for a healthy hemodialysis diet. She jumped at the chance to talk to you, so please welcome Lynda back…

As a nurse in a hospital, I got the chance to see many patients come and go who were on hemodialysis for kidney failure. Most of the time, patients go to dialysis and have no problems with it, but when I got to see them, it was usually because something went wrong.

Unfortunately, this is often caused by patient noncompliance with treatment. The number one reason for patients to end up in my hospital, in my unit was because they skipped a dialysis day. The close second reason was that they did not follow their hemodialysis diet plan.

Hemodialysis and diet go hand in hand. If you do not follow the recommendations set down for you by your kidney doctor and your dietician, you will end up in the hospital. It’s just that simple. Your kidneys are the organs that filter all the waste and fluid from your body. They regulate the various chemicals that can harm you when present in great amounts. When you don’t have your kidneys to protect you, you have to carefully monitor what you put into your system. Don’t give your kidneys more problems than they already have. If you follow these guidelines for eating correctly on hemodialysis, you will have a smooth treatment experience.

Fluid Restrictions

When you are told you have kidney disease, your doctor will most likely put you on a fluid restriction. This is because the kidneys are just not able to move the fluid off of your body.

When you drink too much fluid, several symptoms will appear:

• Weight gain
• Shortness of breath
• Congestive heart failure
• High blood pressure
• Swelling

These symptoms are all because the fluid is backing up in your system and causing it to work harder than it normally would have to. This is why it is so important to follow the hemodialysis diet restrictions that your care team sets for you. You could drown yourself in water if you do not heed your restrictions.

Common restrictions are for:

• 1000 mL
• 1500 mL
• 2000 mL
• 2500 mL

Your doctor will determine which level you need by evaluating your kidney function and how well hemodialysis will remove water from your body. You cannot move these numbers about or learn from the internet how much to drink. Instead, you must have an honest discussion with your doctor about how much you can drink. They use a complicated algorithm based on your medical history to determine your fluid levels.

Remember, fluids include:

• Milk
• Water
• Soda
• Soup
• Jell-O
• Some fruits and vegetables

Sodium

Your sodium intake is another important consideration when thinking about your fluid levels. Sodium is like a sponge, and it will hold on to water and cause you symptoms of retention despite restricting fluid. Again, your doctor will determine for you how much sodium you are allowed to have per day. Most doctors recommend a level between 2,000 and 3,000 mg, depending on your kidney function.

Obviously using a salt shaker will increase your sodium intake, but some foods have hidden sodium, such as:

• Soups
• Luncheon meats
• Fast food
• Processed food
• Canned food
• Dressings
• Sauces

You don’t have to eat a bland diet, but you do have to exercise caution when cooking. Don’t reach for salt substitutes, either, as these are often high in potassium. Instead, look into herbs and seasonings that don’t have a high sodium or potassium content. For instance, you could try basil instead of salt on your foods.

Calorie Requirements

Your calorie requirement will depend a great deal on your weight and diabetic status. If you are overweight, your doctor may ask you to restrict your calories to lose the weight and take some pressure off of your body.

Most doctors recommend calorie restrictions in the following categories:

• 2200 calories
• 2000 calories
• 1800 calories

You should not attempt to eat any less than these guidelines because your body needs the nutrients from food to function after hemodialysis. The procedure can take a toll on a person, and eating enough calories is sometimes the only thing that gives you enough energy. However, overeating is bad for your kidneys because you gain weight, exacerbate your diabetes, and run the risk of eating too many nutrients, such as potassium or sodium.

One important consideration to make in planning your meals is the amount of protein you are taking in. Your body needs protein for muscle building, energy, and repair. In fact, your body is incapable of making certain chemicals, called amino acids, on its own. It needs to get them from proteins every day.

Some foods that are high in protein are:

• Beef
• Chicken
• Fish
• Milk
• Cheese
• Beans

Unfortunately, the processing of proteins causes a waste product to accumulate in the body. The kidneys are responsible for removing this waste product, and if they are not working correctly, your body can build up toxic amounts. For patients who have kidney disease that does not require dialysis, your protein should be restricted to between 10 and 15 per cent of your total calories. On dialysis, though, your body needs the extra protein to repair cells damaged in the procedure. Your doctor and dietician will likely recommend higher amounts of protein in this case.

Requirements of Major Nutrients

Potassium

Potassium is another nutrient that can build up in your body to toxic amounts. Usually, the kidneys filter the blood and keep the potassium regulated. On hemodialysis, your blood is also filtered to remove excess potassium, but you still should keep your potassium intake low because your kidneys are just not able to process it.

Some dangers of high potassium levels include:

• Nausea
• Weakness
• Numbness
• Irregular heartbeats
• Heart failure
• Sudden death

As you can see, you need to be careful when planning your meals to avoid getting too much in your diet. Many foods are high in potassium, so you need to watch your intake of them very carefully. Your doctor will tell you just the right amount of potassium to eat each day, but usually less is better. Your kidneys won’t filter out the potassium, and hemodialysis only occurs every other day. This is long enough to cause dangerously high potassium levels.

Stay away from foods such as:

• Salt substitute
• Bananas
• Oranges and Orange Juice
• Prune Juice
• Dried Peas
• Potatoes
• Tomatoes
• Cooked Spinach
• Vegetable Juice
• Milk
• Yogurt
• Chocolate
• Nuts

Some tips for foods you can eat that are low in potassium include:

• Apples
• Grapes
• Peaches
• Carrots
• Lettuce
• Green Beans

Phosphorous

Another nutrient that you need to watch when on hemodialysis is phosphorus. Your body can build up a toxic amount of this nutrient which can cause problems with the bones. In fact, some doctors even prescribe a drug that binds to phosphorus in foods to prevent it from building up in your bloodstream.

Some side effects of high phosphorus include:

• Bone pain
• Heart problems
• Low calcium levels
• Itching
• Hardening of soft tissue

You should stay away from foods that are high in phosphorus, such as:

• Milk
• Cheese
• Cola
• Chocolate
• Bran
• Whole grain breads
• Pizza
• Nuts
• Processed meats

Some of these foods are on other restricted lists, too, so it makes it easier to plan meals. However, it is often difficult to plan a hemodialysis diet that takes all of these restrictions into consideration. That’s why a good dietician will help you to plan your diet to incorporate your favorite foods and still stay in compliance with your doctor’s restrictions.

Some foods that are low in phosphorus include:

• Fresh fruits and vegetables
• Unsalted popcorn
• Corn and rice cereals
• White rice
• Rice milk
• Home-brewed iced tea

Importance of Alkalizing Foods

One more important job your kidneys do for you is regulating your acid-base balance. Your body requires a specific pH to function. In fact, it prefers to be just slightly alkaline – or towards the base end of the spectrum. Your kidneys filter out nutrients, such as potassium, that make your blood become too acidic.

Some signs of acidosis include:

• Chest pain
• Palpitations
• Headache
• Nausea
• Vomiting
• Weight loss
• Confusion

When your kidneys are failing, they are unable to keep your blood in this tightly controlled range. You can help your body by not giving it foods that are likely to cause your pH to dip towards the acidic end of the range.

Some foods that are alkaline, yet low in phosphorus and potassium are:

• Apples
• Cucumbers
• Lettuce
• Cabbage
• Green beans
• Carrots
• Grapes
• Pears
• Cauliflower
• Cherries

Planning a hemodialysis diet can be challenging, especially if you have to control other processes like diabetes and weight loss. For this reason, you must be comfortable with your kidney team, including your doctor and dietician. You need to express to them the challenges you are facing as you approach your hemodialysis diet plan and come up with strategies to minimize these problems.

References

DaVita; The Hemodialysis Diet
https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/the-hemodialysis-diet/e/5314

Polycystic Kidney Disease Diet; Alkaline Diet List
https://www.pkdiet.com/pages/diet/dietalkalinelist.htm

DaVita; Fruits and vegetables help delay kidney disease progression in early stages
https://www.davita.com/kidney-diet-tips/?tag=fruits-and-vegetables-in-kidney-disease