Dietary Guidelines for Adults Starting on Hemodialysis

Diet and Dialysis
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Use this brochure as a guide until your dietitian prepares a personalized meal plan for you. You will need to:

  • Eat more high protein foods.
  • Eat less high salt, high potassium, and high phosphorus foods.
  • Learn how much fluid you can safely drink (including coffee, tea, and water).

Salt & Sodium

  • Use less salt and eat fewer salty foods: this may help to control blood pressure and reduce weight gains between dialysis sessions.
  • Use herbs, spices, and low-salt flavor enhancers in place of salt.
  • Avoid salt substitutes made with potassium.

Meat/Protein

People on dialysis need to eat more protein. Protein can help maintain blood protein levels and improve health. Eat a high protein food (meat, fish, poultry, fresh pork, or eggs) at every meal, or about 8-10 ounces of high protein foods everyday.

3 ounce = the size of a deck of cards, a medium pork chop, a ¼ pound hamburger patty, ½ chicken breast, a medium fish fillet.

1 ounce = 1 egg or ¼-cup egg substitute, ¼-cup tuna, ¼-cup ricotta cheese, 1 slice of low sodium lunchmeat.

Note : Even though peanut butter, nuts, seeds, dried beans, peas, and lentils have protein, these foods are generally not recommended because they are high in both potassium and phosphorus.

Grains/Cereals/Bread

Unless you need to limit your calorie intake for weight loss and/or manage carbohydrate intake for blood sugar control, you may eat, as you desire from this food group. Grains, cereals, and breads are a good source of calories. Most people need 6 -11 servings from this group each day.

Amounts equal to one serving:

  • 1slice bread (white, rye, or sourdough)
  • ½ English muffin
  • ½ bagel
  • ½ hamburger bun
  • ½ hot dog bun
  • 1 6-inch tortilla
  • ½ cup cooked pasta
  • ½ cup cooked white rice
  • ½ cup cooked cereal (like cream of wheat)
  • 1 cup cold cereal (like corn flakes or crispy rice)
  • 4 unsalted crackers
  • 1½ cups unsalted popcorn
  • 10 vanilla wafers

Avoid “whole grain” and “high fiber” foods (like whole wheat bread, bran cereal and brown rice) to help you limit your intake of phosphorus. By limiting dairy–based foods you protect your bones and blood vessels.

Milk/Yogurt/Cheese

Limit your intake of milk, yogurt, and cheese to ½-cup milk or ½-cup yogurt or 1-ounce cheese per day. Most dairy foods are very high in phosphorus.

The phosphorus content is the same for all types of milk – skim, low fat, and whole! If you do eat any high-phosphorus foods, take a phosphate binder with that meal.

Dairy foods “low” in phosphorus:

  • Butter and tub margarine
  • Cream cheese
  • Heavy cream
  • Ricotta cheese
  • Brie cheese
  • Non-dairy whipped topping
  • Sherbet

If you have or are at risk for heart disease, some of the high fat foods listed above may not be good choices for you.

Certain brands of non-dairy creams and “milk” (such as rice milk) are low in phosphorus and potassium. Ask your dietitian for details.

Fruit/Juice

All fruits have some potassium, but certain fruits have more than others and should be limited or totally avoided. Limiting potassium protects your heart.

Limit or avoid :

  • Oranges and orange juice
  • Kiwis
  • Nectarines
  • Prunes and prune juice
  • Raisins and dried fruit
  • Bananas
  • Melons (cantaloupe and honeydew)

Always AVOID star fruit (carambola).

Eat 2-3 servings of low potassium fruits each day.
One serving = ½-cup or 1 small fruit or 4 ounces of juice.

Choose:

  • Apple (1)
  • Berries (½ cup)
  • Cherries (10)
  • Fruit cocktail, drained (½ cup)
  • Grapes (15)
  • Peach (1 small fresh or canned, drained)
  • Pear, fresh or canned, drained (1 halve)
  • Pineapple (½ cup canned, drained)
  • Plums (1-2)
  • Tangerine (1)
  • Watermelon (1 small wedge)

Drinks:

  • Apple cider
  • Cranberry juice cocktail
  • Grape juice
  • Lemonade

Vegetables/Salads

All vegetables have some potassium, but certain vegetables have more than others and should be limited or totally avoided. Limiting potassium intake protects your heart.

Eat 2-3 servings of low-potassium vegetables each day. One serving = ½-cup.

Choose:

  • Broccoli
  • Cabbage
  • Carrots
  • Cauliflower
  • Celery
  • Cucumber
  • Eggplant
  • Garlic
  • Green and Wax beans (“string beans”)
  • Lettuce-all types (1 cup)
  • Onion
  • Peppers-all types and colors
  • Radishes
  • Watercress
  • Zucchini and Yellow squash

Limit or avoid:

  • Potatoes (including French Fries, potato chips and sweet potatoes)
  • Tomatoes and tomato sauce
  • Winter squash
  • Pumpkin
  • Asparagus
  • Avocado
  • Beets
  • Beet greens
  • Cooked spinach
  • Parsnips and rutabaga

Dessert

Depending on your calorie needs, your dietitian may recommend high-calorie deserts. Pies, cookies, sherbet, and cakes are good choices (but limit dairy-based desserts and those made with chocolate, nuts, and bananas). If you are a diabetic, discuss low carbohydrate dessert choices with your dietitian.

Sample Menu

Breakfast

Cranberry Juice, 4 ounces
Eggs (2) or ½-cup egg substitute
Toasted white bread, 2 slices, with Butter or tub margarine or fruit spread
Coffee, 6 ounces

Lunch

Tuna salad sandwich made with 3 ounces tuna on a hard roll with lettuce and mayonnaise.
(Other good choices for sandwiches include egg and chicken salad, lean roast beef, low salt ham and turkey breast.)
Coleslaw, ½-cup
Pretzels (low salt)
Canned and drained peaches, ½-cup
Ginger Ale, 8 ounces

(Cola drinks are high in phosphorus. Choose ginger ale or lemon-lime beverages instead.)

Dinner

Hamburger patty, 4 ounces on a bun with 1-2 teaspoons ketchup
Salad (1 cup): lettuce, cucumber, radishes, peppers, with olive oil and vinegar dressing
Lemonade, 8 ounces

Aim for at least 2-3 “fish” meals each week. Many fish are rich in heart-healthy “omega-3” fats. Tuna and salmon (rinsed or canned without salt) and shellfish are excellent heart healthy protein choices.

Snack/Dessert

Milk, 4 ounces
Slice of apple pie

This meal plan provides 2150 Calories, 91 grams protein, 2300 mg sodium, 1800 mg (46 mEq) potassium, 950 mg phosphorus. 38 ounces of oral fluid.

Reference: ESHA “Food Processor” nutrition software, version 8.5.0

The National Kidney Foundation would like to thank the Council on Renal Nutrition for the development of this fact sheet.

If you would like more information, please contact us.

©2014 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.