A to Z Health Guide

Dietary Guidelines for Adults Starting on Hemodialysis

Now that you are beginning hemodialysis, there may be many changes in your daily life. Your doctor has probably told you that you may need to make some changes in your diet.
How well you feel will depend on:
  • Eating the right kind and amounts of food.
  • Having the hemodialysis treatments your health professional orders for you
  • Taking the medicines your health professional orders for you.
Your diet is an important part of your treatment. Your kidneys cannot get rid of enough waste products and fluids from your blood and your body now has special needs. Therefore, you will need to limit fluids and change your intake of certain foods in your diet.  The kidney dietitian at your dialysis center will help you plan a diet for your special needs.
 
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, water, and any food that is liquid at room temperature).

Salt & Sodium

Use less salt and eat fewer salty foods: This may help to control blood pressure. It may also help reduce fluid weight gains between dialysis sessions since salt increases thirst and causes the body to retain (or hold on to) fluid.
  • 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 keep healthy blood protein levels and improve health. Protein also helps keep your muscles strong, helps wounds heal faster, strengthens your immune system, and helps improve overall 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 every day.
3 ounces = 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, 1tablespoon peanut butter, ½ ounce of nuts or seeds
Note: Even though peanut butter, nuts, seeds, dried beans, peas, and lentils have protein, these foods are generally limited 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:

  • 1 slice 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:
(ask your dietitian about the serving size that is right for you)

  • 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 (raw or cooked from frozen)
  • 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 (cooked)
  • 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 have diabetes, discuss low carbohydrate dessert choices with your dietitian.

Sample Menu

Breakfast

Cranberry Juice, 4 ounces
Eggs (2) or ½-cup egg substitute
Toasted white or whole wheat bread (2 slices)
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 potassium, 950 mg phosphorus. 38 fluid ounces.
 

How will I know if I am eating right to stay healthy?

Eating well helps you stay healthy. Eating poorly can increase your chances of illness and affect how you feel.  Your dietitian will talk with you about how well you are eating and will help you adjust your diet to your individual needs based on your lab report and conversations with you. 
Some questions you might be asked:
  • Have you noticed a change in the kind or amount of food you eat each day?
  • Have you had any problems eating your usual or recommended diet?
  • Have you lost weight without trying?
  • Have you noticed any changes in your strength or ability to take care of yourself?
Your dietitian or nurse might look at the fat and muscle stores in your face, hands, arms, shoulders, and legs. Your dialysis care team will look for changes in your blood level of proteins, and especially one called “albumin.” A change in this protein can mean that you are losing body protein, but albumin can also be affected if you have an infection or are gaining too much fluid weight between treatments.  The dietitian may recommend a protein supplement such as Nepro™ or LiquaCel™ to increase protein levels.  The dietitian may also suggest small frequent meals and snacks.  Work with your dietitian to improve your blood level of protein. The right amount of dialysis is also important for eating well and staying healthy.
 

What if I have high cholesterol?

Changing your diet may help lower the cholesterol level in your blood. Your dietitian will talk with you about the kinds of fat and animal foods you eat. Increasing intake of low potassium fruits and vegetables, decreasing the amount of fried foods, in addition to 150 minutes of physical activity per week can help to improve cholesterol levels.
 

What if I have diabetes?

At first the kidney and diabetic diet appear to be very different, but they are alike in many ways.    Both diets recommend eating 3 balanced meals, avoiding large amounts of protein, and limiting sodium.    A balanced meal has at least 3 of the food groups (protein, grain, vegetables, fruits, and dairy).  The kidney diet limits the amount of milk that you drink, but many people with diabetes already limit milk to 4 ounces a day. Both recommend ½ plate of vegetables, ¼ plate of carbohydrate rich food, ¼ plate of high protein food, and a piece of fruit.  The biggest change is that the kidney diet does not have as much variety in the types of fruits and vegetable choices because some have more potassium than others.  The diabetic diet recommends 45 to 75 grams of carbohydrate with each meal and spacing meals 4 to 5 hours apart. This recommendation is good for the kidney diet, too. Both the kidney and diabetic diet help to keep your heart healthy.

In some cases, you may need to make only a few changes in your diet to fit your needs as a kidney patient. For example, you may need to limit some of the free foods you have been using may need to be limited on your kidney diet. Your dietitian will help make a meal plan especially for you.

Is there anything else I should know?

The following important tips can be helpful with your diet:
  • Fresh or plain frozen vegetables contain no added salt. Drain all the cooking liquid before serving.
  • Canned fruits usually contain less potassium than fresh fruits. Drain all the liquid before serving.
  • Rice and almond milk are low in phosphorus and can be used in place of milk.
  • Labels on food packages will give you information about some of the ingredients that may not be allowed in your diet. Learn to read these labels to help you limit sodium and control phosphorous.  Avoid foods with ingredients that contain “PHOS”
  • To help you avoid salt, many herbs and spices can be used to make your diet more interesting. Check with your dietitian for a list of these.

If you would like more information, please contact us.

Reviewed by the Council on Renal Nutrition: April 2019​

© 2019 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.

The information shared on our websites is information developed solely from internal experts on the subject matter, including medical advisory boards, who have developed guidelines for our patient content. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.