Kidney Failure

EAT RIGHT TO FEEL RIGHT

on Hemodialysis

U.S. Department 

of Health and

Human Services

NATIONAL INSTITUTES OF HEALTH

National Kidney and Urologic Diseases

Information Clearinghouse

Kidney Failure

EAT RIGHT TO FEEL RIGHT

on Hemodialysis

NATIONAL INSTITUTES OF HEALTH

National Institute of Diabetes and Digestive and Kidney Diseases
Contents

How to Use This Publication . . . . . . . . . . . . . . . . . . . . . . . . 1

How does food affect my hemodialysis? . . . . . . . . . . . . . . . 2

What do I need to know about fluids? . . . . . . . . . . . . . . . . . 3

What do I need to know about potassium? . . . . . . . . . . . . . 7

What do I need to know about phosphorus? . . . . . . . . . . . 10

What do I need to know about protein? . . . . . . . . . . . . . . 11

What do I need to know about sodium? . . . . . . . . . . . . . . 13

What do I need to know about calories? . . . . . . . . . . . . . . 15

Should I take vitamins and minerals? . . . . . . . . . . . . . . . . . 16

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1

How to Use This Publication

When you start hemodialysis, you must make many changes

in your life. Watching the foods you eat will make you

healthier. This publication will help you choose the right

foods.

Print this publication and use it with a dietitian to help you

learn how to eat right to feel right on hemodialysis. Read one

section at a time. Then go through the exercise for that

section with your dietitian.

Once you have completed every exercise, keep a copy of this

publication to remind yourself of foods you can eat and foods

you need to avoid.

My dietitian’s name is

__________________________________________________

Phone

__________________________________________________
2

How does food affect my hemodialysis?

Food gives you energy and helps your body repair itself.

Food is broken down in your stomach and intestines. Your

blood picks up nutrients from the digested food and carries

them to all your body cells. These cells take nutrients from

your blood and put waste products back into the bloodstream.

When your kidneys were healthy, they worked around the

clock to remove wastes from your blood. The wastes left

your body when you urinated. Other wastes are removed in

bowel movements.

Now that your kidneys have stopped working, hemodialysis

removes wastes from your blood. But between dialysis

sessions, wastes can build up in your blood and make you

sick. You can reduce the amount of wastes by watching what

Talk with a dietitian to learn how to eat right on hemodialysis.
3

you eat and drink. A good meal plan can improve your

dialysis and your health.

Your clinic has a dietitian to help you plan meals. A dietitian

specializes in food and nutrition. A dietitian with special

training in care for kidney health is called a renal dietitian.

What do I need to know about fluids?

You already know you need to watch how much you drink.

Any food that is liquid at room temperature also contains

water. These foods include soup, Jell-O, and ice cream.

Many fruits and vegetables contain lots of water, too. They

include melons, grapes, apples, oranges, tomatoes, lettuce,

and celery. All these foods add to your fluid intake.

Fluid can build up between dialysis sessions, causing swelling

and weight gain. The extra fluid affects your blood pressure

and can make your heart work harder. You could have

serious heart trouble from overloading your system with fluid.

Control Your Thirst

The best way to reduce fluid intake is to reduce thirst

caused by the salt you eat. Avoid salty foods like chips

and pretzels. Choose low-sodium products.

You can keep your fluids down by drinking from smaller

cups or glasses. Freeze juice in an ice cube tray and eat it

like a popsicle. (Remember to count the popsicle in your

fluid allowance!) The dietitian will be able to give you

other tips for managing your thirst.
4

Your dry weight is your weight after a dialysis session when all

of the extra fluid in your body has been removed. If you let

too much fluid build up between sessions, it is harder to get

down to your proper dry weight. Your dry weight may

change over a period of 3 to 6 weeks. Talk with your doctor

regularly about what your dry weight should be.

My dry weight should be _____________.

Many foods contain water.

Water
5

Talk With a Dietitian

Even though you are on hemodialysis, your kidneys may

still be able to remove some fluid. Or your kidneys may

not remove any fluid at all. That is why every patient

has a different daily allowance for fluid. Talk with your

dietitian about how much fluid you can have each day.

I can have _________ ounces of fluid each day.

Plan 1 day of fluid servings:

I can have _________ ounce(s) of ____________________ 

with breakfast.

I can have _________ ounce(s) of ____________________ 

in the morning.

I can have _________ ounce(s) of ____________________ 

with lunch.

I can have _________ ounce(s) of ____________________ 

in the afternoon.

I can have _________ ounce(s) of ____________________ 

with supper.

I can have _________ ounce(s) of ____________________ 

in the evening.

TOTAL _________ ounces (should equal the allowance

written above)
6

Be careful to keep track of your fluids and other foods.
7

What do I need to know about potassium?

Potassium is a mineral found in many foods, especially milk,

fruits, and vegetables. It affects how steadily your heart beats.

Healthy kidneys keep the right amount of potassium in the

blood to keep the heart beating at a steady pace. Potassium

levels can rise between dialysis sessions and affect your

heartbeat. Eating too much potassium can be very dangerous

to your heart. It may even cause death.

You can remove some potassium from potatoes by soaking them in water.
8

To control potassium levels in your blood, avoid foods like

avocados, bananas, kiwis, and dried fruit, which are very

high in potassium. Also, eat smaller portions of other highpotassium foods. For example, eat half a pear instead of a

whole pear. Eat only very small portions of oranges and

melons.

Dialyzing Potatoes and Other Vegetables

You can remove some of the potassium from potatoes and

other vegetables by peeling them, then soaking them in a

large amount of water for several hours. Drain and rinse

the vegetables before cooking them. Your dietitian will

give you more specific information about the potassium

content of foods.
9

Talk With a Dietitian

Make a food plan that reduces the potassium in your diet.

Start by noting the high-potassium foods (below) that

you now eat. A dietitian can help you add other foods

to the list.

High-Potassium Foods:

apricots kiwi fruit potatoes

avocados lima beans prune juice

bananas melons prunes

beets milk raisins

Brussels sprouts nectarines sardines

cantaloupe orange juice spinach

clams oranges tomatoes

dates peanuts winter squash

figs pears (fresh) yogurt

Others: ___________________________________________

__________________________________________________

Changes:

Talk with a dietitian about foods you can eat instead of

high-potassium foods.

Instead of _______________, I will eat ________________.

Instead of _______________, I will eat ________________.

Instead of _______________, I will eat ________________.

Instead of _______________, I will eat ________________.
What do I need to know about phosphorus?

Phosphorus is a mineral found in many foods. If you have

too much phosphorus in your blood, it pulls calcium from

your bones. Losing calcium will make your bones weak and

likely to break. Also, too much phosphorus may make your

skin itch. Foods like milk and cheese, dried beans, peas,

colas, nuts, and peanut butter are high in phosphorus.

Usually, people on dialysis are limited to 1/2 cup of milk

per day. The renal dietitian will give you more specific

information regarding phosphorus.

You probably will need to take a phosphate binder like

Renagel, PhosLo, Tums, or calcium carbonate to control the

phosphorus in your blood between dialysis sessions. These

medications act like sponges to soak up, or bind, phosphorus

while it is in the stomach. Because it is bound, the

phosphorus does not get into the blood. Instead, it is

passed out of the body in the stool.

10

Taking a phosphate binder helps control phosphorus in your blood.
11

What do I need to know about protein?

Before you were on dialysis, your doctor may have told you

to follow a low-protein diet. Being on dialysis changes this.

Most people on dialysis are encouraged to eat as much highquality protein as they can. Protein helps you keep muscle

and repair tissue. The better nourished you are, the healthier

you will be. You will also have greater resistance to infection

and recover from surgery more quickly.

Your body breaks protein down into a waste product called

urea. If urea builds up in your blood, it’s a sign you have

become very sick. Eating mostly high-quality proteins is

important because they produce less waste than others. 

High-quality proteins come from meat, fish, poultry, and

eggs (especially egg whites).

Poultry and fish, like broiled flounder, are good sources of high-quality protein.
12

Talk With a Dietitian

Meat, fish, and chicken are good sources of protein. Talk

with a dietitian about the meats you eat.

I will eat ______ servings of meat each day. A regular

serving size is 3 ounces. This is about the size of the palm

of your hand or a deck of cards.

Try to choose lean (low-fat) meats that are also low in

phosphorus. If you are a vegetarian, ask about other ways

to get your protein.

Low-fat milk is a good source of protein. But milk is high

in phosphorus and potassium. And milk adds to your

fluid intake. Talk with a dietitian to see if milk fits into

your food plan.

I (will) (will not) drink milk. I will drink ______ cup(s) of

milk a day.
13

What do I need to know about sodium?

Sodium is found in salt and other foods. Most canned foods

and frozen dinners contain large amounts of sodium. Too

much sodium makes you thirsty. But if you drink more fluid,

your heart has to work harder to pump the fluid through your

body. Over time, this can cause high blood pressure and

congestive heart failure.

Try to eat fresh foods that are naturally low in sodium. Look

for products labeled low sodium.

Do not use salt substitutes because they contain potassium.

Talk with a dietitian about spices you can use to flavor your

food. The dietitian can help you find spice blends without

sodium or potassium.

Find new ways to spice up your food.
14

Talk With a Dietitian

Talk with a dietitian about spices and other healthy foods

you can use to flavor your diet. List them on the lines

below.

Spice: ______________________________________

Spice: ______________________________________

Spice: ______________________________________

Food: ______________________________________

Food: ______________________________________
15

What do I need to know about calories?

Calories provide energy for your body. If your doctor

recommends it, you may need to cut down on the calories

you eat. A dietitian can help you plan ways to cut calories in

the best possible way.

Some people on dialysis need to gain weight. You may need

to find ways to add calories to your diet. Vegetable oils—like

olive oil, canola oil, and safflower oil—are good sources of

calories. Use them generously on breads, rice, and noodles.

Butter and margarines are rich in calories. But these fatty

foods can also clog your arteries. Use them less often. Soft

margarine that comes in a tub is better than stick margarine.

Vegetable oils are the healthiest way to add fat to your diet if

you need to gain weight.

Hard candy, sugar, honey, jam, and jelly provide calories and

energy without clogging arteries or adding other things that

your body does not need. If you have diabetes, be very

careful about eating sweets. A dietitian’s guidance is very

important for people with diabetes.

If you need to get extra calories, vegetable oils like

these are a good choice.
16

Should I take vitamins and minerals?

Vitamins and minerals

may be missing from

your diet because you

have to avoid so many

foods. Your doctor may

prescribe a vitamin and

mineral supplement like

Nephrocaps.

Warning: Do not take

vitamin supplements that

you can buy off the store

shelf. They may contain

vitamins or minerals that

are harmful to you.

Resources

Books

Bowes and Church’s Food Values of Portions Commonly Used

Eighteenth Edition

Jean A.T. Pennington and Judith S. Douglass 

J.P. Lippincott Co. 2004

ISBN: 0-7817-4429-6

The Complete Book of Food Counts 

Seventh Edition

Corinne T. Netzer

Dell Publishing Co. 2005

ISBN: 0-440-24123-5

Take only the vitamins your doctor prescribes.
17

Brochures

Nutrition and Hemodialysis

National Kidney Foundation

30 East 33rd Street

New York, NY 10016

Phone: 1–800–622–9010 or 212–889–2210

How to Increase Calories in Your Renal Diet

National Kidney Foundation

30 East 33rd Street

New York, NY 10016

Phone: 1–800–622–9010 or 212–889–2210

Charts and Posters

Kidney HELPER Phosphorus Guide (chart or poster) 

Kidney HELPER Potassium Guide (chart or poster) 

Available from Consumer MedHelp, Inc.

2437 Bay Area Boulevard

PMB 128

Houston, TX 77058

Phone: 877–248–2331 or 281–486–9258 

Fax: 281–576–8990

Email: info@consumermedhelp.com

Internet: www.consumermedhelp.com

Picture Renal Diet (poster) 

Available from University Hospital, Food and Nutrition Services

619 South 19th Street

Birmingham, AL 35233 

Phone: 205–934–6375

Internet: www.health.uab.edu
18

Cookbooks

These cookbooks provide recipes for people on dialysis:

The Renal Gourmet

Mardy Peters

ISBN: 0-9641730-0-X 

Emenar Incorporated

13n625 Coombs Road

Elgin, IL 60123

Fax: 847–741–8696

Email: webmaster@kidney-cookbook.com

Internet: www.kidney-cookbook.com

Southwest Cookbook for People on Dialysis

Developed by the El Paso Chapter Council on Renal Nutrition 

and the National Kidney Foundation of Texas, Inc. 

Published by a grant from Amgen Inc. 

Internet: www.epogen.com/patient/pdf/

southwest_cookbook.pdf

Creative Cooking for Renal Diets

Cleveland Clinic Foundation

ISBN: 0-941511-00-6

Senay Publishing 

P.O. Box 397

Chesterland, OH 44026 

Phone: 866–648–2693 

Email: jsenay@adelphia.net

Internet: www.patientsupport.net/patsupport/

renal-diet-cookbooks.htm
Creative Cooking for Renal Diabetic Diets

Cleveland Clinic Foundation 

ISBN: 0-941511-01-4 

Senay Publishing 

P.O. Box 397 

Chesterland, OH 44026 

Phone: 866–648–2693 

Email: jsenay@adelphia.net

Internet: www.patientsupport.net/patsupport/

renal-diet-cookbooks.htm

Kidney Friendly Comfort Foods 

Shire US Inc.

Wayne, PA 19087 

Phone: 866–896–6152

Internet: www.fosrenol.com/Consumers/Resources/

CookBooks.aspx

Cooking for David

Culinary Kidney Cooks

P.O. Box 468

Huntington Beach, CA 92648 

Phone: 714–842–4684

Email: Eric.Brooks@CulinaryKidneyCooks.com

Internet: www.culinarykidneycooks.com

More Online Information

The American Association of Kidney Patients provides an

online nutrition counter at www.aakp.org/brochures/

nutrition-counter.

The National Kidney Foundation offers many fact sheets for

patients with kidney disease at www.kidney.org on the

Internet.

19
Acknowledgments

The individuals listed here provided editorial guidance or

facilitated field testing for this publication. The National

Kidney and Urologic Diseases Information Clearinghouse

would like to thank them for their contribution.

20

Lawrence Y. Agodoa,

M.D.

End-Stage Renal Disease

Program

National Institute of

Diabetes and Digestive

and Kidney Diseases

National Institutes of

Health

Bethesda, MD

Kim Bayer, M.A., R.D.,

L.D.

BMA Dialysis

Bethesda, MD

Josephine P. Briggs, M.D.

Howard Hughes Medical

Institute

Chevy Chase, MD

Shirley Cox, R.D., L.D.

Amarillo High Plains

Dialysis Center

Amarillo, TX

Sana Dicey, R.D.

Department of Chronic

Dialysis Programs

Shore Memorial

Hospital

Somers Point, NJ

Laura Byham Gray, M.S.,

R.D., C.N.S.D.

Department of Nutrition

Services

Shore Memorial

Hospital

Somers Point, NJ

Linda Hager, M.S., R.D.

Total Renal Care

Minneapolis Dialysis

Unit

Minneapolis, MN

Melissa Hildebrand,

R.D., L.D.

Total Renal Care

Minneapolis Dialysis

Unit

Minneapolis, MN

Lisa Hill, R.D., C.D.E.

Dialysis Clinic, Inc.

Nashville, TN

Jean King, R.D., C.D.E.

Pikes Peak Dialysis

Center, Inc.

Colorado Springs, CO

Wanda Knopik

Total Renal Care

Minneapolis Dialysis

Unit

Minneapolis, MN

Susan Lindsey-Goldman,

R.D.

Kessler Dialysis

Hammonton, NJ

Betty Murray, R.N.

Dialysis Clinic, Inc.

Nashville, TN

Andrew Narva, M.D.

National Kidney Disease

Education Program

National Institute of

Diabetes and Digestive

and Kidney Diseases

National Institutes of

Health

Bethesda, MD

Jean Pennington, Ph.D.,

R.D.

Division of Nutrition

Research

Coordination

National Institute of

Diabetes and Digestive

and Kidney Diseases

National Institutes of

Health

Bethesda, MD

Gail Radosevich, R.D.,

L.D.

Total Renal Care

Minneapolis Dialysis

Unit

Minneapolis, MN

Susan Schommer, R.D.,

L.D.

Total Renal Care

Minneapolis Dialysis

Unit

Minneapolis, MN

Charlotte Stall, M.A.,

R.D.

The Children’s Hospital

Denver, CO
21

The U.S. Government does not endorse or favor

any specific commercial product or company. Trade,

proprietary, or company names appearing in this

document are used only because they are considered

necessary in the context of the information provided.

If a product is not mentioned, the omission does not

mean or imply that the product is unsatisfactory.
About the Kidney Failure Series

You and your doctor will work together to choose a treatment

that’s best for you. The publications of the National Institute

of Diabetes and Digestive and Kidney Diseases (NIDDK)

Kidney Failure Series can help you learn about the specific

issues you will face.

Booklets

• Eat Right to Feel Right on Hemodialysis

• Kidney Failure: Choosing a Treatment That’s Right for You

• Kidney Failure Glossary

• Treatment Methods for Kidney Failure: Hemodialysis

• Treatment Methods for Kidney Failure: Peritoneal Dialysis

• Treatment Methods for Kidney Failure: Transplantation

Fact Sheets

• Amyloidosis and Kidney Disease 

• Anemia in Kidney Disease and Dialysis 

• Financial Help for Treatment of Kidney Failure

• Hemodialysis Dose and Adequacy 

• Kidney Failure: What to Expect 

• Peritoneal Dialysis Dose and Adequacy 

• Renal Osteodystrophy 

• Vascular Access for Hemodialysis 

Learning as much as you can about your treatment will help

make you an important member of your health care team.

The NIDDK will develop additional materials for this series as

needed. Please address any comments about this series and

requests for copies to the National Kidney and Urologic

Diseases Information Clearinghouse. Descriptions of the

publications in this series are available on the Internet at

www.kidney.niddk.nih.gov/kudiseases/pubs/kidneyfailure/

index.htm.
National Kidney and Urologic Diseases

Information Clearinghouse

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390

Fax: 703–738–4929

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases Information

Clearinghouse (NKUDIC) is a service of the National Institute

of Diabetes and Digestive and Kidney Diseases (NIDDK).

The NIDDK is part of the National Institutes of Health of the

U.S. Department of Health and Human Services. Established

in 1987, the Clearinghouse provides information about

diseases of the kidneys and urologic system to people with

kidney and urologic disorders and to their families, health

care professionals, and the public. The NKUDIC answers

inquiries, develops and distributes publications, and works

closely with professional and patient organizations and

Government agencies to coordinate resources about kidney

and urologic diseases.

Publications produced by the Clearinghouse are carefully

reviewed by both NIDDK scientists and outside experts. 

This publication is not copyrighted. The Clearinghouse

encourages users of this booklet to duplicate and

distribute as many copies as desired.

This booklet is also available at www.kidney.niddk.nih.gov.
24

National Institute of Diabetes and Digestive and Kidney Diseases

NIH Publication No. 07–4274

December 2006

U.S. Department of Health and Human Services

National Institutes of Health