i

Kidney Failure

EAT RIGHT TO FEEL RIGHT

on Hemodialysis

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 booklet . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

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

How to use this booklet

When you start hemodialysis, you must make many changes

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

healthier. This book will help you choose the right foods.

Use this booklet 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 with your dietitian.

Once you have completed every exercise, keep this book to

remind yourself of foods you can eat and foods 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.

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

Now your kidneys have stopped working. Hemodialysis

removes wastes from your blood. But between sessions,

wastes can build up in your blood and make you sick. You

can reduce the amount of wastes by watching what 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 of 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 get serious

heart trouble from overloading your system with fluid.

Control your thirst

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. (Do not forget 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 to your doctor

regularly about what your dry weight should be.

My dry weight should be _____________.

Many foods contain water.

Water
5

Talk to 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 to 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

before cooking. Your dietitian will be giving you more

specific information about the potassium content of foods.
9

Talk to a dietitian

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

Start by circling the high-potassium foods (below) that you

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

not on the list.

High-potassium foods:

apricots kiwi fruit potatoes

avocados lima beans prune juice

bananas melons prunes

beets milk raisins

brussel sprouts nectarines sardines

cantaloupe orange juice spinach

clams oranges tomatoes

dates pears (fresh) winter squash

figs peanuts yogurt

Others: ___________________________________________

__________________________________________________

Changes:

Talk to a dietitian about foods you can eat instead of highpotassium 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

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. This is changed now. Most people on dialysis are encouraged to eat as much high-quality

protein as they can. The better nourished you are, the healthier you will be. You will also have greater resistance to infection and recover from surgery more quickly.

Protein helps you keep muscle and repair tissue. In your

body, protein breaks down into a waste product called urea.

If urea builds up in your blood, you can become very sick.

Some sources of protein produce less waste than others.

These are called high-quality proteins. High-quality proteins

come from meat, fish, poultry, and eggs (especially egg

whites). Getting most of your protein from these sources

can reduce the amount of urea in your blood.

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

Talk to a dietitian

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

to 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 stick to 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 to 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. Then, 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 these contain potassium.

Talk to a dietitian about other spices for your food. The

dietitian can help you find spice blends without sodium or

potassium.

Find new ways to spice up your food.
14

Talk to a dietitian

Talk to 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.

But 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 these less often. Soft

margarine that comes in tubs is better than stick margarine.

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

if needed.

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 vitamins that you can buy off the store

shelf. These may contain vitamins or minerals that are harmful to you.

Take only vitamins prescribed by your doctor.
17

Resources

Books

Bowes and Church’s Food Values of Portions Commonly Used.

Seventeenth Edition. Jean A. T. Pennington. J. P. Lippincott

Co. 1997. ISBN: 0–397–55435–4.

The Complete Book of Food Counts. Fourth Edition.

Corinne T. Netzer. Dell Publishing Co. 1997. 

ISBN: 0–440–22110–2.

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 Potassium Guide. (Chart or poster).

Available from Consumer MedHelp, 94 New Salem Street,

Suite 104, Wakefield, MA 01880–1906. 

Phone: 1–800–556–7117 or (781) 246–7700 

Fax: (781) 246–3086

Internet: www.consumermedhelp.com

Kidney HELPER Phosphorus Guide. (Chart or poster).

Available from Consumer MedHelp, 94 New Salem Street,

Suite 104, Wakefield, MA 01880–1906. 

Phone: 1–800–556–7117 or (781) 246–7700 

Fax: (781) 246–3086

Internet: www.consumermedhelp.com
18

Picture Renal Diet. (Poster). Available from University

Hospital, Food and Nutrition Services, 619 South 19th Street,

Birmingham, AL 35233. 

Phone: (205) 934–8055

Cookbooks

These cookbooks provide recipes for people on dialysis: 

The Renal Gourmet. Mardy Peters. Emenar Inc., 

320 Charmille Lane, Wood Dale, IL 60191. 

ISBN: 0–9641730–0–X. 

Phone: 1–800–445–5653

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. Cookbooks are available from the

National Kidney Foundation of Texas, 13500 Midway Road,

Suite 101, Dallas, TX 75244. 

Phone: (972) 934–8057

Creative Cooking for Renal Diets. Cleveland Clinic

Foundation. Senay Publishing, P.O. Box 397, Chesterland,

OH 44026. ISBN: 0–941511–00–6.

Phone: (440) 256–4435

Creative Cooking for Renal Diabetic Diets. Cleveland Clinic

Foundation. Senay Publishing, P.O. Box 397, Chesterland,

OH 44026. ISBN: 0–941511–01–4. 

Phone: (440) 256–4435
Computer Information

The American Association of Kidney Patients provides an

online sodium–potassium–phosphorus counter. Go to

http://cybermart.com/aakpaz/nakphos.html#top on

the Internet.

The National Kidney Foundation offers many fact sheets

for patients with kidney disease. Go to www.kidney.org

on the Internet.

19

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, this does not mean or

imply that the product is unsatisfactory.
Acknowledgments

The individuals listed here provided editorial guidance or

facilitated field testing for this publication. The National

Kidney and Urologic Diseases Information Clearinghouse

(NKUDIC) would like to thank them for their contribution.

20

Lawrence Y. Agodoa,

M.D.

End-Stage Renal Disease

Program

NIDDK, National

Institutes of Health

Bethesda, MD

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

L.D.

BMA Dialysis

Bethesda, MD

Josephine P. Briggs, M.D.

Director, Division of

Kidney, Urologic, and

Hematologic Diseases

NIDDK, National 

Institutes of Health

Bethesda, 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

Facility Administrator

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

Jean Pennington, 

Ph.D., R.D.

Research Nutritionist,

Division of Nutrition

Research

Coordination

NIDDK, 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
National Kidney and Urologic Diseases

Information Clearinghouse

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390 or (301) 654–4415

Fax: (301) 907–8906

Email: nkudic@info.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).

NIDDK is part of the National Institutes of Health under 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. 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 under “Health

Information” at www.niddk.nih.gov on the Internet.

About the Kidney Failure Series

You and your doctor will work together to choose a treatment that’s best for you. The booklets and fact sheets of the

NIDDK Kidney Failure Series can help inform you about the

specific issues you will face.

Booklets

• Kidney Failure: Choosing a Treatment That’s Right

for You

• Treatment Methods for Kidney Failure: Hemodialysis

• Treatment Methods for Kidney Failure: Peritoneal

Dialysis

• Treatment Methods for Kidney Failure: Transplantation

• Eat Right To Feel Right on Hemodialysis

• Kidney Failure Glossary

Fact Sheets

• Vascular Access for Hemodialysis

• Hemodialysis Dose and Adequacy

• Peritoneal Dialysis Dose and Adequacy

• Amyloidosis and Kidney Disease

• Anemia in Kidney Disease and Dialysis

• Renal Osteodystrophy

• Financial Help for Treatment of Kidney Failure

Learning as much as you can about your treatment will help

make you an important member of your health care team.

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. This series is also

on the NIDDK web site at www.niddk.nih.gov; click on

“Kidney” under Health Information.
24

National Institute of Diabetes and Digestive and Kidney Diseases

NIH Publication No. 01–4274

May 1999

Reprinted April 2001

U.S. Department of Health and Human Services

National Institutes of Health