Question: What to do for Kidney Failure: Choosing a Treatment That's Right for You ?

Answer: All of the treatment options for kidney failure require changes and restrictions in your diet.
                
Hemodialysis
                
Hemodialysis has the most restrictions. You should watch how much water and other liquids you get from food and drinks and avoid getting too much sodium, often from salt; potassium; and phosphorus. You may find it difficult to limit phosphorus because many foods that are high in phosphorus also provide the protein you need. Hemodialysis can remove protein from the body, so you should eat foods with high-quality protein, such as meat, fish, and eggs. Limit your phosphorus by avoiding foods such as beans, peas, nuts, tea, and colas. You may also need to take a pill called a phosphate binder that keeps phosphorus in your food from entering your bloodstream. Talk with your dialysis centers dietitian to find a hemodialysis meal plan that works for you.
                
More information about nutrition for people who are on hemodialysis is provided in the NIDDK health topic, Eat Right to Feel Right on Hemodialysis.
                
Peritoneal Dialysis
                
Like hemodialysis, peritoneal dialysis requires limits on sodium and phosphorus. You may need to take a phosphate binder. The liquid limitations in peritoneal dialysis may not be as strict as those for hemodialysis. In fact, you may need to drink more water and other liquids if your peritoneal dialysis treatments remove too much fluid from your body. Peritoneal dialysis removes potassium from the body, so you may need to eat potassium-rich foods such as potatoes, tomatoes, oranges, and bananas. However, be careful not to eat too much potassium because it can cause an unsteady heartbeat. Peritoneal dialysis removes even more protein than hemodialysis, so eating foods with high-quality protein is important. You may need to limit calories because your body absorbs sugar from the dialysis solution.
                
Kidney Transplantation
                
Kidney transplantation has the fewest restrictions on your diet. You should limit sodium because it can raise your blood pressure. Medicines that you take after the transplant can cause you to gain weight, so you may need to limit calories.
                
Conservative Management
                
The diet for conservative management limits protein. Protein breaks down into waste products the kidneys must remove. Limiting protein may reduce the amount of work the kidneys have to do so they will last longer.
                

                
Hemodialysis    Peritoneal Dialysis    Kidney Transplantation                 In Center                 Home                 CAPD                 CCPD                 Deceased                 Living                     Schedule                 Three treatments a week for 3 to 5 hours or more.                 More flexibility in determining your schedule of treatments.                 Four to six exchanges a day, every day.                 Three to five exchanges a night, every night, with an additional exchange begun first thing in the morning.                 You may wait several years before a suitable kidney is available.                 If a friend or family member is donating, you can schedule the operation when you're both ready.                     After the operation, you'll have regular checkups with your doctor.                     Location                 Dialysis center.                 Home.                 Any clean environment that allows solution exchanges.                 The transplant operation takes place in a hospital.                     Availability                 Available in most communities; may require travel in some rural areas.                 Generally available, but not widely used because of equipment requirements.                 Widely available.                 Widely available.                 Transplant centers are located throughout the country. However, the demand for kidneys is far greater than the supply.                     Equipment      and Supplies                 No equipment or supplies in the home.                 Hemodialysis machine connected to plumbing; chair.                 Bags of dialysis solution take up storage space.                 Cycling machine; bags of dialysis solution.                 No equipment or supplies needed.                     Training Required                 Little training required; clinic staff perform most tasks.                 You and a helper must attend several training sessions.                 You'll need to attend several training sessions.                 You'll need to learn about your medications and when to take them.                     Diet                 Must limit fluids, sodium, potassium, and phosphorus.                 Must limit sodium and calories.                 Fewer dietary restrictions.                     Level of Freedom                 Little freedom during treatments. Greater freedom on non-treatment days.                 More freedom to set your own schedule. You're still linked to a machine for several hours a week.                 You can move around, exercise, work, drive, etc., with solution in your abdomen.                 You're linked to a machine during the night. You're free from exchanges during the day.                 Offers the greatest amount of freedom.                     Level of Responsibility                 Some patients prefer to let clinic staff perform all tasks.                 You and your helper are responsible for cleaning and setting up equipment and monitoring vital signs. Can be stressful on family helpers.                 You must perform exchanges four to six times a day, every day.                 You must set up your cycler every night.                 You must take immunosuppressants every day for as long as the transplanted kidney functions.
                
More information about the treatments for kidney failure is provided in the NIDDK health communication program, National Kidney Disease Education Program.