Dialysis performs some of the functions that kidneys do. However, it doesn’t work as well and as much as the healthy kidneys. Some waste and fluid may still build up between dialysis sessions, which is why doctors encourage kidney disease patients to watch out for certain nutrients and their fluid intake. 

Your choice of food and liquid consumption can make a difference in helping your dialysis treatment work better and minimize waste and fluid build-up in your blood. 

In this article, we will discuss how you can get started with a dialysis diet along with doable tips to sustain it. 

What is Dialysis?

When your CKD becomes severe and reaches a point that it cannot function enough to sustain your body, you may need dialysis or a kidney transplant. An end-stage kidney failure is a point where your kidney function is below 10 percent of its normal capacity. You can follow this link to learn more about end-stage renal failure. 

Dialysis is a procedure that takes over kidney function when the kidneys couldn’t. This treatment filters and purifies the blood through a machine. Dialysis treatment keeps a safe level of the chemical in the blood including sodium, potassium, and bicarbonate. It also helps control blood pressure. 

You may be a candidate for dialysis if you lose 85 to 90 per cent of your kidney function. Alternately, your doctor may recommend starting dialysis while your kidney function is better. Your lab test, age, energy level, overall health and commitment to the treatment plan can determine when to get started with the dialysis treatment. 

Types of Dialysis

There are two types of dialysis, namely, Peritoneal and Hemodialysis. A quick comparison of these two types could give you an idea of what might work best for you:

1.) Peritoneal Dialysis

Process: A catheter, a soft plastic tube, is placed in your stomach through surgery. Then a sterile fluid (dialysate) is passed through the line to help cleanse and filter the blood. The fluid then leaves the body through a catheter as well.

2.) Hemodialysis

Process: A machine functions as an artificial kidney. It is connected to the body once a week to perform the filtering and cleaning of the blood.

For a more detailed comparison of peritoneal and hemodialysis, you can check  https://blog.renaltracker.com/chronic-kidney-disease-101/dialysis-demystified-hemodialysis-vs-peritoneal-dialysis/

Thinking about starting dialysis could be scary and overwhelming. Nevertheless, you can take good care of yourself by following a healthy dialysis diet and some lifestyle changes, like minimizing smoking, to make the most of your treatment. 

Some foods can cause waste and toxin build-up in your blood between your dialysis sessions. Your dialysis treatment may not remove all the toxins if your blood has too much waste. Following a Dialysis Diet can make your dialysis sessions work better and make you feel better. 

Consulting a dietitian

Consulting a renal dietitian would be the first step before starting your dialysis diet. The dietitian will help you determine your required calorie, macronutrient (protein, carbohydrates, and fat), and fluid intake. These requirements are specific to your needs, protecting you from any form of malnutrition.

In the next section, we will be discussing protein & fluid requirement and recommendations on appropriate food selections. This would, at least, prepare you before you consult with a renal dietitian.

Protein Requirement

Protein helps your body heal, regenerate and build muscles. The type of dialysis you'll do will help determine your body's protein requirement. Peritoneal dialysis requires more protein intake than Hemodialysis because it is done about 3-5 times a day. This causes proteins to exit more frequently from the body. Your actual body weight (ABW) is the key factor in computing your protein requirement.

To give you an idea of how your dietitian computes your protein requirement:
For Peritoneal dialysis:
1.5g x ABW in kilograms = Protein Intake per day in grams
For Hemodialysis:
1.2-1.3g x ABW in kilograms = Protein Intake per day in grams

Let's say your body weight is 75 kg, if we use the computation above, your protein requirement based on the type of dialysis would be:
For Peritoneal dialysis:
1.5g x 75kg = 112g of high protein food sources
For Hemodialysis:
1.2g x 75kg =90g of high protein food sources

A difference of about 16g of protein, equivalent to almost 2 oz. of meat.

It sounds simple to compute, right? But the interpretation of grams in actual food servings is rather different. If, for example, you're allowed to have 90g of protein in a day, note that, 90g of protein does not literally mean 90g of fish, chicken, or meat. Its actual measurement would be around 8 ounces of meat, poultry, eggs, and fish per day. When you convert that 8 ounces of high protein source per day into the number of meals, it can be something like this:

Breakfast: 2 eggs (2 oz.) + 2 oz. homemade beef sausage patty
Lunch: Roast Rosemary Chicken leg (2oz.)
Dinner: 2 oz. Baked Salmon in lemon and garlic 

The distribution of key nutrients, protein along with carbohydrates and fats, depends on your preferences. With the help of your dietitian, you could try other creative ways of incorporating your protein into meals. Here’s an example: 

Breakfast: ½ cup serving of 2% cottage cheese partnered with 2 slices of toast
AM Snacks: ½ cup pasta salad with 1 oz. roast meat or 1 boiled egg
Lunch: 2 oz. roast beef with ½ cup homemade mashed potatoes
PM Snacks: An oz. of homemade chicken or beef spread in lite mayo for a sandwich
Dinner: 2 oz. tuna mixed with 1 cup Salad of low potassium veggies

Fluid Restrictions

When the kidney is not performing at its best, the volume and frequency of urine may not be as it has been before. This may cause fluid build-up in the blood, which can lead to "edema" or the swelling of your lower extremities, like legs and feet. Because of this, you may have to limit your fluid intake, which can be determined by the type of dialysis you'll be doing. 

For Hemodialysis patients, it's usually 4 cups a day if you're doing 3 times a week of treatment. For Peritoneal dialysis patients or daily home dialysis, it's less restrictive, and fluid intake may range to 5-6 cups a day. When we talk about fluid, it is anything that contains liquid, which may include:

• Ice

• Beverages like juice drinks, smoothies, coffee, tea
• Soups 
• Desserts like ice cream, pudding
• Watery fruits like Watermelon and Pear (but this may be up for discussion with your dietitian)

Minerals to watch out for

In both diets for early-stage CKD (Chronic Kidney Disease) and those undergoing dialysis, there are two Ps you should watch out for in your meals. These are Potassium and Phosphorus. Although both are necessary for bodily functions, they may pose a threat (to you), if levels are not managed.

So why should you limit these two in your diet?

Since the kidneys are not functioning well, these two minerals and sodium can build up in the blood that may have adverse effects on your body, such as hyperkalemia (excessive potassium levels in the blood) that could eventually cause heart problems and hyperphosphatemia (excessive phosphorus in the blood) which can cause bone and muscle problems.

Phosphorus is often used as an additive or preservative in packed meals. Check the ingredients section of the nutrition label and look for the suffix "Phos" as a guide. 

Examples of additives with Phosphate are:

• Dicalcium phosphate
• Disodium phosphate
• Monosodium phosphate
• Phosphoric acid
• Sodium hexameta-phosphate
• Trisodium phosphate
• Sodium tripolyphosphate
• Tetrasodium pyrophosphate

Additionally, sodium and potassium can also be found in boxed meals, bread products, and instant meals. Further to this, be wary of cured and preserved meat products since they have high amounts of sodium. 

You may look for potassium, phosphorus, and sodium in the ingredients list or nutrition facts label. As a guide by the FDA (Food and Drug Administration), if the daily value percentage found on the right side of the nutrition facts label is higher than 20%, it is considered a high source of a specific nutrient. Therefore, it is highly recommended to look for products with a daily value percentage per serving below 5% -- esp. for the minerals previously mentioned.  

To know more about reading nutrition facts label, you may check this link from the Food and Drug Administration: https://www.fda.gov/media/135304/download

Fruits and vegetables may also contain high levels of potassium. You can add this list of low potassium fruits and veggies to your diet instead. 

Some additional tips for meal preparation

Starting a dialysis diet may be challenging, and food may taste bland-- a reason why most feel discouraged. But it does not always have to be the case. Here are some tips that may help you enjoy your food and still follow the diet:

1.) Seasonings that don't involve salt 

Meals can be bland without salt. Luckily, herbs and spices can make your meals flavorful and healthier! Here are a few seasonings you can add to your home cooking:

• Basil
• Ginger
• Thyme
• Oregano
• Rosemary
• Sage
• Chives or scallions
• Cilantro
• Mint
• A few drops of lemon

There are non-salt-containing seasonings available in the market, such as Cavender's Salt-free Greek Seasoning, Mrs. Dash's No Salt Spices, and Bragg's Organic 24 Herbs and Spices Seasoning.

2.) Enjoy a variety of ways of cooking your food.

You can go for these cooking methods:

• Steaming
• Baking
• Roasting
• Pan-frying
• Braising
• Slow-cooking

3.) Plan ahead when eating out 

Knowing that a diet can be somewhat restrictive, planning where to eat and ordering can be worrisome. It would be best if you could:

• Check the menu online or call the restaurant for more information
• Talk to the Chef or Restaurant Manager for any special request 
• Consider ordering foods cooked in less oil and sauces, as restaurants tend to season their food with pre-prepared mixes that contain high amounts of salt and additives
• Consider eating half portions only if the restaurant serves big portion sizes
• Remove breaded layers on fish, chicken, and meat as they tend to be laden with salt and high in fat

The Bottom line

To sum it all up, here are some points to remember, so you could get started with your Dialysis Diet.

1. Have your macronutrients and energy intake assessed by a dietitian
2. Protein requirements will vary depending on the type of dialysis you'll be in. Peritoneal dialysis requires a higher protein intake compared to Hemodialysis. Preferably, protein sources have to be from high protein-containing foods like poultry, eggs, fish, and meat. 
3. Fluid intake will also vary depending on the type of dialysis. Peritoneal dialysis and daily in-home dialysis are not restrictive to fluid intake compared to Hemodialysis. Fluid intake refers to anything that has liquid in it. This would include ice, beverages, ice cream, and even, pudding. 
4. Limit your potassium, phosphorus, and sodium intake. Read the nutrition facts label, and the daily value percentage per serving should not be more than 20% and preferably below 5%. 
5. Consider using alternative seasonings that don't contain salt (sodium). Usually, these are non-salt-containing seasonings such as Cavender's Salt-free Greek Seasoning, Mrs. Dash's No Salt Spices, and Bragg's Organic 24 Herbs and Spices Seasoning. Use herbs and spices like basil, ginger, oregano, thyme, rosemary, etc., to enhance food flavor.

Starting dialysis can be overwhelming and scary as it requires adjustments in your diet and lifestyle. However, you can make great lifestyle choices to help you get the most out of your sessions.  What you eat and drink can make a difference in your recovery and help your treatments work better. Work with your renal dietitian or refer to your dialysis center’s renal dietitian, so they can help you get started with your Dialysis Diet meal plan.