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Date issued: April 2023 

Review date: April 2025

Ref: B-266/Dietetics/CT/eating well on haemodialysis v7 

PDF:  Eating well on Haemodialysis final April 2023 v7.pdf [pdf] 339KB

Eating well on Haemodialysis

Dialysis is used to help remove waste products from your blood, but it is less effective than healthy kidneys at removing them completely.  You will be advised on whether you need to make some changes to your diet to help keep the wastes (such as potassium and phosphate) in your blood at a safe level.

• Potassium:  If you are following a low potassium diet your dietitian will advise you on whether it is safe to relax this now you have started dialysis.

• Phosphate:  You may already be following a low phosphate diet or take a phosphate binder (e.g. Calcichew, Sevelamer, Renacet) to help control your phosphate level.

Your diet may need to change as your kidney function, blood results or medications change.  Remember that every patient is different and the advice you are given is individual to you.

Eating well on haemodialysis can:

• Help you maintain a healthy weight and keep well

• Replace protein that is lost during dialysis

• Reduce the risk of becoming fluid overloaded

• Help keep the levels of waste products within a safe range

Your blood results

Your bloods are usually checked at least once per month on haemodialysis, and you can ask one of the haemodialysis nurses or the dietitian about your potassium and phosphate levels. 

If you have access to a computer, you can monitor your blood results using “Patients Know Best” (PKB).  Visit the website www.patientsknowbest.com/renal to register.  Once you have registered, email the renal secretaries on plh-tr.renaladmin@nhs.net who will add your data onto your PKB account.

How can I eat well on haemodialysis?

1.  Eat regular meals

Dialysis is a tiring process.  Eating regularly will help keep your energy levels up and keep you feeling well.  If your appetite is poor, try eating small meals/snacks throughout the day and choose high calorie foods.

1. Eat enough protein

Protein is needed for muscle growth, wound healing and fighting off infections.  Unfortunately, a small amount of protein is lost from your blood during haemodialysis and so it is important to include enough protein rich foods in your diet as follows:

 

Protein

Try to include a source of protein at each meal	Choose high protein snacks
Meat Poultry Fish Eggs Cheese Lentils, reduced salt baked beans, pulses Tofu, soya, Quorn®	Hummus Unsalted nuts, nut butter Cheese portions Boiled eggs Yoghurts Cereal bars or flapjacks with added protein

For example, a sandwich or egg/cheese/fish on toast for lunch will be much higher in protein than a soup and slice of bread.

Try to select more fresh foods rather than processed varieties, which tend to be high in salt and additives. 

1. Reduce your fluid intake

 

	Fluid allowance Your daily fluid allowance is currently estimated as:

 

 

 

 

 

 

When you first start dialysis you may be passing plenty of urine.  However over time you may pass less, or stop passing urine altogether.

The less urine you pass, the smaller the volume of fluid you will be able to drink without becoming fluid overloaded. 

Being fluid overloaded may result in damage to your heart and lungs and can cause the following side effects:

• Shortness of breath                         

• Raised blood pressure

• Swollen ankles and feet

• Puffy eyelids and face

• Rapid increases in weight                                                                                                                                                                                                                      

You will be given a target “dry” weight and will be weighed before and after each dialysis session.  This will help the haemodialysis nurses know how much fluid to remove to bring you back to your dry weight.  Large volumes of fluid removals on haemodialysis can cause nausea, dizziness and cramps.

If you are gaining more than 2 kg between dialysis sessions you will need to reduce the amount fluid you drink

1. Reduce your salt intake

Too much salt in your diet can make you thirsty, and so it will be more difficult to keep your fluid intake down.  You can reduce your salt intake by limiting salt in cooking, not adding salt at the table and swapping to lower salt foods:

High lower salt

High in salt	Lower salt alternative
Cured, smoked or tinned meat and fish e.g. bacon, ham, anchovies, tinned fish in brine	Fresh, unprocessed meat and fish Tinned fish in oil or spring water
Cook-in sauces Seasonings and marinades Table sauces e.g. soy, ketchup	Vinegar, lemon juice Herbs and spices Tomato puree
Salted or roasted nuts, crisps and cheese flavoured snacks	Unsalted popcorn and nuts, rice cakes, plain breadsticks
Tinned foods Ready meals	Check traffic light labels for “green” or “amber” options
Stock cubes and gravy granules	Choose “reduced salt” varieties

Salt substitutes, such as “Lo-Salt®” or “Saxa So Low®” should be avoided as these are high in potassium.

5 . Take your RENAVIT vitamin supplement daily

Haemodialysis can also remove vitamins from your blood.  Renavit is a vitamin and mineral supplement designed specifically for haemodialysis patients, and should be taken every evening.  Your dietitian will arrange for this to be prescribed by your GP.

It is not advisable for people with kidney disease to take 'over-the-counter' multivitamins.