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Kidney Health: Eat Right on Hemodialysis (185)

Kidney Health: Eat Right on Hemodialysis (185) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition



Eat Right on Hemodialysis

When kidneys do not work well, waste and
fluid can build up in your blood, making you
feel sick. Hemodialysis (HD) can clear
some waste and fluid. Eating right can help
make less waste build up in your blood,
which makes you feel better and keeps you
healthier. The most important dietary factors
to monitor when on dialysis are protein,
sodium, phosphorus, potassium, and fluid.

Protein is needed to build and repair muscle.
Protein also helps you fight off infections.
Eating enough protein can help you live
longer on HD. People on HD need to eat
more protein because some protein is lost
during the dialysis process.

How much protein can I eat?
On average, dialysis patients need 7-10
ounces of good protein sources daily. These
count as one ounce of protein:
ξ 1 ounce beef, chicken, lamb,
pork, fish
ξ ¼ cup salmon, tuna, crab, lobster,
ξ ¼ cup cottage cheese
ξ 1 ounce or 5 medium shrimp
ξ 1 egg
ξ ¼ cup egg substitute
ξ 4 ounces tofu
ξ *2 tablespoons peanut butter
ξ *½ cup cooked beans, peas, or
ξ *1 ounce natural cheese (Swiss,
Cheddar, etc)
*Choices higher in phosphorus
and/or potassium

Milk is a protein source, but should be
limited to less than 1 cup or 8 ounces
daily because it is high in potassium and

Each choice has 8 grams of protein. Each of
these is equal to one choice:
ξ 1 cup milk
ξ 1 cup yogurt
ξ ½ cup Greek yogurt
ξ ¾ cup custard
ξ 1 cup (milk based) soup
ξ ½ cup ice cream
ξ 1 cup milk-based pudding

Eating too much sodium (also known as
salt) can make you thirsty. The more fluid
you drink, the more your heart works to
pump the fluid through your body. Over
time, this can cause heart failure. Limit
sodium to less than 2000 mg per day.

To limit sodium, avoid using highly
processed foods, canned goods, and salty
seasonings. Restaurant food is very salty. To
limit salt, it is best to prepare more foods
from fresh ingredients at home.

These foods are high in sodium:
ξ Salted or smoked meat/fish
(bacon, brats, hot dogs, corned
beef, smoked fish, sardines, ham,
lunchmeat, smoked sausage)
ξ Breads and rolls with salt
ξ Cheeses (especially processed
cheese such as Velveeta® or


ξ Convenience and processed
foods (frozen dinners, soup, pot
pies, packaged entrees or noodle
mixes, gravy, sauce mixes,
pickles, olives, relish, salty
snacks likes chips, canned
tomato products like spaghetti

Be careful with seasonings! Stay away
from items with sodium such as MSG, salts
like garlic salt, sauces like BBQ, chili, soy,

Do not use salt substitutes that have large
amounts of potassium such as: Morton’s Salt
Substitute®, No Salt®, Diamond Crystal®,
and Morton’s Lite Salt®

Do use:
ξ Herbs like garlic, parsley,
pepper, or oregano
ξ Lemon juice
ξ Pleasoning® Mini Mini Salt
ξ Herbal Bouquet®
ξ Lawry’s Seasoned Pepper®
ξ Mrs. Dash® (all types)
ξ Spike® salt-free
ξ Tabasco® sauce
ξ Veg-it®

Most people on dialysis need to limit their
fluid intake to 1-1.5 liters per day, which is
the same as 4-6 cups, or 32-48 ounces. This
is usually based on urine output.

If you drink too much fluid between
hemodialysis sessions, you may feel short of
breath and your heart will have to work
harder. Your blood pressure may be high.
You may gain weight or get edema or

Fluids are anything you drink, or food you
eat that becomes liquid at room temperature,
such as soup, ice, Jello®, Popsicles, yogurt,
or ice cream.
Potassium is a mineral that can build up in
your blood between dialysis treatments. It is
very important to keep potassium levels
under control. Too much or too little
potassium in your blood can cause muscle
cramps or stop your heart.

Here is a list of fruits and vegetables that
contain low, medium and high amounts of
potassium for a single serving. A serving
size is 1 Cup raw or ½ Cup cooked, or one
medium-sized fruit.

Low Potassium Group (try to choose most
of your fruits and vegetables from this
ξ Apple juice, applesauce, or apple
without skin
ξ Blackberries, blueberries,
boysenberries, raspberries, or
ξ Canned apricots, figs, fruit
cocktail, grapes, Mandarin
oranges, peaches, pears,
pineapple, or plums
ξ Cranberries, cranberry sauce, or
cranberry juice
ξ Fresh grapes, lemon, limes,
pears, pineapple, raspberries,
rhubarb, strawberries, or
ξ Nectars: peach, pear, or apricot

ξ Bamboo shoots, canned
ξ Beans – green or waxed
ξ Broccoli and cauliflower, fresh
or boiled
ξ Cabbage, 1 stalk of celery, or


ξ Eggplant
ξ Greens (raw or cooked): collards,
dandelion, kale, mustard, or
ξ Hominy
ξ Raw spinach
ξ Leeks or onion: green, red,
yellow or white
ξ Lettuce, cos, romaine, iceberg,
leaf, endive, or watercress
ξ Mushrooms
ξ Peppers: sweet or hot
ξ Double-cooked* potatoes
ξ Squash: summer or spaghetti
ξ Radishes, turnips, and water
*See page 4 for double-cooked
potatoes recipe

Medium Potassium Group (limit to 1-2
servings daily)
ξ Apple, with skin
ξ Canned cherries
ξ Fresh apricots, cubed casaba, 15
cherries, 2 figs, ½ of a grapefruit,
orange, peach, 2 plums, or cubed
ξ Juice: grape, grapefruit, or
pineapple juice

ξ Asparagus, frozen or cooked
ξ Artichoke heart, boiled
ξ Brussels sprouts
ξ Carrots
ξ Corn, canned or 1 small ear
ξ Garbanzo beans
ξ Greens, frozen, cooked: kale or
ξ Mixed vegetables
ξ Okra, frozen or cooked
ξ Peas, green
ξ Summer squash: yellow,
crookneck, or white scallop

High Potassium Group (do not eat these
foods every day and keep portions small)
ξ ½ of an avocado, banana,
honeydew, or cantaloupe melon
ξ Dried fruits: apricots, dates, figs,
prunes, or raisins
ξ Kiwi fruit
ξ Mango
ξ Nectarine
ξ Prune or Orange Juice
ξ Tangelo

ξ Artichoke
ξ Beets and beet greens
ξ Dried beans and peas: kidney,
lima, navy, pinto, black-eyed
peas, or split peas
ξ Kohlrabi
ξ Potato: baked, boiled, fried, not
ξ Pumpkin
ξ Rutabaga, cooked
ξ Cooked Spinach
ξ Sweet potato or yams
ξ Tomato, fresh or canned
ξ Unsalted tomato or vegetable
ξ Winter squash: acorn, butternut,
or hubbard

Double-cooking potatoes will not
make potatoes a low-potassium food,
but it can decrease the potassium
content by about half. Avoid Yukon
gold potatoes as they will still be high
in potassium after double-cooking.
1. Wash and peel the potato.
2. Slice into thin slices.
3. Place the sliced potato in room
temperature water. Use two times the
amount of water to the amount of


4. Bring to a boil.
5. Drain the water and add two times
the amount of water to the amount of
vegetable of fresh room temperature
6. Boil again and cook until soft and

Phosphorus is another mineral that builds in
your blood. This pulls calcium from your
bones. Your bones can become weak.
Calcium and phosphorus can settle in your
soft tissues, your blood vessels and your
heart, causing damage.

Phosphorus Binders
Because protein foods contain phosphorus
and you do need plenty of protein, your
doctor may also ask you to take a medicine
with meals to bind phosphorus from the
food you eat. When the phosphorus is bound
with the binder medicine, it will be excreted
in the stool. Examples of binder medicines
include: Renagel®, Renvela®, Phoslo®,
Tums®, Auryxia®, Velphoro®, orFosrenol®.

Foods with a large amount of phosphorus
ξ Dairy products like milk, cheese,
yogurt, custard, pudding, ice
ξ Some grain products like bran,
oats, cornbread, wheat germ, and
boxed cake/bread mixes
ξ Chocolate, cocoa, caramel, beer,
cola, molasses, pizza
ξ Meat, liver, fish, and eggs
ξ Nuts, peanut butter, beans,
lentils, and seeds

Phosphorus Additives
Many processed food items contain
phosphorus additives, which binders will not
help much with. The more you prepare fresh
food at home, the less you will be exposed
to these additives. You can find these
additives on the ingredients list on the food
label. Examples are phosphoric acid,
hexametaphosphate, or tricalcium
phosphate. Always read the ingredients list
of packaged foods for “phos” foods.

Examples of foods that often contain
phosphorus additives include:
ξ Fast Food
ξ Bottled beverages and drink
mixes (like Coke®, Pepsi®, Dr.
Pepper®, Koolaid®, Gatorade®
and other sports drinks, and iced
ξ Processed meats (like lunchmeat,
breakfast sausage, hot dogs)
ξ Boxed baking items (like cake,
cornbread, or cookie mix)

www.kidney.org The National Kidney
www.NutritionData.com For looking up
There are several cookbooks designed
especially for people with kidney failure.
These may help add variety to your diet.

Creative Kidney Cooking for the Whole
Family by Rebekah Engum, RD. Expert
Publishing. 2012.

National Kidney Foundation list of Cookbooks
for Kidney Patients:


Teach Back
What is the most important thing you learned from this handout?

What changes will you make in your diet/lifestyle, based on what you learned today?

If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770

Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 11/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department
of Nursing. HF#185