Why Is the Dialysis Diet Important For End-Stage Kidney Disease?

When living with chronic kidney disease, there are many lifestyle changes that can be made to help support your kidneys and prevent the disease from progressing to later stages. A kidney-friendly diet is one of the most important precautions you can follow. For those already in end-stage kidney disease, you may find yourself wondering if it’s worth following a kidney diet. The answer is yes, especially if you are starting dialysis. 

For you to feel your best and improve dialysis success, a carefully planned diet will play a major role in your treatment. While some of the basic guidelines from a kidney-friendly diet will still be important to adhere to, there are even more dietary precautions to take when starting dialysis.

What is a Kidney-Friendly Diet?

kidney-friendly diet is a specific eating plan that helps protect your kidneys from more damage. Foods found on a kidney diet are easy on your kidneys, liver, and digestive system to limit the amount of work each organ system needs to perform to break down and process food. 

The kidneys are small, bean shape organs located just below the rib cage with one kidney on each side of the spine. These small, but powerful organs play a major role in the body’s cleansing and detoxification process. The main job of the kidneys is to cleanse the blood of toxins and excess fluid and transform the waste into urine. By filtering out excess fluid and toxins, the kidneys are able to keep the body in a healthy balance of water, salt, and minerals.

When the body falls out of balance and the kidneys aren’t able to filter blood properly, you may start to experience early symptoms of kidney disease:

  • Nausea and vomiting
  • Muscle cramps
  • Loss of appetite
  • Edema
  • Changes in urination
  • Dry, itchy skin

Once damage has occurred to the kidneys, there is no way to reverse it. Following a kidney-friendly diet can help ease your symptoms and prevent further damage. It does this by preventing a build-up of minerals like potassium, phosphorus, and sodium, which can be dangerous if levels get too high. In addition, it also limits the amount of protein you eat. While protein is an important macronutrient, too much protein can make kidneys work harder. 

What is a Dialysis Diet?

If you are starting hemodialysis your kidney function has dropped below 15% or symptoms have become severe. This means the kidneys can’t filter the blood at all and will need some help in order to keep your body healthy and balanced.

When you start hemodialysis, it’s important to be even more mindful of what you are eating and how much fluid you are drinking.  This means limiting fluid intake and certain foods in your diet while increasing others. On the dialysis diet, you will need to:

  • Increase protein intake
  • Limit fluid
  • Reduce salt/sodium
  • Limit potassium and phosphorus

While this may seem like an overwhelming or impossible task, an easy way to make sure you are getting the right nutrients and avoiding the wrong ones is by eating a high-protein diet that consists of whole, unprocessed foods


Potassium is a vital mineral that is used by all tissues in the body. It’s classified as an electrolyte because when it dissolves in water, it produces positively charged ions. This allows it to conduct electricity, which helps the body carry out processes like a steady heartbeat, fluid balance, nerve signals, and muscle contraction. 

Healthy kidneys are able to keep the right amount of potassium in the blood to keep your body functioning properly.  When the kidneys are damaged and dialysis is needed to filter the blood, potassium levels can rise quickly between sessions. Too much potassium in the blood is known as hyperkalemia. It can be dangerous and may lead to chest pain, heart palpitations, muscle weakness, and abdominal pain. 

To control potassium levels, limit potassium foods like

  • Avocados
  • Banana 
  • Dried fruit
  • Potato and sweet potato
  • Green beans
  • Spinach
  • Dairy products

Make sure to check in with your doctor periodically to monitor potassium levels so they don’t get too high. 


Phosphorus is another important mineral that is vital to bone development and maintenance, the development of connective tissue, and muscle movement. When phosphorus-dense foods are digested, the small intestine absorbs the phosphorus so it can then be stored in the bones. 

The kidneys filter phosphorus in the same way it filters potassium. But because of the time between dialysis sessions, phosphorus can easily build up in the blood. When there is too much phosphorus in the blood it can pull the calcium from the bones. This makes bones weak and brittle, and easier to break. You may also experience itchy skin if there is too much phosphorus. 

It can be difficult to limit foods high in phosphorus because those same foods are also necessary for a dialysis diet, like protein. Some foods to limit or avoid that are high in phosphorus include:

  • Dairy
  • Beans and lentils
  • Some nuts and seeds
  • Bran cereals
  • Poultry

If phosphorus levels get too high and you are having difficulty limiting phosphorus-rich foods, your doctor may prescribe a phosphate binder. A phosphate binder will help control the phosphorus in the blood between dialysis sessions by preventing it from entering the bloodstream. 


Sodium is a mineral found in salt. The body uses sodium for muscle and nerve functions, and it helps keep fluid in the body balanced.  Like potassium, sodium is an electrolyte that controls the fluid passing in and out of the body’s cells and tissues. It also helps regulate blood pressure and blood volume, and the acid balance of the blood.

While the body needs sodium, too much sodium can be harmful to people on dialysis because the kidneys can’t eliminate excess fluid or sodium. This leads to imbalance of sodium and water in the body. Too much sodium can lead to symptoms like:

  • Difficulty breathing or shortness of breath
  • Elevated blood pressure
  • Muscle cramping and edema
  • Blood pressure drop during a dialysis session

Aside from salt, sodium is found in many of the foods we eat. Processed foods often have higher levels of sodium compared to natural, whole foods. Some ways to help limit sodium intake include:

  • Keeping an accurate food diary
  • Reading food labels to check for sodium
  • Limit processed, canned, or frozen foods
  • Use fresh herbs and spices to add flavor to foods
  • Request condiments and dressings on the side when eating out
  • Request the cook not to add salt to the dish
  • Avoid cured meats and soup

Because sodium is an abundant mineral, it’s vital to work with a dietitian to help minimize sodium intake if you find you are having difficulty managing it yourself. Dieticians can tell you how much sodium is ok for you to have each day and guide you in making the right food choices.


Staying hydrated is vital to a healthy body. Water helps the body regulate temperature, lubricate joints, deliver nutrients to cells, eliminate toxins, and keep organs functioning at their best. But when you are on dialysis for kidney disease, it’s easy for there to be an overload of fluid.

Fluid overload is called hypervolemia. Because damaged kidneys can’t filter excess fluid, it can build up in the body and cause symptoms like rapid weight gain, swelling, and heart problems. Too much water between dialysis treatments can lead to hypervolemia. 

There are a few ways you can prevent hypervolemia while on dialysis:

  • Track fluid intake
  • Follow fluid guidelines as provided by your care team
  • Manage thirst by using ice chips or frozen fruit
  • Reduce sodium, too much sodium can make you thirsty

Many dialysis patients will need to limit fluid intake to 32oz per day. The exact amount will be determined by your care team. If you are having difficulty adhering to your fluid amount, you can ask your care team if they can adjust your dialysis to compensate for the extra fluid. 


A standard kidney-friendly diet calls for low amounts of protein because protein is hard on the kidneys. However, when you start dialysis, you will need to increase your protein intake. This is mainly because you lose protein during dialysis treatments. It also produces less waste for removal during dialysis. 

There are many benefits to a high protein diet, like:

  • Maintaining healthy blood protein levels
  • Keeping muscle strong
  • Aiding in the muscle recovery process
  • Healing wounds faster
  • Keeping the immune system strong

When choosing protein sources it’s important to opt for high-quality, lean, and unprocessed foods. The best protein sources for dialysis patients are fresh meat, fish, poultry, and eggs. Other protein sources like processed meats (think hot dogs or salmi), dairy, lentils, beans, nuts, and seeds should be limited because they are often high in potassium, phosphorus or sodium. 

The exact amount of protein needed will vary from person to person, but a good general rule of thumb is to have some protein with every meal and snack. An easy way to determine a serving size of protein is to use the hand method. The size of the palm of your hand is about 3 ounces. You would use this type of measurement for meat, poultry, and seafood. The size of your thumb is about 1 ounce, which is useful for things like nuts and seeds. 

Managing the Dialysis Diet

Many people on dialysis have a low appetite and find it difficult to eat. This may make it hard to get enough calories in on a daily basis. If you find you are having a hard time getting enough nutrients it’s important to tell your care team. There are some easy ways to get extra calories without feeling overly full:

  • Use healthy oils, like avocado, oil, and coconut. Oil can be added to raw or cooked vegetables, grains like rice and quinoa, or spread onto bread. 
  • Choose nutrient-dense foods. These not only have more nutrients but can also be higher in calories. Things like nuts and nut butter, full-fat dairy, and fattier cuts of meat will make it easier to get more calories in.
  • Smoothies are an easy way to pack a lot of calories and nutrients into an easily digestible form. Many times you can make a delish smoothie with only 4 ounces of water, so it won’t take away much from your daily fluid intake. 

To ensure you are getting the right nutrients, your renal dietician may recommend specific vitamins or supplements. There are some supplements that are specifically used for patients with kidney failure to help them feel better and improve their treatment outcomes. It’s important to discuss any changes in your diet with your care team before making them. They can help ensure the changes are going to help improve your diet and treatment. 

Living with end-stage kidney failure is an incredibly challenging time. Despite having support from your team and loved ones, it is still easy to feel alone. PatientsLikeMe is here for you. There are thousands of members living with kidney disease and understand how you may feel. Join the community to connect with members who can encourage you along your CKD journey. 

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