Nutrition & Hemodialysis 3-4x/Week

Nutrition & Hemodialysis 3-4x/Week

When you have chronic kidney disease, nutrition is an important part of your treatment plan.

Your dietitian will help you plan your meals with the right foods and in the right amounts. Nutrients affecting the kidneys at this stage are:

  • Protein
  • Sodium
  • Potassium
  • Phosphorus
  • Vitamins
  • Fluid

Renal Dietitian

Your doctor or renal dietitian will monitor your blood work. If any changes are required to your diet, a renal dietitian will work with you to develop a meal plan that will fit within your cultural and lifestyle needs. It is important to remember that dietary changes may vary among people with kidney disease.

Sodium, potassium, phosphorus and fluid need to be limited in the diet to avoid large amounts building up in the blood between treatments.

Some protein is removed from your body with each dialysis treatment. Adequate protein should be eaten when you are on dialysis.

Protein is found in many foods, but is higher in:

  • Tofu
  • Dried peas, beans and lentils
  • Nuts and nut butters
  • Eggs
  • Cheese
  • Fish and seafood
  • Poultry (chicken, turkey and duck)
  • Red meat

Eating the right amount of protein will help to:

  • Build muscles and repair body tissues
  • Fight infections and helps with healing
  • Prevent wastes from building up in your blood

Note: Cheese and processed meats are high in phosphorus and should be limited.  Try to include plant proteins such as tofu, dried peas, beans and lentils.

Limiting sodium to 2300 mg or less (about 1 teaspoon of salt) per day:

  • Helps reduce fluid build up in the body (swelling of the ankles, fingers, eyes)
  • Helps control blood pressure within normal ranges

Sodium is a mineral and is found in most foods, but is especially high in:

  • Table salt and sea salt
  • Salty seasonings (e.g. soy sauce, teriyaki sauce, garlic salt and seasoning salt)
  • Most canned foods and some frozen foods
  • Processed meats (e.g. ham, bacon, sausage and cold cuts)
  • Salted snack foods (e.g. chips, crackers and pickles)
  • Most restaurant and take-out foods
  • Canned or dehydrated soups (e.g. packaged noodle soup)


  • Eat foods closest to their natural state (not processed)
  • Read food labels for the amount of sodium
  • Add flavour to your food. Try a dash of:
    — Hot pepper sauce
    — Lemon juice
    — Vinegar
    — Fresh or dried herbs and spices
    — No-added salt blends (Mrs. Dash®, McCormick’s No Salt Added®)

Avoid: Salt substitutes (Half Salt®, Salt Free® or No-Salt®)

  • Is an important mineral that helps your heart and muscles work properly
  • Too much or too little potassium in your blood can be dangerous
  • Not everyone needs the same amount of potassium. How much you need will depend on:
    — How well your kidneys are working
    — How much you eat
  • Potassium is found in all foods but large amounts are found in:
    — Some fruits and vegetables (bananas, oranges, potatoes, tomatoes, dried fruits and juices)
    — Milk and yogurt
    — Dried beans and peas
    — Salt substitutes (Half Salt®, Salt-Free® or No-Salt®)
    — Chocolate

People on hemodialysis usually need to restrict their potassium intake. Individuals with a large appetite can have high blood potassium levels even if they are trying to limit “high potassium” foods. Remember to watch your portion sizes.


  • Avoid constipation as potassium is also removed by the bowels. Include lower potassium fruits, vegetables and whole grains.
  • Double boiling potatoes and root vegetables will reduce the amount of potassium. To double boil: Peel and cut potatoes or vegetables in small pieces. Boil in a large amount water for 10 minutes. Drain. Refill pot with fresh water and finish boiling.
  • Dried peas, beans and lentils can be soaked in a large amount of water for 12 hours to lower potassium. Discard water and boil in fresh water until done. Discard leftover water.
  • Canned chickpeas and kidney beans are lower in potassium straight out of the can. Rinse before using.
  • Also known as phosphate is a mineral that works with calcium to form strong bones and teeth

In the later stages of kidney disease, phosphorus starts to build up in your blood. Calcium is then pulled from your bones into your blood. This causes serious problems like:

  • Damage to the heart and other organs
  • Poor blood circulation
  • Bone pain and weakness
  • Skin sores

Phosphorus is found in most foods. Large amounts are found in:

  • Dairy products (milk, cheese, pudding, yogurt and ice cream)
  • Other beverages (colas, beer and cocoa)
  • Chocolate
  • Seasoned meats and processed/convenience foods
  • Baking powder

Your dietitian will discuss ways to help you lower your phosphorus intake. Your doctor may prescribe a phosphate binding medication to be taken just before meals to help control the level in your blood.

  • When your diet is limited you may need to take a special vitamin pill made for people with kidney disease
  • Do not take over-the-counter vitamins
  • Do not take over-the-counter Vitamin D or calcium pills unless recommended by your kidney doctor
  • Check with your kidney doctor and/or pharmacist about herbal supplements
  • Fluid intake is usually limited to 1000 –1500 ml per day
  • The amount you can drink will depend on your 24 hour urine volume and/or whether you have fluid build up


  • All beverages, ice, ice cream, Jell-O® and soup count as fluids
  • Comes from the foods you eat
  • Without enough calories, your body will use up your protein to give you energy. This will cause wasting (loss of muscle)

Eating enough calories helps:

  • You stay at a healthy weight
  • Your body use protein for building muscles and tissues


  • Eat three meals each day
  • Have something to eat every four to six hours
  • Watch how much or how little you eat (portion control)
  • Your dietitian will help you with your calorie needs
  • Provide energy and are part of a healthy diet


  • Include a small amount (30-45 ml or 2-3 tbsp) of unsaturated fat each day. This includes oil used for cooking, salad dressings, margarine and mayonnaise
  • Use vegetables oils such as canola, olive and soybean
  • Choose soft margarines that are low in saturated and trans fats (look for labels that say non-hydrogenated)
  • Limit butter, hard margarines, lard, shortening, fried and deep fried foods
  • Include lean meat and meat alternatives by consuming a portion between 2-3 ounces (about the size of a deck of cards), two to three times per day

Comparing Diets – No Restrictions vs Kidney Friendly for Hemodialysis

BREAKFASTOrange juice
Bran cereal
Milk Coffee with milk
½ cup canned fruit
Rice Krispies®
½ cup of milk
1 boiled egg
1 slice white/rye toast w/ margarine
LUNCHCanned Pea soup
Bologna sandwich
(lettuce, tomato, cucumber and celery)
Homemade low-salt soup
Unsalted crackers
Roast beef sandwich
(2-3 ounces beef)
Salad (lettuce, cucumber and celery)
½ cup grapes
Water/hot beverage/non-cola soda
Canned peas
Frozen fried potatoes
4-5 ounces pork roast
½ cup frozen or fresh peas
½ cup homemade
double-boiled potatoes
1 dinner roll, margarine
Water/hot beverage/non-cola soda
& sausage
1 slice white/rye toast with
1 tbsp peanut butter
Water/hot beverage/non-cola soda

Visit our Nutrition Tools page to download “Nutrition Guidelines for Hemodialysis”.