Why Meal Planning is Important

Home hemodialysis replaces some—but not nearly all—of your kidney function. Doing all of your dialysis treatments, exactly as you’re taught, is a key part of staying healthy, and following a diet that is designed just for you is another key part. Most people on nocturnal hemodialysis have few limits and a normal or near-normal diet. If you choose conventional home hemodialysis, you will need to keep a watchful eye on certain nutrients.

Your nephrologist will prescribe a diet for you. Your dietitian will work with you to explain nutrients and choose foods and recipes that will keep you feeling your best. The exact details will depend on whether you are still making some urine and on the results of your blood tests. Here are some of the elements of diet that you’ll be learning about:

• Fluid – Your hemodialysis treatments will remove some fluid. If you do dialysis while you’re awake, you can do a longer treatment to take off more or less fluid, based on your weight, blood pressure, and any swelling in your body. If your treatments remove all your excess fluid (most likely with nocturnal home hemodialysis), you may not need much of a fluid limit. But if you have signs of fluid overload (weight gain, higher blood pressure, swelling), you will have to reduce your fluid intake. Your dietitian can give you tips to control your fluid intake.
• Calories – Most people on hemodialysis, even those doing dialysis at home, have a hard time gaining “real” weight. If you’re underweight or overweight, your dietitian can suggest ways to get to your ideal weight. Good nutrition is important to stay healthy. Whether you need to gain or lose weight, getting more exercise can help your appetite and firm muscles. If you need to lose weight, you may need to cut back on calories in your meal plan. So, if you drink soda, for example, you may want to switch from regular to diet or to water. Cutting down on fat and snack foods can help you make sure that the foods you do eat are healthy for you.
• Protein – Foods with protein (like beef, pork, chicken, fish, soy, or egg whites) help your body build and repair tissues. On home hemodialysis, you lose a little protein with each treatment, which makes it important to be sure you eat enough in your diet. You’ll get a blood test each month for serum albumin, a form of protein. If your level is not 4.0g/dL or higher, your dietitian may suggest that you eat more protein, or even add a tasteless protein powder to your food. Malnutrition can occur if you don’t get enough protein—your body will steal it out of your muscles. Malnutrition is linked to a higher risk of infection, hospitalization and even death.
• Potassium – Potassium maintains nerve and muscle function in your body, including your heart. It is very critical that the levels of potassium in your blood be in your healthy range. (Too high or too low potassium levels can stop your heart or cause muscle weakness, numbness, hallucinations, and other problems). When you do home hemodialysis, you will have days off between dialysis treatments, so excess potassium can build up in your body. You’ll have a blood test each month to check your potassium level. If it’s too low or high, your dietitian may suggest that you eat more or less of foods that are high in potassium. Some high-potassium foods include:
  • Dried fruit (raisins, prunes, dried apricots, figs)
  • Avocados
  • Mangos
  • Papayas
  • Cantaloupe
  • Kiwi
  • Bananas
  • Oranges
  • Tomatoes
  • Potatoes
  • Cooked spinach
  • Salt substitutes with potassium
• Phosphorus – Present in nearly all foods, the mineral phosphorus plays a key role in energy transfer in your body. You’ll have a blood test each month to check your phosphorus level. Healthy kidneys remove extra phosphorus, so with kidney failure—even with home hemodialysis (unless you do it nearly every day), your levels may be too high. If this happens, in the short run you might notice severe itching. In the long run, your bones could be damaged. In most cases, people on home hemodialysis will need to take phosphate binders. These pills, taken with meals and snacks, bind with phosphorus and remove it in your stool. You may also need to limit high-phosphorus foods in your diet. These include:
  • Dairy products of all types
  • Dried beans and peas
  • Whole grains
  • Nuts
  • Cola drinks (root beer, clear, and fruit-flavored sodas don’t tend to have much phosphorus)
• Sodium – Salt contains sodium, which helps to control fluid levels in your body. If you eat too much salt (or sugar), you’ll be thirsty and may drink too much fluid. This can lead to swelling and high blood pressure. Foods that are high in sodium include:
  • Processed meats (like hot dogs, bologna, corned beef, ham, etc.)
  • Canned soups and dried soup mixes
  • Packaged “Helper” foods
  • Bottled sauces
  • Pickles, pickle juice, olives, and other pickled foods

Eating well can help to keep you healthy. Not eating well will cause you to become weak as you break down your muscles for protein, and become malnourished. Malnutrition is linked to a higher risk of infection, hospitalization and even death. If changes occur in your taste or appetite, talk with your dietitian to make changes to your meal plan. Your dietitian will be happy to work with you to make a meal plan you can follow and enjoy.