patient education : 16241--Renal Diet Overview

Renal Diet for Hemodialysis

Since your kidneys are not working well and dialysis is needed, it is important for you to follow the renal diet to keep you as healthy as possible. If the kidneys are not filtering the blood of excess nutrients and waste, the renal diet can help control the build-up of wastes and fluid. Note: This is a simple renal diet explanation. More specific recommendations should be discussed with your renal dietitian.

Protein

Protein is needed for many processes in the body, including building muscle, healing wounds and fighting infections. If you are on dialysis your protein needs are even higher. It is best to eat some protein with each meal. Good protein sources are: chicken, beef, venison, fresh pork, fish, and eggs.  Peanut butter, nuts, legumes, milk, and milk products are good sources of protein, but may be higher in phosphorus. For most patients who are limiting intake of processed and fast foods, monitoring portions and taking phosphorus binders as instructed, the phosphorus can be controlled.

Potassium

Potassium is important for nerve, muscle, and heart function. If your potassium level is too high, it can be very dangerous and lead to a heart attack or death. Potassium is mainly found in fruits and vegetables. Your dietitian can provide information on high and low potassium foods. It’s important to pay attention to your portion size, as too many low potassium foods can lead to high potassium blood levels. It is also important to avoid salt substitutes as they are made with potassium.

Phosphorus

Phosphorus can build up in the blood if the kidneys are impaired.  Too much phosphorus in the blood can affect the bones and soft tissues in your body.  Your doctor may prescribe a phosphate binder to take with each meal or snack, so be sure to take it as directed.  Phosphorus is found naturally in many foods; however, sometimes it is added to processed foods. It is better to eat fresh foods and be careful of foods with a “phos” word (such as phosphoric acid) in the ingredients list.

Sodium

Too much sodium can cause your body to retain fluid and affect your blood pressure.  If your kidneys are not working properly, the main way to get rid of the extra fluid is by following your diet and medication orders and through your dialysis treatments.   Too much sodium in your diet can cause extra fluid weight gains which can cause cramping and low blood pressure during your treatments. It is important to avoid cooking with salt, adding salt to food at the table, or eating processed foods.

Fluids

Fluid intake generally should be limited to 32-48 ounces per day or as directed by your dietitian.  Anything liquid at room temperature should be counted, including popsicles, ice cream, gelatin, soup, and ice. It is important to limit your fluid intake to prevent high weight gains between treatments.

This is a general guide based on the latest guidelines from 2020 to allow for more variety, whole grains and healthier plant based foods.  Depending on your condition and lab work you may require a different diet that should be discussed with your renal dietitian.

Protein Foods: (Meat and Plant-Proteins)

Choose: 2 to 3 eggs or egg whites; lean, fresh beef, wild game, and “all natural” chicken, fish, pork, seafood, or turkey; beans, edamame, lentils, nut butters, or tofu (when eating meatless meals); lower sodium canned tuna, chicken, or salmon (rinsed)

Limit: Protein foods that have added sodium or phosphorus (“phos”) in their ingredients; salty processed meats, such as bacon, breakfast sausage, bologna and other luncheon meats, deli meats, ham, salami, hot dogs, brats, sausage, and pre-seasoned proteins

Tip ▶ Include a palm-sized protein portion with most meals.  Look for “all natural” fish, pork, chicken, turkey, or seafood because they do not have added sodium or phosphorus.   

Breads, Cereals, and Grains

1 serving = ½ English muffin, 1 slice bread, 1/3 cup cooked pasta or rice, ½ cup cooked cereal, 3 cups popcorn, or a 6-inch tortilla

Choose: Whole grain cereal, corn tortillas, couscous, crackers, English muffin, bread, old-fashioned or steel-cut oats, pasta, pita, popcorn, quinoa, rice, rice cakes, cream of wheat, or grits

Limit: Foods with added phosphorus (“phos” ingredients), such as biscuits, box mixes, pancakes, waffles, quick breads, and other convenience foods

Tip ▶ Look for lower sodium breads, cereals, and grains.

Fruit

1 serving = ½ cup or 1 small fruit

Lower Potassium: Apple, applesauce, berries, clementine, fruit cup, grapes, lemon, lime, mandarin oranges, pear, pineapple, plum, tangerine, or 1 cup watermelon; Juices: apple, cranberry, grape, lemon, lime, or pineapple juice

Higher Potassium: Avocado, banana, cantaloupe, dried fruits, honeydew, kiwi, mango, nectarine, orange, papaya, peach, plantain, or pomegranate; Juices: pomegranate, prune, or orange juice

Choose: Fresh, frozen, or unsweetened canned fruit (drained)

Tip ▶ Ask your dietitian which fruits are right for you.

Vegetables

1 serving = 1 cup leafy greens or ½ cup fresh, cooked, or canned

Lower Potassium: Asparagus, broccoli, cabbage, carrots, cauliflower, celery, corn, cucumber, eggplant, green beans, kale, lettuce, okra, onion, peas, peppers, radish, raw spinach, spaghetti squash, turnip, or yellow summer squash; Greens: collard, mustard, or turnip

Higher Potassium: Artichoke, Brussels sprouts, cooked chard, kohlrabi, parsnips, potatoes, pumpkin, rutabaga, most squash, sweet potatoes/yams, tomato, tomato/pasta sauce, or zucchini; Juices: carrot, tomato, or vegetable juices, including low-sodium types

Choose: Fresh, frozen, or no-added salt canned vegetables that do not have sauces, seasonings or added salt

Tip ▶ Ask your dietitian which vegetables are right for you.

Dairy and Milk Alternatives

1 serving = ½ cup (4 oz) milk, soy milk, unfortified almond or rice milk, yogurt, or 1 oz cheese

Choose:

• Lower phosphorus milk alternatives: unfortified almond, rice, or soy milk

• Lower phosphorus cheese: brie, goat cheese, cream cheese, mozzarella, parmesan, or ricotta cheese

Limit:

• Processed cheeses, such as American cheese, boxed macaroni and cheese, and other cheese spreads or sauces

• Milk-or cheese-based soups or sauces

• Nondairy creamers or half-and-half with “phos” ingredients

Fluids

Fluids include coffee, juice, soda, soup, fresh-brewed tea, water, gelatin, and anything that melts, such as ice, popsicles, sherbet, or ice cream

Choose: Water, coffee, lemonade, Crystal Light lemonades and teas (not other flavors), and Arizona, Pure Leaf, or Snapple teas; Sodas: clear or orange sodas, root beer, Mello Yellow, or Mountain Dew

Limit: Milk, beer, wine, and all beverages with “phos” ingredients, such as colas, most canned or bottled teas, sports drinks, flavored waters, energy drinks, some drink mixes

Tips

▶ Look for drinks without “phos” ingredients.   If you make very little or no urine, limit fluids to 4 cups (32 ounces) per day. If you have a fair amount of urine, limit fluids to 6 cups (48 ounces) per day.  Use a small glass (4 to 8 ounces or ½ to 1 cup) with meals and snacks.

Fats and Seasonings

Choose:

• A small amount of healthy fats, such as olive oil, vegetable oils, or lower sodium salad dressings; butter, cream cheese, margarine, mayonnaise, and sour cream in moderation

• Condiments, salad dressings, and sauces with less than 200 mg sodium per serving

Limit: Salt and avoid salt substitutes or seasonings with potassium chloride

Tip ▶ Use lemon, vinegar, herbs, and spices to flavor foods instead of salt.

Snacks and Sweets

Snacks and Sweets should be eaten in moderation. Follow guidelines for diabetics if you have diabetes.