Outpatient Hemodialysis Nutrition Care

For individuals with kidney failure receiving outpatient hemodialysis, proper nutrition is essential for treatment success and quality of life. Dialysis alters how the body processes nutrients, making dietary adjustments critical.

Understanding the Nutritional Challenge

Hemodialysis removes waste products and excess fluid from the blood when kidneys can no longer perform these functions. However, the process also removes beneficial nutrients, creating a unique nutritional challenge. During each session, patients lose water-soluble vitamins, protein, and amino acids. At the same time, dialysis patients must limit intake of sodium, potassium, phosphorus, and fluids that their kidneys cannot effectively process.

Nutrient	Recommended Approach	Rationale
Protein	1.2-1.3 g/kg body weight daily	Higher intake needed to replace protein lost during dialysis
Sodium	Limit to 2,000 mg daily	Excess sodium causes fluid retention and high blood pressure
Potassium	Limit to 2,000 mg daily	High potassium can cause dangerous heart rhythm disturbances
Phosphorus	Limit to 800-1,000 mg daily	Excess phosphorus draws calcium from bones, causing bone disease
Fluids	Usually 1-1.5 liters daily	Excess fluid accumulates between sessions, straining the heart

Dietary Recommendations by Food Group

Protein Foods

• Egg whites (whole eggs have high phosphorus content)
• Fresh meat, poultry, and fish
• Small portions of dairy (limit due to phosphorus)
• Protein supplements recommended by your renal dietitian

Grains and Starches

• White bread, pasta, and rice (lower potassium than whole grain options)
• Tortillas, cereals, and crackers without added nuts or seeds
• Avoid bran, granola, and whole wheat products (high phosphorus and potassium)

Fruits and Vegetables

• Better fruit choices: apples, berries, grapes, peaches (limit portions)
• Avoid high-potassium fruits: bananas, oranges, kiwi, avocados, dried fruits
• Leaching vegetables (soaking and boiling) can reduce potassium by 30-50%
• Better vegetable choices: green beans, carrots, corn, cauliflower, cucumber
• Avoid high-potassium vegetables: tomatoes, potatoes, spinach, winter squash

Fats and Snacks

• Healthy fats: olive oil, canola oil, avocado oil
• Avoid processed meats and cheeses (high phosphorus and sodium)
• Appropriate snacks: unsalted popcorn, plain rice cakes, apple slices
• Limit nuts, seeds, and nut butters (high phosphorus and potassium)

Controlling Thirst

• Rinse your mouth with cold water without swallowing
• Chew on ice chips instead of drinking fluids
• Suck on sugar-free hard candy or gum
• Eat frozen grapes or other approved frozen treats

Dining Out

• Research restaurant menus online beforehand
• Request foods be prepared without added salt
• Ask for sauces and dressings on the side
• Avoid appetizers with high-sodium items like pickles or cheese

Handling Taste Changes

• Experiment with herbs and spices (avoid salt substitutes high in potassium)
• Try different cooking methods like grilling or roasting
• Use lemon juice (in moderation) to enhance flavors without adding sodium
• If experiencing metallic taste, use plastic utensils

Working with Your Renal Dietitian

Your renal dietitian is your most important resource. To make the most of appointments:

• Bring a 2-3 day food record to each visit
• Ask questions about confusing dietary information
• Discuss challenges you're facing with following your diet
• Request cooking tips related to your cultural food preferences
• Review lab results with your dietitian regularly

Breakfast: Scrambled egg whites with spinach (leached), slice of white toast with little butter, cup apple juice

Snack: cup blueberries with whipped topping

Lunch: Grilled chicken breast salad with cucumber, green beans, low-sodium dressing, small dinner roll, water with lemon

Snack: Plain rice cake with thin layer of jelly

Dinner: Baked white fish seasoned with herbs, white rice with peas (leached and drained), small salad with vinegar dressing, sherbet

Evening snack: Small handful of unsalted popcorn

Note: Individual needs vary. Adjust based on your specific lab results and prescribed restrictions.

Special Considerations for Diabetics

• Carefully coordinate carbohydrate intake with diabetes medications
• Monitor blood glucose more frequently when starting dialysis
• Choose consistent amounts of carbohydrates at each meal
• Select carbohydrates that are also lower in potassium and phosphorus
• Work with both your renal dietitian and diabetes educator

Conclusion

Proper nutrition is an integral part of hemodialysis treatment. Following a renal-friendly diet can help maintain healthy blood pressure, reduce hospitalizations, prevent bone disease, preserve remaining kidney function, and improve overall quality of life.

While the dialysis diet can feel restrictive at first, most patients adapt with practice and support. Focus on what you can eat rather than what you cannot, and work closely with your healthcare team to develop an approach that works with your lifestyle and food preferences. Remember that your dietitian can be your greatest ally in navigating these changes and optimizing your nutrition as part of your dialysis care plan.