Nutritional Guide for Hemodialysis Patients

Some hemodialysis patients must limit their potassium intake, which can be challenging. Keep reading to find out more about this and other nutritional guidelines when undergoing this kind of treatment. 

Once a patient faces limited kidney functionality, there are two treatment options: either enter a dialysis program (hemodialysis or peritoneal dialysis) or kidney transplantation.

Renal replacement therapy: Dialysis

The dialysis technique starts at a glomerular filtration rate of 5 to 19 mL/min / 1.73 m2, when one or more symptoms or signs attributable to kidney failure are present.

The dialysis process consists of filtering the blood with a machine in order to remove excess fluids and substances that the kidneys are no longer able to eliminate on their own. There are two main dialysis techniques: hemodialysis and peritoneal dialysis. 

What is hemodialysis?

Before a patient enters a hemodialysis program, an arteriovenous fistula must be performed or a catheter implanted temporarily (permanently if the fistula cannot be achieved).

Hemodialysis sessions are normally carried out three times a week at a hospital, on alternate days and for an indefinite period of time. It’s important to note that dialysis isn’t a cure for the disease, but rather a mechanism to prolong the life of the patient.

A nutritional guide for hemodialysis patients

During hemodialysis treatment -and when suffering from kidney failure in general– patients must pay attention to what they eat. This is especially important when it comes to protein and minerals. However, the diet guidelines vary from patient to patient depending on the type of kidney disease, glomerular filtration, or the presence of other comorbidities.

When it comes to caloric intake, there are no specific requirements. In other words, the caloric intake for the average individual works fine.

Protein intake

Experts recommend that the daily protein intake stays between 0.6 and 0.8 grams of protein per kilogram of body weight per day.

Sodium intake

Sodium, the main component of table salt, is one of the critical points of nutritional treatment in kidney disease. Patients who in addition suffer from high blood pressure, proteinuria, and fluid retention must limit their sodium intake to two grams per day, that is, to less than five grams of salt.

In this context, good nutritional education is essential to help kidney patients understand nutritional labels since the use of salt is highly common in the food industry.

Potassium intake

Potassium intake will depend on the level of serum potassium in the blood after a lab test. If the levels are within range, patients won’t have to worry about limiting intake. However, if levels are high, they must completely eliminate this nutrient from their diet, which can be very challenging.

The nutrient is present in most fruit and vegetables, and other foods such as chocolate or whole-grain cereals. In order to make it easier to reduce potassium intake, plant-based diets where vegetables are soaked and twice-cooked are the best option.

In addition, frozen or packaged vegetables have lower potassium content. However, make sure you wash them thoroughly to remove excess sodium and food preservatives.

Phosphorus

Dairy and, to a lesser extent, legumes are a natural phosphorus source. Kidney patients must limit this nutrient’s intake if they’re blood phosphorus levels are high, since an excess of it increases the risk of cardiovascular issues. 

In order to reduce it, it’s important to pay attention to inorganic phosphorus which isn’t naturally present in food. Usually, it comes in the form of preservatives of precooked foods, such as:

• Lecithin or E322.
• Phosphates corresponding to the following codes: E338, E339, E340, E341, E342, E343, E450, E451, E452.
• Sodium and aluminum phosphate, or E541.
• Flavor enhancers such as E626, E627, E628, E629, E630, E631, E632, E633, E634, and E635.
• Some modified starches with the codes: E1410, E1411, E1412, E1413, E1414, or E1442.

Calcium

For patients undergoing hemodialysis, daily intake should be under 1,500 mg per day.

Hemodialysis and nutrition in short

To summarize, this is what kidney patients should pay attention to:

• Make sure they follow a plant-based diet.
• Choose plant-based protein instead of animal-derived.
• Limit or eliminate salt intake, and beware of processed foods that are already high in salt.
• Control the consumption of foods with high potassium and phosphorus content if lab tests suggest so.

Lastly, it’s worth noting how important it is to consume lots of fiber since it can be neglected when limiting minerals in a diet. Also, fluid intake varies from patient to patient, although doctors generally recommend limiting it.