ESRD - Kidney failure diet
- Medically reviewed by
- AKF's Medical Advisory Committee
- Last updated
- April 12, 2022
Dialysis helps to do some of the work that your kidneys did when they were healthy. But dialysis does not work as well as healthy kidneys, and it cannot do everything that healthy kidneys do. Some waste and fluid may still build up in your body, especially between dialysis treatments. In time, the extra waste and fluid in your blood can cause heart, bone and other health problems. If you have kidney failure/ESRD, you must monitor the amounts of fluid and certain nutrients you take in each day. This can help keep waste and fluid from building up in your blood and causing problems.
Exactly how strict your diet should be depends on your treatment plan and other health concerns.
Potassium is a mineral found in almost all foods. Your body needs potassium to make your muscles work, but too much potassium can be dangerous. Having too much potassium in your blood is called hyperkalemia. When you are on dialysis, your potassium level may be too low or too high. This can cause muscle cramps, weakness and irregular heartbeat. Having too much potassium can cause a heart attack. Ask your dietitian how much potassium you should have each day. Print and use this potassium log to keep track of how much potassium you take in!
Phosphorus is a mineral found in many foods. It works with calcium and vitamin D to keep your bones healthy. Healthy kidneys help keep the right balance of phosphorus in your body. When you are on dialysis, phosphorus can build up in your blood. Having too much phosphorus is called hyperphosphatemia. This can lead to bone disease, which causes weak bones that break easily. Limiting the amount of phosphorus you take in can help prevent this problem. Talk to your dietitian about how much phosphorus you should have each day.
Download a guide on how to prevent high phosphorus
When you are on dialysis, fluid (water) may build up in your body between treatments. Too much fluid in your body can cause high blood pressure, swelling, trouble breathing and heart failure. Having extra fluid in your blood can also make your dialysis treatments more difficult. If you need to limit fluids, you will need to cut back on how much you drink. You may also need to cut back on some foods that contain a lot of water. Soups and foods that melt, such as ice, ice cream and gelatin, have a lot of water in them. Many fruits and vegetables are also high in water content. Talk to your dietitian about how much fluid you should have each day.
If you are limiting fluid and feel thirsty, try these tricks to quench your thirst:
- Chew gum.
- Rinse your mouth without swallowing. you can keep mouthwash in the refrigerator and use it as a cold rinse for your mouth.
- Suck on a piece of ice, mints or hard candy (remember to count the ice as fluid, and to pick sugar-free candy if you have diabetes).
- Try sucking on a reusable ice cube. It feels cold but does not add any fluid to your body.
Learn more about managing food and fluid with kidney failure
Everyone's body needs sodium to work correctly. Sodium helps you keep the right amount of fluid in your blood. Healthy kidneys help keep the right amount of sodium in your body. When your kidneys are not working, sodium can build up in your blood. When this happens, your body holds on to too much water. This can make your blood pressure too high and can cause problems during your dialysis treatments. Limiting how much sodium you take in each day can help keep your blood pressure under control and help prevent your body from holding on to too much fluid. Talk to your dietitian about how much sodium you should have each day, and use these tips to limit sodium in your diet:
Phosphorus Food Guide
Phosphorus is a nutrient many people with kidney disease must pay attention to and track, because having too much phosphorus in the body can lead to negative health consequences.
And tracking the amount of phosphorus you eat can be tough because phosphorus is not listed on a standard nutrition label.
Download the guide to learn the amount of phosphorus in many common foods and know which foods are considered low, medium and high sources of phosphorus.
Find kidney-friendly recipes on Kidney Kitchen
In Kidney Kitchen, you can take a deep dive into what each nutrient means for people with kidney disease, and how much of these nutrients common foods contain. Learn what healthy eating means for people in every stage of kidney disease, including those on dialysis or living with a kidney transplant. Find recipes on Kidney Kitchen.
- Do not add salt to your food when cooking or at the table. Try cooking with fresh herbs, lemon juice or salt-free spices.
- Choose fresh or frozen vegetables instead of canned vegetables. If you do use canned vegetables, rinse them to remove extra salt before cooking or eating them.
- Avoid processed meats, such as ham, bacon, sausage and lunch meats.
- Munch on fresh fruits and vegetables rather than crackers or other salty snacks.
- Avoid pickled foods, such as olives and pickles.
- Limit high-sodium condiments, such as soy sauce, BBQ sauce and ketchup.
If you are on hemodialysis and have treatments three times per week, you will likely need to strictly limit potassium, sodium, phosphorus and fluids. This is because when your blood is being cleaned only three times per week, there is more time between treatments for waste and fluid to build up in your blood. You may also need to limit how much protein you take in. If you do hemodialysis at home, and do your treatments every day, you may be able to be less strict with your diet. Talk to your dietitian about making a diet plan that is right for you.
Peritoneal dialysis diet
If you do peritoneal dialysis (PD), you may be able to take in slightly more phosphorus, potassium, sodium and fluid than if you did hemodialysis. You will also need to eat more protein. This is because PD works all day and night to take waste and fluid out of your blood. This keeps the waste and fluid from building up in your blood like it does between hemodialysis treatments. If you do PD, talk to your dietitian about making a diet plan that is right for you.
Special steps for people with diabetes
If you have diabetes, work with your dietitian to make a diet plan that allows you to avoid the nutrients you need to limit, while also controlling your blood sugar. If you do PD, keep in mind that PD solution has dextrose in it. Dextrose is a type of sugar. When you do PD, some of the dextrose is taken in by your body. If you have diabetes, it is very important to count the dextrose in your PD solution as extra sugar in your diet. Talk to your health care provider or dietitian if you have questions about managing your blood sugar if you do PD.