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Nutrition for peritoneal dialysis patients

Since the kidneys have lost their capacity to balance electrolytes, and remove waste products and excess fluid, it is necessary to have a close look at the following topics.

Energy & Protein

Energy is mainly obtained from carbohydrates and fat. Since patients with kidney failure have a higher risk of having elevated cholesterol, you may be advised to avoid foods that are high in saturated fats or cholesterol. Read food labels carefully to determine the fat and cholesterol content. Choose unsaturated fats of a higher quality like olive oil or fish. If you have diabetes be very careful about eating sweets. A dietician’s guidance is especially important for people with diabetes mellitus.

If you do not eat adequate amounts of carbohydrates and fat, protein might be used by the body as energy with the risk of muscle tissue breaking down in order to release protein.

Not eating enough protein can lead to malnutrition, weight loss, muscle weakness and poor health. Malnutrition is a serious risk in dialysis patients. Before starting dialysis, your nephrologist may have told you to follow a low-protein diet to preserve kidney function. But now you have different nutritional priorities. Most people on dialysis are encouraged to eat as much “high-quality” protein (e.g. poultry, fish, beef) as they can. 

Fluids & Sodium

Fluids help maintain our body structure, cell activity, and body temperature. When kidneys fail, excess fluid cannot be removed from the body and you need to restrict the daily amount of fluid intake.

Sodium chloride (salt) is essential for water regulation, nerve transmission, and muscle function. When you eat food that is salty, it causes you to drink more. Too much sodium can cause fluid retention. This can lead to oedemas and increased blood pressure and/or shortness of breath. Sodium is mainly found in table salt and convenience food (e.g. sausages, canned food, frozen pizza), but also for example bread, cheese and ham contain salt. Limited salt intake will make it easier for you to restrict the daily amounts of fluid intake.

The more water that needs to be removed during peritoneal dialysis treatment, the more uncomfortable it may be for you. Fluid is found in all drinks, but also in food such as gravy and soups, sauces, vegetables and fruit. Your dietician will discuss with you how much you can drink each day.

Restricting fluids is not easy, but you may find it is not as difficult as you thought if you follow our tips.

Tips to help you limit your fluid intake:

Keeping cool will help reduce your thirst, especially during periods of warmer weather. Drink cold liquids instead of hot beverages.

  • If you are thirsty between meals, have ice cold vegetables and fruit as a snack 
  • If allowed, take your pills with apple sauce or gravy. 
  • If you are a diabetic patient, maintain your prescribed blood glucose levels. High levels will increase your thirst. 
  • Use smaller cups and glasses and sip your beverages
  • Battle dry mouth: try rinsing your mouth, using mouthwash or brushing your teeth. Sucking on hard sweets (lemon drops) or a wedge of lemon or lime will also help. You may also try to freeze part of your allowed amount of water to suck on ice cubes. 
  • Do not add salt to your foods
  • Avoid high sodium foods (convenience food, sausage, cheese, salami)
  • Cook with herbs and spices instead of salt 
  • Do not use salt substitutes. They may contain potassium instead
  • Avoid foods with sodium listed on the food label as one of the first five ingredients

Potassium

Potassium is an important mineral for neuromuscular action and protein metabolism. Healthy kidneys remove excess potassium from the body. High levels can cause muscle weakness and an irregular heartbeat which may be dangerous.

Potassium is found mainly in fruit and vegetables such as bananas, apricots and tomatoes, dairy products and chocolate. Your nephrologist may prescribe potassium binding medication to prevent high levels. 

Here are some tips to reduce your potassium uptake:

  • You can remove some of the potassium from potatoes and other vegetables by peeling, cutting and soaking them in a large container of water for several hours. Replace the water before cooking
  • Isotonic beverages are usually high in potassium. Check the label before drinking

Phosphate

The mineral in phosphate is phosphorus - it works with calcium to maintain the strength of your bones and teeth. Healthy kidneys remove excess phosphate. Usual dialysis procedures cannot remove all the excess phosphate. (This may not be true for long dialysis sessions – please consult your nephrologist). Elevated blood phosphate concentration causes calcium to be removed from your bones, making them weak and more fragile –renal bone disease.

To prevent this from happening, your nephrologist may prescribe phosphate binders, a medication taken when you eat to bind the phosphate and excrete it. 

Limit foods rich in phosphate such as dairy products, nuts and beans although they are high in protein. Your dietician will guide you on how to lower your intake while maintaining the protein levels in your renal diet.

Dietary supplements

Many different dietary supplements are available that are a good aid to preventing undernourishment or malnutrition. If you do need a dietary supplement, your dietician will help you find one that is suitable for you.