Home dialysis basics
Home dialysis and your diet
The kind and frequency of dialysis you do will impact your diet. When home dialysis is done five or six days a week, the diet is more liberal than for in-center dialysis. This is because waste and extra fluids are removed on a more regular — sometimes daily or nightly — basis. When a patient chooses a dialysis modality that is performed more frequently than three times per week, they are generally able to have a more liberal diet.
The type of home dialysis you choose has a lot to do with the foods you can eat and the foods you may have to limit or avoid.
Types of home dialysis
Home hemodialysis (HHD)
- Traditional home hemodialysis
Performed three times per week, typically for about four hours per session.
- Short daily home hemodialysis
Performed five or six times a week, typically for two to three hours per session.
- Nocturnal home hemodialysis
Performed during sleep, typically six to eight hours a night, three or more nights a week.
Peritoneal dialysis (PD)
- Automated peritoneal dialysis
An automated machine called a cycler performs most exchanges at night while the patient sleeps, typically six to eight hours a night.
- Continuous ambulatory peritoneal dialysis
The exchange process is usually performed four to five times per day without a machine.
Everyone is unique
Not only is each type of home dialysis treatment different, but every home dialysis patient is unique. For this reason, your specific diet should be tailored to your needs. Your renal dietitian will help you come up with a diet that works best for you. He or she will analyze your lab results to see what foods you need to eat more of and what foods you should limit, taking your health and your type of home dialysis into account. He or she will perform a complete nutrition assessment and develop a nutrition care plan for you. This includes an analysis of your lab results, access to food and food preparation, consideration of your weight loss or excess weight, malnutrition, other conditions like diabetes, ethnic food customs, your ability to buy food, your living situation and appetite.
Main components of the home dialysis diet
Although everyone is unique and dialysis diets vary, there are some main components that every dialysis patient should consider.
- Protein
Protein is important for all dialysis patients to keep their albumin levels up. Albumin is a protein that helps the body stay healthy, and it’s used as a measure of nutrition for dialysis patients. Peritoneal dialysis (PD) patients need extra protein because they lose protein every time they drain the dialysis solution from their abdomen. The peritoneum is very permeable to amino acids and whole proteins so with each PD exchange, precious proteins are lost. Unless these losses are replaced by eating more high-protein foods, the patient remains in a state of negative protein balance — constantly losing more than is consumed. The body then has to rely on breaking down proteins from muscles and organs to provide essential proteins. For this reason, PD patients need more protein than home hemodialysis patients.
Good sources of protein include turkey, pork, eggs, tofu, chicken, lean beef and fish. A general guideline for home dialysis patients is to eat 7 to 10 ounces of protein a day. Your dietitian can help you better understand your protein requirements.
- Sodium
Your dietitian will consider your kidney function, urine production and dialysis treatment type when deciding how much sodium you should consume. High sodium intake can cause thirst and fluid retention. The result of this is shortness of breath and congestive heart failure. In addition, dialysis treatments for patients with too much fluid retention can be difficult due to drops in blood pressure and cramping as the extra fluid is removed.
Patients doing traditional home hemodialysis are usually advised to limit their sodium intake. However, if you do more frequent home dialysis, you may be able to have more sodium. Most daily dialysis patients on home hemodialysis or peritoneal dialysis follow a 2,000 to 4,000 mg sodium diet. Other conditions such as hypertension and cardiovascular disease must be considered for each person when determining sodium restrictions.
- Fluid
Controlling your fluid intake is more important when you are dialyzing fewer times a week. Some home dialysis patients who dialyze more frequently may be able to have more fluids than traditional hemodialysis patients. Daily or nightly home dialysis works more like healthy kidney function and allows fluid removal everyday so extra fluid doesn’t have time to build up. It’s important to remember that even if you do daily dialysis, you can still over consume fluids, causing more difficult treatments and changes in blood pressure and weight. Your nurse and dietitian will work with you to determine how much fluid is safe for you to consume on a daily basis.
- Calories
When you are at a healthy weight, you feel your best. That’s why it’s important to get the right amount of calories to maintain a healthy weight. Traditional hemodialysis patients may not have a good appetite; however, it is important to eat enough calories to maintain a healthy weight. Nocturnal or short daily hemodialysis patients generally have healthier appetites than in-center hemodialysis patients and, therefore, meet daily calorie requirements. PD patients may need to cut calories a little to maintain a healthy weight because of the sugar in the dialysis solution.
Some people on daily hemodialysis have a great appetite, which causes them to eat more calories than their bodies need. As a result, they may gain extra body fat, which can be unhealthy. These patients must still work to eat a healthy diet, avoid over eating and include exercise to maintain a healthy body weight.
Many patients on traditional home hemodialysis and PD may have poor appetites or experience gastrointestinal symptoms that interfere with food intake (feelings of fullness, nausea, constipation). Some medications cause changes in appetite. More frequent dialysis may help resolve some of these problems and may even mean fewer medications are needed. This can help alleviate some of the appetite problems.
- Potassium
Potassium is restricted to 2,000 mg or less for patients on traditional home hemodialysis. High levels of potassium can be life threatening for dialysis patients. Therefore, it’s important for all dialysis patients to follow their dietitian’s guidelines for potassium consumption.
Home hemodialysis patients who do short daily or nocturnal treatments and peritoneal dialysis patients may not have to limit potassium as much as someone on traditional hemodialysis. These patients may be able to eat 3,000 to 4,000 mg of potassium or may need to add extra potassium foods to prevent low levels.
- Phosphorus
Phosphorus is one of the biggest dietary challenges most dialysis patients face because dialysis does not remove large amounts of phosphorus. Medications called phosphorus binders must be taken with food to bind phosphorus that dialysis cannot remove. A low phosphorus diet is 800 to 1,000 mg.
Peritoneal dialysis patients should limit phosphorus since it is not removed well through PD treatments. Home hemodialysis patients that do traditional hemodialysis will also be advised to limit foods containing phosphorus. Patients who do nocturnal home hemodialysis five to six times a week can often stop taking binders and experience normal phosphorus levels with a more liberal diet.
Summary
Diets for those patients who dialyze more frequently than three times each week generally have fewer restrictions than the in-center dialysis diet. It’s important to listen to your health care team and follow the dietary guidelines they set to avoid health problems. You will be able to tell if the diet you are following is successful by how you feel. If your diet is effective, you should feel better, have a healthier appetite, achieve good blood pressure control and experience less swelling. Talk to your doctor today to learn more about home dialysis.
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