Dialysis Diet Differences: Hemodialysis and Peritoneal Dialysis 

By DaVita® Dietitian Christine Swafford, MS, RD, CSR, LD

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

Whether you’re on hemodialysis (in-center traditional, in-center nocturnal or home) or peritoneal dialysis(PD), your kidney-friendly eating plan is tailored to your needs. Your current body weight, age and other underlying conditions and lab results also play a role in what type of dialysis diet is prescribed for you.

Similarities and differences

Although many components of a dialysis or kidney diet are the same for people on hemodialysis and PD, there are also differences. To some extent, your diet guidelines are determined by the kind of dialysis you choose.

Calories

Hemodialysis and PD each require adequate calories for your body to function and not become malnourished.

But there’s a difference in that some of the calories for PD patients come from the dialysate solution, the cleansing fluid placed in the abdomen that pulls waste and extra fluid out of the blood. It contains dextrose, a form of sugar, providing calories and decreasing the need for as many calories from food. That’s why PD patients may eat fewer carbohydrates than hemodialysis patients do.

People with diabetes should be mindful of the added sugars.

Protein

Protein needs are higher in people undergoing dialysis. This may be for several reasons.

  • Hemodialysis patients can lose 10 to 12 grams of amino acids, the building blocks of protein, per treatment.
  • PD patients may lose 5 to 15 grams of protein per treatment.
  • Infection, inflammation, sores, anemia and other medical conditions call for a higher protein intake.
  • People who perform daily treatment are able to consume more protein in their diet.

Protein lost during dialysis can be replaced by eating high-quality meat, poultry, fish and eggs.

Sodium

Hemodialysis and PD patients should limit their sodium intake to 2,000 mg or less daily. Large amounts can lead to increased thirst, swelling, shortness of breath, high blood pressure and heart failure. High amounts of sodium are found in pre-packaged, processed, frozen, canned, restaurant and fast foods.

Potassium

High potassium levels are more common in people on hemodialysis. For people in this category, the recommendation is usually 2,000 mg each day. Some people may safely consume more depending on whether they still make urine, how frequently they dialyze and other individual needs.

Potassium removal is more efficient on PD because the treatment occurs daily. A typical daily goal for PD patients is 3,000 to 4,000 mg of potassium.

People on short daily HHD may have less restriction on potassium because they dialyze almost every day.

Phosphorus

Excess phosphorus is excreted by healthy kidneys. Phosphorus is found in colas, milk, cheese, processed meats, fish, poultry, chocolate, whole grains and nuts. When the kidneys fail, phosphorus builds up in the blood, which can cause severe bone and heart problems, tissue calcification and itching. That’s why the recommended amount is 800 to 1,000 mg per day.

Most dialysis patients take phosphate binders, which bind up the phosphorus so it can be excreted in the stool instead of being absorbed.

Calcium

No matter which dialysis treatment you’re on, calcium intake should be no more than 2,000 mg daily. If your calcium or vitamin D level is low, calcium is pulled out of the bones causing them to become weak and brittle. Calcium can also bind with excess phosphorus, depositing in the soft tissue, and lead to serious health issues.

Fluid balance

Hemodialysis patients may feel the negative effects of fluid imbalance more than PD patients or those on short daily HHD. Although this doesn’t mean PD and HHD patients can drink unlimited amounts, their fluid allowance is usually more generous. However, if PD patients consume too much fluid, they may have to use a more concentrated glucose dialysis solution to remove it.

It’s recommended that people on dialysis who don’t make urine consume less than 4 cups (32 ounces) of fluid each day. This includes foods, such as soup, ice pops, gelatin, gravy and ice that are liquid at room temperature. If you still urinate, the general rule is you may consume 4 cups plus the equivalent amount of urine you make daily.

Fiber

Whether you’re on hemodialysis or PD, it’s recommended that you consume 20 to 25 grams of fiber per day. By consuming a diet rich in kidney-friendly fruits and vegetables along with some lower-phosphorus grain products, you should be able to meet your fiber needs.

Related kidney disease education articles on DaVita.com


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