What you eat takes on a whole new meaning when you have kidney disease. This section will help you understand what to eat and what to avoid or minimize as you plan your meals. You can explore creative ways to limit your fluid intake and have fun trying new recipes.

A healthy diet of nourishing food is essential for everyone, but it is very important if you have chronic kidney disease (CKD) and end-stage renal disease (ESRD). Healthy kidneys help regulate the amount of water, minerals and electrolytes in the body. Your kidneys also work around the clock 24/7, 365 days a year. Those with diminished function need to adjust their diet to maintain the delicate balance. If you are on dialysis your diet needs to change even further, because the dialysis machine can’t replace the constant work your kidneys do.

What you eat may help you manage your CKD and potentially prevent or slow down the disease from progressing faster. Some research has shown that diets low in protein help people with CKD delay kidney failure. However, diet may not slow down the progression of CKD to ESRD for everyone.

High blood pressure, another factor in CKD, is also affected by what we eat. The DASH (Dietary Approaches to Stop Hypertension) Diet is known to help decrease blood pressure. It focuses on eating primarily fruits, vegetables, nuts, legumes and low-fat dairy and limits sodium, sugar, and red meat. It is low in saturated and trans fats and high in calcium, potassium, magnesium, fiber, and protein. It has also been found to lower the risk of heart disease, stroke, and possibly kidney disease and other chronic illnesses. According to the Georgetown University Center for Hypertension, Kidney & Vascular Research, people who already have severe kidney disease, a creatinine level above 3 mg/dl, or who have had an abnormally high serum potassium level, should not use the DASH Diet. This is because it is high in potassium which is not appropriate for those with ESRD.

The type of treatment that you choose for ESRD also plays a part in what you can eat and the amount of fluids you can have in-between treatments. Home dialysis gives you more food and fluid options than in-center dialysis. The most basic difference is that in-center dialysis is generally done less frequently than home dialysis, either peritoneal dialysis or home hemodialysis. With either method of home dialysis, treatment occurs more frequently and there is less time for a buildup of waste products in the body. This means in general, there are fewer dietary and fluid restrictions for home dialysis patients. However, the dialysate solution used in PD is sugar based and you will need to change your diet to deal with the extra sugar.

Watch Your Intake

All dialysis patients need to watch their intake of phosphorus (fos-fer-uhs), calcium (kal-see-um), potassium (poe-tass-ee-um), carbohydrates (kar-bo-hi-drates), sodium (so-dee-um) and fluids for the following reasons:

  • Phosphorus is an essential mineral that plays a major role in bone development. Dialysis patients, especially those on hemodialysis, need to limit the amount of phosphorus they eat. Too much and it disrupts the body’s balance between phosphorus and calcium. This can lead to hardening of soft tissues and removes calcium from the bones making them weak.
  • Calcium is the most abundant mineral in the body and is needed for proper bone growth. Increased calcium is often important for dialysis patients to offset the additional phosphorus in their body.

  • Potassium is a mineral that is important for nerve and muscle function. Too much potassium may lead to muscle failure and in rare cases heart failure.  Dialysis can only remove a fixed portion of potassium so it is important to limit foods that are high in the mineral. If you are a PD patient, you don’t have to limit potassium as much as other forms of dialysis.
  • Carbohydrates are in a class of nutrients that includes sugars and starches that provide a major source of energy in the body. Carbohydrates are important for all diets, but especially important for hemodialysis (HD) patients as they become a major portion of your diet. Peritoneal dialysis patients need to eat fewer carbohydrates because the dialysate solution is largely made of sugar.
  • Protein is important to staying healthy. However, as a chronic kidney disease patient you may need to limit your protein intake. Unhealthy kidneys lose the ability to remove protein waste, and your protein intake will be determined based on your kidney function, nutrition status and body size.
  • Fluid limitation is important once your kidneys stop functioning. While dialysis treatments will eliminate excess fluid, it is not as effective as your 24-hour kidney function. Going over on your recommended fluid allowance can cause swelling and build up in your lungs.

  • Sodium is one of the body’s three major electrolytes. Sodium is essential for the body to regulate blood pressure, transmit impulses for nerve function and regulate the acid-base balance of the blood; without healthy kidneys you are unable to eliminate excess sodium which can increase blood pressure.

Managing Your Nutrition

Below you’ll find more information about how to manage elements of your nutrition.

Learn More About Nutrition


Reading Food Labels

Nutritional Guidelines

Cooking at Home

Dining Out

Food Substitutions

Diabetes Diet and Kidney Disease