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What Is Dialysis?

Written by: Consultant Dietitian Charity Chin

Dialysis is a life-saving treatment for individuals whose kidneys are no longer functioning properly. When the kidneys fail, they can no longer filter waste, toxins, and excess fluids from the blood effectively. Dialysis mimics the kidneys’ function by using processes like diffusion and ultrafiltration to remove these substances from the bloodstream.

Who Needs Dialysis?

Dialysis is usually recommended for people with kidney failure or end-stage renal disease (ESRD). Treatment typically begins when:

  • Waste products and electrolytes in the blood reach dangerous levels

  • The glomerular filtration rate (GFR) drops to approximately less than 15 mL/min

Types of Dialysis

There are two main types of dialysis:

1. Hemodialysis (HD)

  • Blood is removed from the body, filtered through a dialyzer (artificial kidney), and returned.

  • Typically done in hospitals or dialysis centers: 3–5 hours per session, three times a week.

  • Home-based hemodialysis is an option for some, done 4–7 times per week for shorter durations.

  • Nocturnal hemodialysis can be performed while the patient sleeps.

2. Peritoneal Dialysis (PD)

  • Utilizes the peritoneum (lining of the abdomen) as a natural filter.

  • A dialysis solution containing water, salt, and other additives is introduced into the peritoneal cavity.

  • Waste and fluids pass from blood vessels into the solution.

  • Can be done 4 times per day (each session 60–90 mins) or overnight using an automated system.

  • Allows for more independence and flexibility in daily life.

Dietary & Nutrition Management for Dialysis

Nutritional care is critical for people on dialysis to maintain health, manage complications, and reduce the risk of further issues. According to the 2020 KDOQI Guidelines, individualized Medical Nutrition Therapy (MNT) is essential.

Key Nutritional Goals:

  • Maintain nutritional status and muscle mass

  • Control serum phosphorus, potassium, and sodium levels

  • Prevent malnutrition and inflammation

  • Tailor intake to physical activity level, age, and comorbidities

Macronutrients & Energy:

  • Protein: 1.0–1.2 g/kg body weight; at least 50% should be high biological value (HBV) sources like eggs, poultry, fish, dairy, soy, and legumes.

  • Calories:

    • <60 years: 35 kcal/kg

    • >60 years or obese: 30–35 kcal/kg

    • Sedentary individuals require fewer calories; active or underweight individuals may need more.

Sodium & Fluid Intake:

  • Limit sodium to <2.3 g/day to manage blood pressure and fluid retention.

  • Fluid intake depends on urine output:
    • >1 L/day: 2–4 g Na, 2 L fluid

    • <1 L/day: 2 g Na, 1–1.5 L fluid

    • No urine (anuria): 2 g Na, 1 L fluid

  • Excess fluid can cause swelling, breathing difficulty, and heart issues.

Micronutrients & Electrolytes:

  • Potassium: 40 mg/kg ideal body weight; keep serum levels within a safe range.

  • Phosphorus: 800–1000 mg/day or <17 mg/kg; avoid processed and fast foods.

  • Calcium: Adjust based on Vitamin D use to avoid hypercalcemia.

  • Magnesium: 0.2–0.3 g/day

  • Vitamins: Routine supplementation of Vitamins A and E is not recommended due to toxicity risks.

Fat & Fiber:

  • Fat: <30% of total calories; <10% from saturated fats

  • Cholesterol: <300 mg/day

  • Fiber: 20–25 g/day for digestive and cardiovascular health

Recommended Daily Nutrient Intake (Adults on Dialysis)

Nutrient Recommendation
Protein
1.2 g/kg (50% HBV protein)
Energy
30–35 kcal/kg (adjusted by age/activity level)
Sodium
<2.3 g/day
Potassium
40 mg/kg ideal body weight
Phosphorus
800–1000 mg/day or <17 mg/kg body weight
Fluid
Adjusted based on urine output
Fiber
20–25 g/day

Phosphorus Food Choices

Food Group Lower in Phosphorus Higher in Phosphorus
Grains
Fresh bread, oatmeal
Processed cereals, waffles
Proteins
Fresh poultry, tofu
Bacon, organ meats
Dairy
Unsweetened almond milk
Processed cheese
Veggies
Fresh or frozen w/o sauce
Veggies with sauces
Fruits
Fresh w/o additives
Canned with phosphate
Beverages
Water, tea
Colas, energy drinks

Potassium Food Choices

Food Group Lower in Potassium Higher in Potassium
Vegetables
Broccoli, cabbage
Avocado, spinach
Fruits
Apples, berries
Bananas, papaya
Grains
White rice, plain cereal
Bran cereal, granola
Protein
Peanut butter, tofu
Lentils, red meats
Beverages
Lemonade, water
Coconut water, broth

Note: Potassium content may vary based on whether food is fresh, canned, or cooked.

Tips for Kidney Management

Hyperkalemia (High Potassium):

  • Choose low-potassium options

  • Avoid salt substitutes (often high in potassium)

  • Limit dairy and portion sizes of meat

Fluid Overload:

  • Track all liquids (including soups, ice cream, etc.)

  • Watch for swelling, shortness of breath

Dry Mouth:

  • Reduce sodium to minimize thirst

  • Use ice chips or water sprays

Nausea/Vomiting:

  • Eat small, frequent meals

  • Try ginger tea

Constipation:

  • Avoid fried, fatty foods

  • Increase fiber and stay active

Conclusion

People undergoing dialysis must follow strict dietary guidelines tailored to their specific medical condition. Nutritional counseling and continuous monitoring are vital to managing complications and improving outcomes. Personalized Medical Nutrition Therapy and lifestyle adjustments are essential for better health and quality of life. Always consult your healthcare provider for guidance on your dietary needs.

Reference List

  1. Ikizler T, A, Cuppari L: The 2020 Updated KDOQI Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease. Blood Purif 2021; 50:667-671.
  2. Ikizler T, Burrowes JD, Byham-Gray LD, Teta D, Wang AY-M. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. American Journal of Kidney Diseases. 2020 [cited 2022Mar.6]. Available from: https://www.ajkd.org/article/S0272-6386(20)30726-5/fulltext
  3. Dialysis: Types, How It Works, Procedure & Side Effects. Cleveland Clinic. 2021 [cited 2022Mar.6]. Available from: https://my.clevelandclinic.org/health/treatments/14618-dialysis
  4. Byham-Gray L, Wiesen K. A Clinical Guide to Nutrition Care in Kidney Disease. American Dietetic Associati; 2004.
  5. De Waal D, Heaslip E, Callas P. Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis. Journal of Renal Nutrition. 2016;26(1):1-.
  6. Phosphorus Content of Foods. Nutrition Care Manual. [cited 2022Mar.6]. Available from: https://www.nutritioncaremanual.org/
  7. Potassium Content of Foods. Nutrition Care Manual. [cited 2022Mar.6]. Available from: https://www.nutritioncaremanual.org/
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