Hemodialysis Nutrition

     With hemodialysis, the diet is affected by kidney function, dialysate components, duration of dialysis, and rate of blood flow through an artificial kidney. The goal with hemodialysis nutrition therapy is to maintain nutritional status, prevent excessive accumulation of fluids and waste products, and minimize the metabolic effects of ESRD. 

    The total amount of energy/calories that is adequate to follow during hemodialysis is about 35kcal/kg for adults under 60 and a normal weight. For obese adults and adults over 60 about 30kcal/kg should be consumed. Kcals refer to the number of calories. 

    The protein amount consumed should increase because proteins that are lost during dialysis need to be replaced. It is recommended that 1.2g/kg should be consumed. The normal recommended amount of 0.8g/kg so there is most definitely an increase in protein consumption for dialysis users. Special protein drinks have been manufactured for dialysis patients to receive adequate protein amounts. Saturated fat must be limited and it is beneficial to consume fish oils and olive oil instead of unhealthy fat. Sodium, potassium, and fluid consumption should be restricted based on an individualized level to minimize intradialytic weight gain. Too much sodium can result in high blood pressure and fluid retention. Eating too many salty foods can also increase thirst, making one consume too many fluids. "Low sodium" labeled products may also not be good as they are high in potassium. Too much potassium can change the way the heartbeats, resulting in heart problems or even a heart attack. Drinking too much fluid can weaken the heart by forcing it to work harder. Too much fluid may cause discomfort, raise blood pressure, and cause difficulty breathing. These can all result in heart problems. It is important to regulate fluid consumption when on hemodialysis. 

    Phosphurus is restricted with a hemodialysis diet because hyperphosphatemia contributes to hyperparathyroidism. More products than one would think are high in phosphorus, such as milk, milk products, peanuts, beef liver, chocolate, and legumes. Medications can be used to control phosphorus levels. Trying to consume more protein while keeping a low phosphorus level is challenging as many protein-rich foods alternative to meats are high in phosphorus (beans, peanut butter, and other nuts). 

    Vitamins such as vitamin B6, folic acid, and other water-soluble vitamins may be deficient because of poor intake and loss through dialysis. Water-soluble vitamin supplements are recommended which fat-soluble vitamins should not be supplemented. Fat-soluble vitamins include vitamins A, D, E, and K. 

Sources: 

Mancino, J. (Presenter). (2021, April 8). Chapter 14 Liver, GB, Pancreas Chapter
     18 Nutrition for Diseases of the Kidney. Lecture presented at Duquesne
     University, Fisher Hall, Pittsburgh, PA, United States.

Patient Manual [Leaflet]. (2019). Dialysis Clinic, Inc.