Kidney Diet Tips

Comparing Kidney Diets: Peritoneal Dialysis vs. Hemodialysis

In any situation, there are pros and cons when deciding between two options. Making the decision for which form of dialysis to treat end stage renal disease (ESRD) is no exception. Knowing the difference between kidney diets and the guidelines for peritoneal dialysis (PD) and those for in-center hemodialysis (HD) may be helpful in making your pros and cons list.

The table below is a brief comparison including the components of kidney diets for HD and PD. Read further for a more detailed description.

Diet Component HD PD
High Protein Yes Yes
High Calorie Yes No
Low Potassium Yes No
Low Phosphorus Yes Yes
Low Sodium Yes Yes
Fluid Restriction Yes No


Protein in PD and HD Kidney Diets

Increased dietary intake of protein is beneficial for PD and HD patients. Patients with ESRD that receive dialysis of any kind have much higher protein needs than the average person. Maintaining good protein status helps keep patients healthy and out of the hospital. It helps patients recover from illness faster. And it also helps the process of fluid removal for those on HD. Dialysis patients needs are roughly 1.2 times higher than the average person, sometimes more. High quality protein sources include: beef, bison, turkey, chicken, pork, lamb, fish, seafood and eggs.


Those receiving HD have increased calorie or energy needs, especially during times of infection or trauma. PD patients typically do not have higher calorie needs as the liquid solution used for treatment provides 500 or more calories per day. Although in times of infection or trauma, calories may be increased for PD patients.


Potassium is one of the nutrients the kidney are in charge of removing from the body. When they are no longer functioning, potassium builds up and can cause problems. Most PD patients do not need to restrict dietary potassium. Since exchanges are completed multiple times daily it cleans the body of toxins and potassium more often. Some PD patients still produce urine which also helps the body remove potassium. Higher potassium foods may be encouraged. At times, PD patients even need an oral potassium supplement. Some HD patients continue to produce urine but this residual urine decreased for most HD patients. HD patients are encouraged to restrict potassium between 2000-3000 mg per day. Potassium naturally occurs in many foods. Foods of note to limit or avoid include: potatoes, tomatoes, oranges, bananas, nuts and seeds, beans and legumes.


Phosphorus is another nutrient the kidneys remove from the body. While dialysis cleans some potassium, it does not remove a lot of phosphorus. Both PD and HD patients are encouraged to follow a low phosphorus diet. Dietary intake of phosphorus is limited to 800-1000 mg daily for most PD and HD patients. When the diet is not controlled, additional phosphorus goes to soft tissues, like the heart, which may contribute to heart and bone disorders. More often than not, a phosphate binder is required. The binder acts like a magnet in the digestive tract to remove dietary phosphorus which is excreted in the stool. Even if a person takes binders with food, the dietary restriction is still necessary. High phosphorus foods include: dark colas, processed meats (sausage, hot dogs, and pepperoni), dairy products, nuts and seeds, chocolate and processed foods with phosphate additives, especially fast food items.


It is recommended to keep sodium intake between 2000-3000 mg daily. Limiting sodium helps control fluid weight gain between treatments and minimizes high blood pressure for both PD and HD. Decreasing sodium for HD patients also helps the fluid removal process and reduces cramping while receiving treatment. Here is a small list of high sodium foods to limit/avoid: salty crackers and chips, processed meats and cheeses, pizza, fast food, salty condiments like ketchup; canned soups, canned vegetables and beans.


When the kidneys are not working, they are not removing excess fluid. Intake of fluids should decrease for HD patients as they receive treatment only three times per week. If fluid intake remains the same fluid will accumulate in the lower legs and feet, in the arms and hands, abdomen, around the eyes and the heart. With multiple exchanges daily, PD patients do not need to be as strict with their fluid.

The kidney diet can seem overwhelming. There are parts that overlap like avoiding processed meat helps decrease phosphorus as well as sodium. Think of each of these as a guideline rather than a restriction. The registered dietitian nutritionist (RDN) at your dialysis center can help create a diet plan that coincides with your dietary needs. .

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.


This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

Annie Jacobson, RDN, LN

Annie Jacobson, RDN, LN

Annie Jacobson, RDN, LN has been a registered dietitian for 10 years with the last year spent in the renal specialty. She previously worked in long-term care, gaining a specialty certification in Gerontological nutrition. Annie loves talking to anyone and everyone about nutrition, but only if they ask first. Her passions are family, fitness and nutrition. She recently joined a CrossFit gym and admits she is a little addicted!