Home Dialysis May Offer More Flexible Kidney Diet
Choosing home dialysis often means a more flexible kidney diet. This is because home dialysis therapies are performed more frequently than in-center hemodialysis therapy.
Peritoneal Dialysis (PD)
One type of home dialysis treatment is peritoneal dialysis (PD). In this treatment the peritoneum membrane that surrounds the abdominal cavity works as a filter. It helps with removal of waste and excess minerals from the blood. This is how PD treatments help keep blood chemistries under control. PD is done daily, similar to the work a kidney would do. In some cases kidney patients still have renal residual function (RRF). This means that the kidneys are still able to help remove some of the fluid and waste from the blood. Some PD patients enjoy having a more flexible kidney diet because they still have RRF.
Protein and Potassium Levels and PD
Due to amino acids loses with each PD treatment, many of my patients labs results show a lower level of protein in the blood (albumin). Some also have a lower level of potassium. Why? One reason is most likely due to not increasing their protein intake once they start doing PD. Protein is removed during the PD treatment. This means a higher protein diet is needed. In addition, PD patients lose potassium with every treatment. This means a higher potassium diet is needed to keep levels from dropping too low. Some patients still have urine output, which also removes potassium from the blood. Your renal dietitian will help decide how much more protein and potassium rich foods you need. Getting enough of these nutrients is important since PD treatments are performed daily. Your dietitian can provide a list of high protein and high potassium foods based on your needs.
Try one of these high protein recipes from DaVita.com: 
- Apple Pork Chops with Stuffing
- Baked Chicken with Rice Stuffing (Pollo al Horno con Relleno de Arroz)
- Braised Short Ribs of Beef
- Halibut with Lemon Caper Sauce
Dietary Fiber
Another important area to remember for PD patients is to avoid constipation. A good way to do this is by adding more high fiber foods. The daily goal for fiber is 20 to 25 grams per day. Your renal dietitian will most likely recommend more whole grains, legumes, fresh fruits and vegetables. If your potassium is normal to low, your dietitian might suggest to eat prunes daily. This is because prunes have a natural laxative called sorbitol. Probiotics, flax seed, chia seeds are a few foods that may be beneficial. Ask your RD about their recommendations.
Home Hemodialysis (HHD)
Home hemodialysis is similar to in-center hemodialysis. However, treatments are shorter, performed more frequently and in the comfort of your home. You need a care partner to assist with this type of dialysis. Mainly, they help with your vascular access and monitor blood pressure, which can drop due to fluid removal. A HHD nurse can help provide education and guidance on home dialysis. HHD is performed five to six times a week. During the treatment it is removing waste such as BUN (blood urea nitrogen), and excess minerals, such as potassium, phosphorus and sodium. In addition, excess fluid is removed during each treatment. Those who still have some residual function (RRF) may more easily meet goals for blood chemistries and fluid control.
Patients who do this type of dialysis tend to have fewer symptoms of depression (1) and improved mental and physical health (2). Also improved appetites have been reported (3).
Depending on your blood pressure readings, you will probably continue taking BP medications. However, due to more frequent dialysis, you might need to decrease the amount or dose of your medications. Your doctor can provide you with guidance about this. A low sodium diet is still required.
Diet can also be more flexible with HHD therapy. Your dietitian and doctor will review your lab results approximately once a month. Your dietitian will be able to help determine your dietary protein needs as well as the amount of rich in potassium foods you need to eat and the amount of phosphorus binders you need to take with each meal. Ask for a copy and review it with your care partner and healthcare providers.
Flexible Kidney Diet In Summary
Remember not all patients are the same when it comes to adequacy of dialysis treatment. This calculation is based on many things such as your height, weight, fluid gains, blood chemistries, amount and frequency of dialysis and the RRF you have left.
Many home patients are able to follow a more flexible kidney diet. However, most of them still need to take their phosphorus binders and other medications to stay healthy. Plan to see a registered dietitian when you transition or start doing a home dialysis therapy. You can ask your doctor for a referral. If you have early or late stage chronic kidney disease (CKD) but are not on dialysis you can attend a Kidney Smart® class for more information. During treatment it is important to eat healthful and according to your nutritional needs using an individualized plan from your dietitian.
References:
1 Jaber B et al. Am J Kidney Dis. 2010;56:531-539.
2 Finkelstein F et al. Poster presentation – Annual Dialysis Conference, 2011).
3 Galland R et al. Kidney International. 2001;60:1555-1560
Additional Kidney Diet Resources
Visit DaVita.com and explore these diet and nutrition resources:
DaVita Kidney-Friendly Recipes
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.
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