Peritoneal dialysis diet considerations

When you find out you need dialysis due to kidney failure, options for treatment include transplant, traditional in-center hemodialysis (ICHD), home hemodialysis (HHD), in-center nocturnal dialysis (ICND) and peritoneal dialysis (PD). Each treatment choice has different pros and cons when it comes to diet. Today let’s take a look at the peritoneal dialysis diet.

PD is performed on a daily basis which means waste and fluids are removed more often compared to three times a week traditional in-center hemodialysis. For this reason some parts of the diet are more liberal.

Protein – Protein is lost in each exchange so a high protein diet is required to keep albumin normal and prevent muscle wasting. This means eating generous potions of meat, poultry, fish, seafood, eggs or egg whites and in some cases adding a protein supplement. Higher phosphorus protein foods such as milk, yogurt, cheese, beans and nuts are limited in the PD diet.

Potassium – daily removal of this mineral helps keep blood levels in the normal range. A liberal potassium diet of 3000 to 4000 mg/day is often prescribed but this may vary based on individual needs, number and frequency of exchanges, use of an automated cycler, remaining kidney function and lab values. Some PD patients must eat high potassium foods or take potassium supplements to keep potassium from dropping too low.

Sodium – Sodium removal is very efficient with PD, so most people are prescribed a 3000 to 4000 mg sodium diet. This level is easy to reach without too many diet changes. However people who eat out frequently and use many processed and convenience foods could easily exceed this limit. Stricter levels may be required if other health conditions are present.

Fluid – Each exchange allows removal of fluids so there is seldom accumulation of excess fluid in the body. PD patients can regulate fluid by adjusting the glucose concentration in the dialysate. Most patients can consume 2-3 liters of fluid a day but this varies with remaining kidney function and type of peritoneal dialysis therapy.

Additional considerations about diet for peritoneal dialysis include phosphorus, calories, vitamins and minerals.

Phosphorus – This mineral is not easily removed by PD so patients must follow a low phosphorus diet and take phosphate binders when they eat. Higher protein diets contain more phosphorus so keeping phosphorus in control can be a challenge.

Calories – The PD solution or dialysate used to remove waste and fluid contains dextrose which provides easily absorbed sugar calories. Some PD patients gain weight because they are getting 400 or more calories a day from the dialysate.

Vitamins – Several vitamins are lost in the dialysate so a daily supplement is recommended. Special renal vitamins provide folic acid, B complex and 60 to 100 mg vitamin C. Vitamin D, both nutritional and activated, may be prescribed based on blood levels of vitamin D and parathyroid hormone levels.

Minerals – PD patients may require iron supplementation, depending on their ferritin and hemoglobin levels. IV iron therapy is often prescribed when needed of oral supplements may be taken if tolerated.

If you would like more information about dialysis at home including peritoneal dialysis and home hemodialysis: