Top 20 foods to avoid if your on dialysis

The Top 20 Foods to Limit or Avoid When You're On Dialysis:

(CAVEAT:Each Renal Dietician has their own views of the ingredients listed here. There are different schools of thought (and even that has evolved over time) on what are good choices and what to avoid. ALWAYS CHECK WITH YOUR RENAL DIETICIAN FOR WHAT WORKS FOR YOU.)

Hey Friends!

Hope your day's been good. I had a blood test yesterday morning, so I'm staying in for the next few days. It's just too hot out!

Seriously though, I live in Westchester County, New York, and it's supposed to be over 100 degrees for the next few days. I don't want to sweat off the little fluid I'm allowed to drink. Plus, I'll have an extra day without dialysis. Honestly, I usually don't struggle with my fluid restriction.

I drink 46oz a day (it's a unique amount for everyone, depending on how much you pee, your treatment, and how well you dialyze). I never go over, and I actually struggle to reach it. I'm always scared I'll get dehydrated. I'm super strict about counting fluids, I count everything (especially solid foods that count as fluid). But I still pee a lot. Sometimes I weigh in at dialysis and I've only gained .2k. I guess that'll change over time.

So I make sure to count my semi-solid to solid foods because my diet restrictions require me to limit my sodium (the most important of the "3 musketeers": sodium, potassium, and phosphorus) to around 2,000mg or less per day.

Potassium is a pretty important mineral, so as a hemodialysis patient, I have to keep my daily intake under 2,000. For someone with good bloodwork, the average can be between 2,000 and 3,000 mgs a day.

Here's what I've found: (I asked my kidney dietitian, Danielle, for her expert advice on this blog post. She's always given me great suggestions. You should get to know your care team. They're there to help you succeed.)

Individualized Needs: Dialysis modality impacts allowances. For example, patients on daily or nocturnal home hemodialysis might not have to limit potassium as aggressively, while others may require tighter restrictions. [1, 2]A typical daily potassium limit for a hemodialysis patient is 2,000 milligrams (mg). [1, 2] It depends on what your renal dietician and nephrologist recommend)

Most dialysis patients that treat 3x's a week need to restrict foods high in potassium, phosphorus, and sodium to prevent dangerous electrolyte buildup and fluid retention between treatments as well as keeping their buildup from causing multiple health concerns. Remember, your kidneys can no longer filter these minerals. Top restricted items include avocados, bananas, dark-colored sodas, processed meats, and dairy products*. [1, 2, 3]

Dietary restrictions are highly individualized for dialysis. Specific foods should only be eliminated under the strict guidance of a renal dietitian. [1]

Top 20 Foods to Avoid or Limit

These foods are categorized by the primary nutrient or risk they pose to dialysis patients. [1, 2]

High-Potassium Foods:

Potassium cannot be easily filtered by failing kidneys, leading to potential heart rhythm issues. [1, 2]**If you were told by your care team to limit your potassium or follow a low potassium diet, the following foods should be limited/avoided.

1. Avocados: Extremely rich in potassium, even in small portions.
2. Bananas: Known for high potassium content, which can burden the heart.
3. Oranges & Orange Juice: Highly concentrated potassium sources.
4. Potatoes & Sweet Potatoes: Must be boiled (and the water discarded) to leach out potassium, or avoided.
5. Tomatoes & Tomato Sauce: Naturally high in potassium and usually high in sodium.
6. Spinach & Swiss Chard: Leafy greens contain very high potassium levels, especially when cooked down.
7. Dried Fruits (Dates, Raisins, Prunes): Potassium is highly concentrated in these without the water content.
8. Melons (cantaloupe & honeydew, as well as the other varieties,except for watermelon): Very high in potassium. [1, 2, 3, 4, 5, 6, 7]

High-Phosphorus Foods:

Excess phosphorus weakens bones and causes severe itching. Many modern foods contain hidden phosphorus additives. Natural sources can be consumed in small amounts based on lab results.

9. Dark-Colored Colas: Contain heavy amounts of phosphorus additives that the body absorbs easily.

10. Dairy Products (Milk, Cheese, Yogurt): Rich in calcium and naturally very high in phosphorus.

11. Nuts & Seeds: Highly concentrated in phosphorus and potassium.

12. Processed Meats (Bacon, Hot Dogs, Pepperoni): Loaded with phosphate preservatives and excess sodium.

13. Chocolate: Cocoa beans are naturally high in phosphorus and potassium.

14. Whole Grain Breads & Cereals: Higher in phosphorus and potassium than white or refined grains. [1, 2, 3, 4, 5, 6, 7]

Always remember to take your phosphorus binders with all meals(this includes snacks that have significant phosphates in them) Remember, you want the pill to process with or right before you put the food in your mouth. The key is to stop the phosphorus in its tracks, before it reaches the stomach.

Phosphate binders are designed to be taken precisely with meals—typically just before, during the first few bites of, or immediately after eating—to be effective in managing phosphorus absorption. [1, 2]

Because kidneys in certain conditions cannot naturally filter out excess phosphorus, these medications act like magnets or sponges in the gut to trap it. If the binder is not present in the digestive tract when food arrives, the body may absorb the phosphorus into the bloodstream. [1, 2, 3]

The specific timing and method for taking binders can vary depending on the medication prescribed. Some general guidelines for binder types include: [1]

• Calcium-Based Binders: Options like calcium acetate are often consumed right before eating.
• Sevelamer: Products like sevelamer carbonate or sevelamer hydrochloride are frequently taken during the initial bites of a meal.
• Chewable Options: Certain binders, such as sucroferric oxyhydroxide, are thoroughly chewed along with the food. [1, 2]

If a dose is forgotten, taking it during the meal is generally recommended rather than skipping it entirely. Always follow the specific instructions provided by a healthcare professional, such as a renal dietitian or doctor. [1, 2]

For more tips on integrating binders into your routine, resources like the DaVita Kidney Care Guide or the Cleveland Clinic Phosphate Binder Overview are available. [1, 2]

High-Sodium & Fluid Foods:

Excess salt causes severe fluid retention, stress, leading to swelling, high blood pressure, and strain on the heart . (*For some patients this category is more prevalent to watch.)

15. Canned Soups & Vegetables: Often heavily laden with sodium to preserve shelf life.

16. Chips, Crackers, & Pretzels: Provide a massive hit of sodium and are often made from high-potassium potatoes.

17. Pickles & Olives: Cured and preserved in salt-heavy brines.

18. Fast Food: Combines massive amounts of sodium, phosphorus preservatives, and fluid volume.

19. Soy Sauce, BBQ Sauce, & Seasoning Salts: Highly concentrated sodium sources. [1, 2, 3, 4, 5, 6]

Other Dangerous Foods:

20. Starfruit: Must be universally avoided by all kidney patients. It contains a neurotoxin that damaged kidneys cannot clear, which can cause seizures and confusion. [1, 2])

***Mango, Papaya and Kiwi: These fruits should also be monitored because they are high in potassium and should be eaten sparingly. (Always check with your dietician.)

Because the kidneys of "hemodialysis" patients cannot completely remove excess potassium, strictly managing intake is necessary to prevent hyperkalemia (dangerously high blood potassium, which can cause irregular heartbeats or cardiac arrest). [1, 2, 3]

Key details regarding potassium management include:

• The Goal Range: Most hemodialysis patients are advised to aim for 2,000 to 3,000 mg per day, depending on their lab results, dialysis prescription, and remaining kidney function. [1, 2]
• Blood Levels: The target for serum potassium is typically between 3.5 and 5.5 mEq/L. Levels above 6.0 mEq/L are considered dangerous. [1]
• High-Potassium Foods: Patients are usually instructed to limit or avoid foods containing more than 200–250 mg of potassium per serving. Common examples include bananas, potatoes, tomatoes, avocados, and oranges. [1, 2, 3]
• Individual Variations: Patients who undergo treatments more frequently (such as home hemodialysis) or who still have some residual kidney function may be allowed a more generous intake. [1, 2]

Always consult with your Nephrologist or a Renal Dietitian to determine the specific potassium restriction that is appropriate for your individual needs. [1]

Reliable Resources & Diet Tools:

The following tools and verified organizations can help you manage your diet safely: [1, 2]

• National Kidney Foundation (NKF): Access their comprehensive Dining Out With Confidence Guide and Nutrition and Kidney Failure Overview to learn about what foods to avoid and why. [1]
• DaVita Kidney Care Diet Tools: Utilize the interactive DaVita Kidney Diet Helper to track nutrients, plan recipes, and search a comprehensive database of dialysis-safe foods. [1, 2, 3]
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Read the actionable Eating and Nutrition for Hemodialysis guide to learn about protein goals, fluid allowances, and phosphorus management. [1]
• Renal Dietitian Locator: Find a specialized renal dietitian in your area who can create a personalized meal plan tailored to your exact blood test results. [1, 2, 3]

If I Had a Say:

It's pretty suspicious how the foods I love most are the ones I gotta avoid or seriously limit. Interesting... But seriously, there are limits, but my renal dietician always says, "portion control and everything in moderation."

So I only eat the bad stuff once or twice a month as a treat. I make sure, if I choose to eat potatoes that I leach them over night and replace the water several times(it remove between 50%-75% of the potassium, but you still need to watch your consumption) I do the work and limit my sodium, potassium, and take my binders as often as needed. I'm not perfect, but I try to focus on the concept that  "Sometimes I succeed, sometimes I fail, but every day is a clean slate and a fresh opportunity"—was written by author Gretchen Rubin in her bestselling book The Happiness Project.

I try to find better alternatives to the foods to avoid, like creamed cauliflower to mimic mashed potatoes, or kale chips to substitute for potato chips. They obviously aren't the same, but they simulate well enough. (There are others and maybe I'll do a blog post on it another time.) If you have any suggestions, email me and I check them out and maybe add them on this page!

If you think about it, there really are less of the foods I can't have compared to how many I can have. That's relieving when I put it in the right perspective. I hope everyone that lives with diet restrictions can find use of this post and the resource links that I've attached. Use them, you can do this!

Tina

My quote for you:

"To eat is a necessity, but to eat intelligently is an art." — François de La Rochefoucauld

My links are in the sidebar

(Please, please, please share these links everywhere!)