Resources - Kidney Dialysis

Hemodialysis
Peritoneal Dialysis (PD)
Dialysis Diet
Milk and dairy products
Meat and meat substitutes
Starches
Vegetables
Fruits
Fats
High-calorie foods
Salty foods
Liquids

What do my kidneys do?

Your kidneys clean waste and extra fluid from your blood. This makes up your urine (pee). They also do many other jobs that you need in order to live. Your kidneys:

Control chemicals and fluid in your body
Help control your blood pressure
Help keep your bones healthy
Help you make red blood cells

Where are my kidneys?

Your kidneys are part of your urinary tract. They are located on either side of your spine, just below your rib cage. Each kidney is connected to your bladder by a thin tube called a ureter.

What is kidney disease?

The term "chronic kidney disease" (CKD) means lasting damage to the kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant in order to live.

CKD can be caused by many different diseases. The most common causes of CKD are diabetes and high blood pressure. Some infections, inherited diseases and injuries can also cause CKD.

Treating Kidney Disease

Treating kidney disease in its earlier stages can help slow it down and prevent related problems like anemia, bone disease and heart disease. But even with the best care, some people will develop kidney failure. This is when your kidneys are not working well enough to keep you alive on their own. When your kidneys fail, you need dialysis or a kidney transplant in order to live.

There are a few different treatment options that you will need to consider. Work with your healthcare team to find the option that works best for you.

Hemodialysis

Dialysis is a treatment for kidney failure. It helps replace the work of the kidneys when they have stopped working. Hemodialysis is a type of dialysis.

What is hemodialysis?

Hemodialysis is a way of cleaning wastes and extra fluids from your blood using a machine.

In hemodialysis, blood goes through a tube from your body to a special filter called a dialyzer. The dialyzer filters waste and extra fluid from your blood. Then, the "clean" blood travels through another tube and back into your body.

Where can I get hemodialysis treatments?

In most cases, hemodialysis is done at a dialysis center. This is sometimes called "in-center hemodialysis." Your doctor will decide how often you need treatment, but most people have in-center hemodialysis treatments three times per week. Each treatment usually lasts about three to five hours.

Some things to consider about in-center hemodialysis are:

You may need help getting to and from the dialysis center.
Some centers have more flexible hours than others.
Your doctor may only work with a few dialysis centers in your area.
During your hemodialysis treatments, you can do several activities. Many people use their time at the dialysis center to:
- Read a book
- Listen to music
- Play hand-held video games
- Do crossword puzzles
- Take a nap

In some cases, hemodialysis can be done at home. This means that you (and usually a partner) would need to be trained on how to insert needles and run the machine. Many dialysis centers have staff that can train you to do home hemodialysis.

What is an access?

For hemodialysis, blood is taken from your body, cleaned and returned to your body. This happens through a place on your body called an access (or vascular access). There are three types of access:

Fistula
A fistula (also called an AV fistula) is a place where one of your arteries connects to one of your veins. Your fistula would be created during a minor surgery and would need time to heal and "mature" before it can be used. Then, during dialysis treatments, needles will be put into your matured fistula.
In most cases, your fistula will be placed in your non-dominant arm. This means that if you are right-handed, your fistula would likely be in your left arm.
A fistula is the best kind of access. It is the least likely to get clots or infections. Fistulas also tend to last longer than other types of access. But, because fistulas can take longer to heal, it is important to plan ahead. Talk to your doctor about your options and whether a fistula is right for you.
Graft
A graft (also called an AV graft) is a special tube that connects an artery and a vein in your arm. Like with a fistula, a graft would be placed under your skin during a minor surgery. Your graft will need time to heal, too, but it probably won't take as long as a fistula to be ready. During dialysis treatments, needles will be put into the graft.
In most cases, your graft will be placed in your non-dominant arm. This means that if you are right handed, your graft would likely be in your left arm.
Grafts are not as safe as fistulas. They are a little more likely to have infections or get clots. Still, many people do well with grafts. Talk to your doctor about your options and whether a graft is right for you.
Catheter
A catheter is a tube that goes directly into a vein in your neck or leg. During dialysis treatments, the machine takes blood from your catheter and returns blood to your catheter. This means that you won't have needle sticks at each treatment, like you would have with a fistula or a graft. But catheters are more likely to get infected or have clots. For this reason, catheters are only recommended in emergencies or for short-term use.

How should I care for my access?

Caring for your access is very important! Your access lets you have the treatment you need in order to live. Take good care of your access, no matter which kind you have.

To care for fistulas and grafts:

Keep the area clean
Use your access only for dialysis
Do not have blood tests or check blood pressure on your access arm
Avoid having tight clothing or jewelry near your access
Protect your access from bumps and cuts
Avoid lifting heavy objects
Try not to lay or sleep on your access
Learn how your needles will be placed for dialysis (The staff at your dialysis center can help you with this.)
Make sure that the staff at your dialysis center checks your access at each treatment
Tell your doctor right away if you notice any swelling, redness or other changes in your access

To care for a catheter:

Make sure that all clamps are closed and caps are on tight
Protect the area from water and dirt as much as possible
Keep the area clean, dry and bandaged
Clean and re-bandage the area at each treatment (The staff at your dialysis center can help, but make sure that you know how to do this at home in case the bandage becomes wet or dirty between treatments.)
Tell your doctor right away if you have a fever or notice any swelling, redness or other changes around the access

Peritoneal Dialysis (PD)

Dialysis is a treatment for kidney failure. It helps replace the work of the kidneys when they have stopped working. Peritoneal dialysis (also called PD) is a type of dialysis.

What is PD?

PD is a way of cleaning waste and extra fluid from your blood. PD uses a special fluid called dialysate and the lining of your belly to do this.

The organs in your belly are inside a special lining called the peritoneum. This natural lining is thin and acts like a filter. It lets some things through and keeps others out.

For PD, you will have a soft flexible tube (called a catheter) that goes from outside your body to inside your peritoneum. This catheter is placed during a minor surgery. Then, you will:

Put dialysate fluid into your belly through your catheter
Let the dialysate sit in your belly for several hours
During this time, the dialysate fluid pulls waste and extra fluid out of your blood. This is called the "dwell time."
Drain the dialysate, along with the waste and extra fluid, out through your catheter
Put new dialysate fluid into your belly and repeat the process

This process is called an exchange. Your doctor will tell you how many exchanges to do each day. Your doctor will also tell you what kind of dialysate to use.

Where can I do PD treatments?

PD treatments are usually done at home in a clean, dry place. Because PD is fairly portable, you may also do it while traveling. This makes it a more flexible treatment option.

While you do not need to go to a dialysis center for your treatments, you will still need to work with a center to learn how to do your PD exchanges and to get your supplies.

How can I stay healthy on PD?

One of the most common problems with PD is the risk of peritonitis. This is when your peritoneum, that natural lining in your belly, gets infected. This might happen if germs get into your belly through your catheter.

Bad infections can keep you from being able to do the PD treatments you need. To help prevent an infection:

Learn the right way to do your exchanges
The staff at your dialysis center can help. Don't be afraid to ask questions.
Keep all of your PD supplies in a clean, dry place
Do all of your exchanges in a clean, dry place
Always wash your hands before doing an exchange
Wear a surgical mask when you do exchanges

If you think you do have an infection, get treatment quickly. Tell your doctor right away if:

You see pink or red around your catheter
You have pain around your catheter
Your catheter shifts or starts to come out
Any of the clamps on your catheter break
Your dialysate looks cloudy
You have a fever
You feel very sick or throw up

How long can a person live on dialysis?

There is no limit to how long a person can live on dialysis. On average, the life expectancy for someone on dialysis is between five and six years, but this can vary a lot depending on a person's age, other health concerns and how well he/she follows his/her treatment plan. With good care, it is very possible for a person to live for many years on dialysis.

What should I do if I have a complaint about my dialysis center?

Any problems that you have with your dialysis center should be taken up the chain of command. If you can't work out the problem with the person directly involved, talk with the Charge Nurse. If the problem continues, talk with the Director of Nursing, then the Administrator. Also let your doctor know about any problems you are having. If you are still having trouble with your dialysis center, contact the ESRD Network for your area or your state health inspector.

Dialysis Diet

A dialysis diet controls the amount of potassium, phosphorus, sodium and liquid in your diet. The dialysis diet also provides you with enough calories and protein to be healthy. Your caregiver will help you plan a diet with the right amount of phosphorus, potassium, sodium, fluid, and other nutrients for you. If you need peritoneal (per-I-toh-NEE-al) dialysis, your diet may not be as limited as a person who needs hemodialysis (he-mo-deye-AL-I-sis). Your diet may need to change over time based on your weight, blood test results, and other reasons.

You may also need to make other diet changes if you have other health problems. These health problems may include diabetes, heart disease, high blood pressure and other health conditions.

What can I do to make a dialysis diet part of my lifestyle?

Changing what you eat and drink may be hard at first. Following a dialysis diet may help you feel better. Think of these changes as "lifestyle" changes, not just "diet" changes. You will need to make these changes part of your daily routine.

Choose a variety of foods on this diet to avoid getting tired of having the same foods every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet.
Carry a list of items allowed on this diet to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can help you follow the diet.
Ask your caregiver, a dietitian, or a nutritionist any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you.

What can I eat and drink while on a dialysis diet?

Ask your caregiver how much potassium, phosphorus, sodium, liquid and protein you need in your diet. The food list below can help you plan your meals.

Milk and dairy products:
The following servings of food have four grams of protein, 120 calories, 80 mg of sodium, 185 mg of potassium, and 110 mg of phosphorus.
- One half of a cup of milk (fat free, low-fat, whole, buttermilk, or chocolate milk).
- One-half of a cup of ice milk or ice cream.
- One-half of a cup of plain or fruit-flavored yogurt.
- Nondairy milk substitutes: These foods have one-half of a gram of protein, 140 calories, 40 mg of sodium, 80 mg of potassium, and 30 mg of phosphorus.
- One-half of a cup of nondairy frozen dessert, or nondairy frozen dessert topping.
- One-half of a cup of nondairy creamer.
Meat and meat substitutes:
These foods have 7 grams of protein, 65 calories, 25 mg of sodium, 100 mg of potassium, and 65 mg of phosphorus. Do not use salt when preparing these foods.
- One ounce of beef, such as round, sirloin, T-bone, porterhouse steak, rib, ground beef or ground chuck.
- One ounce of pork such as fresh ham, tenderloin, chops, loin roasts, or cutlets.
- One ounce of lambchops, legs, or roasts.
- One ounce of poultry, such as chicken, turkey, Cornish hen, domestic duck, or goose.
- One ounce of any fresh and frozen fish.
- One ounce of lobster, scallops, shrimp, or clams.
- One and one-half ounces of crab or oysters.
- One ounce of canned tuna, unsalted canned salmon, or unsalted sardines.
- One large whole egg, or two large egg whites or yolks.
- One-fourth of a cup of low-cholesterol egg product.
The following meats and meat substitutes are high in sodium. This means that they have 100-300 mg of sodium in a serving. You may need to avoid eating the following meats:
- One ounce of deli-style roast beef, boiled or deli-style ham, or deli-style chicken or turkey.
- One ounce of canned salmon or sardines.
- One-fourth of a cup of cottage cheese.
The following meats and meat substitutes are high in sodium, phosphorus, or saturated fat. These foods should be avoided in your diet:
- All cheeses except cottage cheese.
- Frankfurters, bratwurst, Polish sausage, and bacon.
- Lunch meats including bologna, liverwurst, picnic loaf, salami, summer sausage.
The following meats and meat substitutes are high in potassium and phosphorus. These foods should be avoided:
- Nuts and peanut butter.
- Dried beans, peas, and lentils.
Starches:
These foods have 2 grams of protein, 90 calories, 80 mg of sodium, 35 mg of potassium, and 35 mg of phosphorus.
- Breads and rolls:
  - One slice of bread (French, Italian, raisin, light rye, or sourdough white).
  - One-half of a hamburger or hot dog bun.
  - One-half of a small Danish pastry or sweet roll, without nuts.
  - One small dinner roll or hard roll.
  - One-half of an plain English muffin, or one-half of a small plain bagel.
  - Two, six inch corn or flour tortillas.
- Cereals and grains:
  - Three-fourths of a cup of most brands of ready-to-eat cereal. (Some cereals are high in sodium).
  - Two cups of puffed rice.
  - One-half of a cup of cream of rice, cream of wheat, farina, or cooked grits.
  - One-third of a cup of oat bran or oat meal.
  - One-half of a cup of cooked pasta such as noodles, macaroni, or spaghetti.
  - One-half of a cup of cooked brown or white rice.
- Crackers and snacks:
  - Four saltine or round butter crackers.
  - Four graham crackers.
  - One and one-half cup of plain popped popcorn.
  - Nine tortilla chips. (This equals three-fourths of an ounce.)
  - One-fourth of an ounce of sticks or ring pretzels. (Salted pretzels are high in sodium.)
- Desserts:
  - Two inch square, or one and one-half ounces of cake.
  - Four sandwich cookies. (These cookies are high in sodium and phosphorus).
  - Ten vanilla wafers.
  - One-eighth of an apple, berry, cherry, or peach fruit pie.
  - One-half of a cup of sweetened gelatin.
The following are starches that are high in low-quality protein and phosphorus. Do not eat these foods often. If you do eat them, eat only small amounts.
- Bran cereal or muffins, granola cereal or bars.
- Boxed, frozen, or canned meals, entrees (main courses), or side dishes.
- Pumpernickel, dark rye, whole-wheat or oatmeal breads.
- Whole-wheat crackers or cereals.
Vegetables:
These foods have 1 gram of protein, 25 calories, 15 mg of sodium, and 20 mg of phosphorus. The amount of sodium listed is for vegetables that are canned or prepared with no added salt. One serving is one-half cup, unless another amount is given.
- Low potassium (0-100 mg):
  - One cup of alfalfa sprouts.
  - Green or wax beans, and bean sprouts.
  - Raw cabbage.
  - Peeled cucumber.
  - All varieties of lettuce (one cup).
  - One green, sweet pepper.
- Medium potassium (101-200 mg):
  - Five spears of asparagus.
  - Broccoli, cauliflower, eggplant, and onions.
  - One small raw carrot, or one stalk of raw celery.
  - One-half of a cup, or one-half of an ear of corn.
  - Fresh and canned mushrooms. (Mushrooms have 40 mg of phosphorus or more, per serving.)
  - Green or snow peas. (Peas have 40 mg of phosphorus or more, per serving.)
  - Raw spinach.
  - Summer squash.
- High potassium (201-350 mg):
  - Artichoke, or cooked celery.
  - One-fourth of a whole avocado.
  - One chili pepper.
  - Unsalted or regular vegetable juice cocktail. (Regular vegetable juice cocktail is high in sodium.)
  - Unsalted or regular tomato juice. (Regular tomato juice is high in sodium.)
  - One-fourth of a cup of tomato sauce.
  - One medium tomato.
- High Potassium (201-350 mg) and more than 40 mg of phosphorus:
  - Brussels sprouts or okra.
  - Potato, boiled, mashed.
  - Two tablespoons of tomato paste.
  - Fresh, cooked mushrooms.
  - Winter squash.
- Very high potassium (more than 350 mg):
  - Hash browned potato.
  - Sweet potato. (Sweet potatoes have 40 mg of phosphorus or more, per serving.)
  - One-fourth of a cup of beet greens.
  - One-half of a medium baked potato.
  - One ounce of potato chips (one ounce equals about 14 chips).
  - Cooked spinach. (Cooked spinach has 40 mg of phosphorus or more, per serving.)
Fruits:
These foods have one-half gram of protein, 70 calories, and 15 mg of phosphorus. Each serving is one-half cup, unless another amount is given.
- Low potassium (0-100 mg):
  - Applesauce.
  - Blueberries.
  - One cup of cranberries or cranberry juice cocktail.
  - Canned pears.
  - Grape juice.
- Medium potassium (101-200 mg):
  - One small apple (two and one-half inches across) or apple juice.
  - One fresh peach (two inches across).
  - Sweet or sour cherries.
  - Canned or fresh pineapple or fruit cocktail.
  - Grapes, strawberries, mango, or watermelon.
  - One-half of a small grapefruit, or grapefruit juice.
  - One tangerine (two and one-half inches across).
- High potassium (201-350 mg):
  - One cup of canned or fresh apricots or five dried apricots.
  - One small nectarine (two inches across).
  - One-half of a cup of orange juice, or one small orange.
  - One-eighth of a small cantaloupe.
  - One-fourth of cup of dates or two whole dried figs.
  - One medium fresh pear.
  - One-eighth of a small honeydew melon.
- Very high potassium (more than 350 mg):
  - One-half of a medium banana.
  - Prune juice, dried prunes, or canned prunes.
Fats:
These foods have very little protein, 45 calories, 55 mg of sodium, 10 mg of potassium, and 5 mg of phosphorus.
- Unsaturated fats:
  - One teaspoon margarine or one tablespoon reduced calorie margarine.
  - One teaspoon mayonnaise or one tablespoon low-calorie mayonnaise.
  - One teaspoon oil: safflower, sunflower, corn, soybean, olive, peanut, canola.
  - Two teaspoons salad dressing, mayonnaise type.
  - One tablespoon salad dressing, oil type.
  - Two tablespoons low-calorie salad dressing.
  - One and one-half teaspoons tartar sauce.
- Saturated fats:
  - One teaspoon butter.
  - Two tablespoons coconut.
  - One tablespoon powdered coffee whitener.
  - One teaspoon solid shortening.
High-calorie foods:
These foods have very little protein, 100 calories, 15 mg of sodium, 20 mg of potassium, and 5 mg of phosphorus.
- Liquids: (Be sure to include these liquids when adding up the amount of liquids allowed for a day.)
  - One cup of a soda-type liquid: Ginger ale, lemon-lime.
  - One cup of a fruit-flavored drink, limeade, or lemonade.
  - One cup of cranberry juice cocktail.
- Frozen deserts: (Be sure to include these liquids when adding up the amount of liquids allowed for a day.)
  - One-half of a fruit ice bar.
  - One three ounce juice bar.
  - One-half cup of sorbet.
- Candy and sweets:
  - Four pieces of hard candy.
  - Ten jelly beans.
  - Two fruit rolls.
  - One-fourth cup of cranberry sauce or relish.
  - Five large marshmallows.
  - Two tablespoons brown or white sugar, marmalade, jam or jelly, syrup, honey.
Salty foods:
These foods have 250 mg of sodium.
- One-eighth of a teaspoon of seasoned salt such as onion or garlic salt.
- Two tablespoons of barbecue sauce.
- One and one-half tablespoons of ketchup.
- One and one-half tablespoons of chili sauce.
- One-sixth of a large dill pickle.
- Four teaspoons of mustard.
- Two medium green olives or three large black olives.
- One-fourth of a teaspoon of soy sauce.
- Two and one-half teaspoons of steak sauce.
- One and one-fourth teaspoons of teriyaki sauce.
Liquids:
These liquids may be included in your diet. Be sure to include these liquids when adding up the amount of liquids allowed for a day.
- Non-cola sodas (ginger ale, lemon-lime sodas).
- Ice.
- Lemonade or limeade.
- Water or mineral water.
These liquids have some potassium or phosphorus in them. Avoid these liquids, or drink only small amounts.
- Colas and pepper-type sodas.
- Beer and wine.
- Coffee, regular or decaffeinated.
- Fruit-flavored drinks with added vitamin C.
- Tea.
- Thirst-quencher liquids.
These liquids are very high in sodium or potassium and should be avoided.
- Broth or bouillon.
- Consomme.
- Salt-free broth or bouillon which are made with salt substitute
- (potassium chloride).

What other diet guidelines should I follow?

Any food that contains liquid, such as soup, must be added in the amount of liquid that you may have each day. Any food that melts when it is not cold, such as gelatin or ice cream, must also be counted.
Ask your caregiver if you should make other diet changes because of other health problems you may have. You may need to take a vitamin and mineral supplement (pill). Your caregiver will recommend the right vitamin and mineral supplement for you if you need one.
You may need to stop using salt substitutes because they also contain potassium.
Eat high fiber foods to avoid becoming constipated. Constipation is having dry, hard stools that are difficult to pass. High fiber foods include vegetables and fruits, whole grains (whole wheat bread and bran cereals) and legumes (beans, lentils). Eat only the amounts of high fiber foods suggested by your caregiver to avoid getting too much potassium, phosphorus and sodium.

Risks:

Following a dialysis diet may cause you to lose interest in eating. This may happen because foods may taste different than they used to. It may also happen because you will not be able to eat certain favorite foods. If you do not eat enough food, your body may not get the calories, protein, and other nutrients you need to be healthy. Talk to your caregiver if you lose interest in eating.
Not following a dialysis diet may cause malnutrition (your body does not get the right amount of nutrients to work properly). You may have trouble controlling your blood pressure and balancing blood chemicals and fluids. You may also develop other health problems.
Some over-the-counter vitamin and mineral supplements can be harmful if you are on dialysis. Take only the vitamin and mineral supplements suggested or ordered by your doctor.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your diet. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.