If you or a loved one is starting hemodialysis, you might be wondering: What do I eat now? It’s a great question, and an important one. Because while dialysis helps remove waste and excess fluid, nutrition plays a powerful role in supporting your energy, managing symptoms, and improving your quality of life. As a registered dietitian who has worked in dialysis clinics, I’ve seen firsthand how overwhelming those first few weeks can be. That’s why I’m breaking things down in a clear and manageable way to help you feel empowered about what a hemodialysis diet can look like.
Table of Contents
What is Hemodialysis?
Hemodialysis is a life-sustaining treatment for people whose kidneys can no longer effectively remove waste and fluid on their own.
As of 2024, over 500,000 people are on dialysis, with about 90% of these people on hemodialysis.
It uses a machine to clean your blood by filtering it through a special dialyzer (artificial kidney) before returning it to your body.
When does a person start dialysis?
You might qualify for hemodialysis when your GFR drops below 15 and you start experiencing symptoms of kidney failure like fatigue, nausea, swelling, or changes in labs such as high potassium or phosphorus.
Ultimately, it is up to you as the patient as to if or when you want to start dialysis.
It is your nephrologists job to address the potential option for dialysis and explain the risks and benefits of starting or not starting dialysis.
Nephrologists may start discussing dialysis treatment options as early as stage 4 to prepare their patients for the potential need of dialysis.
In-Center vs. Home Hemodialysis
There are two main ways to receive hemodialysis: in-center or at home.
In-Center Hemodialysis
This takes place at a dialysis clinic, typically 3 or 4 times per week for about 4 to 5 hours per session. It’s managed by a trained team including a nurse and dialysis technician.
Your nephrologist will likely visit you at least once per month during your dialysis treatment. They may also request that you come to their office for additional appointments.
Your dietitian, nurse, and social worker will also visit with you during your dialysis treatments to review medications, discuss your diet and answer nutrition questions, set up appointments and transportation, and provide support in other ways.
Home Hemodialysis
This allows patients (and often a caregiver) to do dialysis at home. You’re first trained thoroughly by the dialysis nurse and team in a dialysis clinic so you will be able to confidently manage your treatments at home.
Hemodialysis sessions may be shorter and more frequent, depending on the schedule recommended by your nephrologist.
For example, you may dialyze for 4 to 6 days per week, but for only 2 or 3 hours at a time.
You’ll have monthly appointments to come into the clinic for medications and a team meeting to check in and make sure everything is going smoothly with your treatments at home.
Less than 2% of people with end stage kidney disease are on home hemodialysis.
However, there are many initiatives by multiple kidney health organizations working to increase this amount due to the potential benefits with home hemodialysis.
Both types have pros and cons, and your healthcare team will help determine which fits your medical needs and lifestyle.
Regardless of your hemodialysis choice, you will have a dietitian to support you if you are getting dialysis in the United States. (I cannot speak to the healthcare requirements of other countries.)
And while this article can never trump your own dietitian’s guidance, I hope it can serve as an extra resource and help you discuss your dietary questions and concerns with your own dietitian.
A Diet For Hemodialysis
Dialysis helps, but it doesn’t do everything your kidneys used to do. That’s where your diet becomes especially important.
Here’s a breakdown of key nutrition components and what they mean for dialysis patients:
Calories
Hemodialysis can increase calorie needs, especially if you’re losing weight or muscle.
Think of hemodialysis as a workout for your body. Afterall, it’s going through a physically strenuous removal, cleansing, and replacement of your blood.
The recommended amount of calories per day someone on hemodialysis should aim for is between 25 to 35 calories per kilogram of body weight per day.
Factors that can influence your calorie needs include;
- Age
- Sex
- Physical activity
- Body composition
- Weight goals
- CKD stage
- Hemodialysis treatment adequacy
- Inflammation
- Other health conditions such as diabetes, congestive heart failure, or cancer
It’s important to discuss with a dialysis dietitian to ensure you are on the right track, even if you are able to determine your calorie needs from the starting calculation.
Undereating can lead to malnutrition, so this is not the time to overly restrict your intake.
Carbohydrates
Carbohydrates are an important way to eat enough calories and support your overall health.
Approximately 45 to 65% of your calories should come from carbohydrates.
Focus on whole food sources like fruits, vegetables, and whole grains. (We will cover potassium a little later in the article.)
Fiber
Fiber helps with digestion and blood sugar control.
If you’re managing diabetes, balancing carbs with fiber and protein becomes even more essential.
Women should aim for at least 25 grams of fiber per day.
Men should aim for at least 38 grams of fiber per day.
However, most people on hemodialysis are nowhere near their daily fiber goal. Some get only about 10 grams of fiber per day.
Slowly increase your fiber intake If you are far from the daily fiber goal.
Adding just 2-3 grams (or about 10%) of fiber every few days allows the body to adjust to the additional fiber.
Benefits of Adding Fiber to a Hemodialysis Diet
Getting enough fiber consistently can result in less constipation; one of the top complaints for people with CKD and on dialysis.
Additionally, people that eat enough fiber have a significantly lower risk of cardiovascular disease and death—up to 29% reduced risk.
You may experience better hemoglobin levels with more fiber in your diet, resulting in better anemia management.
Protein
Dialysis removes protein waste, but also increases your protein needs to replace what’s lost.
Most dialysis patients need higher protein intake than earlier stages of CKD.
Guidelines recommend hemodialysis patients aim for 1 to 1.2 grams of protein per kilogram of body weight per day.
Think lean poultry, fish, eggs, or plant-based proteins like tofu, edamame, and tempeh.
Talk with your dietitian about the right amount for you and the best sources.
Fats
Like carbohydrates, fats are often misunderstood but an important part of eating enough calories to support dialysis treatments.
About 15 to 25% of your daily energy should come from healthy fats.
Choose heart-healthy fats like olive oil, avocado (in moderation), nuts, and seeds. These support cardiovascular health—a big consideration for those on dialysis.
Fish Oil & Omega-3 Supplements
A study published in 2026 found that a daily supplement of 4 grams of omega-3 polyunsaturated fatty acids led to a significant (up to 63%) lower risk of cardiovascular events such as stroke, heart attack, and death.
Always discuss supplements with your dialysis healthcare team prior to starting anything new.
Sodium
Limit sodium to reduce blood pressure and fluid retention. Daily sodium guidelines for a hemodialysis diet are usually 2,300 milligrams per day or less.
Look for foods with less than 140 mg per serving and avoid added salt, seasoning mixes, and processed foods that pack in sodium.
Watch out for sneaky sources like canned soups, frozen meals, and deli meats.
Learn different sodium labels here.
Potassium
Dialysis can only remove so much potassium per dialysis treatment safely. Getting enough dialysis will help ensure you get as much potassium removed as possible.
Historically, it was assumed that all people on a hemodialysis diet would need to limit potassium.
What we now know is that potassium balance is more complicated than just looking at what we’re eating.
Other factors like gut health, blood sugar control, and yes, getting enough dialysis, can impact potassium levels.
Current guidelines dictate that potassium blood levels need to be monitored routinely.
Renal dietitians evaluate estimated potassium needs based on a person’s typical potassium intake, as well as other factors like the ones mentioned above.
A diet for hemodialysis patients may allow anywhere from 2,000 milligrams of potassium per day to over 4,000 milligrams of potassium per day.
High Potassium (Hyperkalemia)
About 35 to 40% of people on hemodialysis may experience at least one elevated potassium level, aka hyperkalemia.
High potassium can be dangerous. You may need to limit high-potassium foods like bananas, oranges, potatoes, tomatoes, and spinach—depending on your lab results.
Your renal dietitian can help you include some potassium-rich foods safely if your labs allow.
For low potassium food lists including low potassium fruits and vegetables, low potassium proteins, and low potassium drinks, read this.
Phosphorus
Too much phosphorus in the blood can weaken bones and damage blood vessels.
High phosphorus levels, otherwise known as hyperphosphatemia, occurs in about 40% of people on hemodialysis.
While phosphorus is found naturally in foods like meats, dairy, nuts, seeds, and even whole grains—this is not the type of phosphorus to be overly concerned about.
Rather, phosphorus added to foods as an ingredient is known as “inorganic phosphorus.” Inorganic phosphorus is highly absorbed and therefore more important to pay attention to.
Similarly to potassium, phosphorus is removed via dialysis. However, we tend to eat much more phosphorus than dialysis can safely remove.
A standard hemodialysis treatment of 4 hours held three times in a week will remove about 3,000 milligrams of phosphorus.
However, a typical week of eating includes 7,000 milligrams of phosphorus per week.
This imbalance leads to a buildup of phosphorus in the blood.
Phosphorus Binders
Because of this imbalance, most people on dialysis will require a medication known as a phosphate binder. It helps “bind” to the phosphorus in food and remove it.
Phosphorus binders can help lower phosphorus levels by preventing them from getting into the blood stream in the first place.
Struggling with high parathyroid hormone (PTH)?
High phosphorus levels can cause PTH levels to climb quickly.
A diet with less phosphate additives and a good binder routine can help manage PTH levels. Some other medical interventions may be needed as well, but phosphorus management is a key place to start.
Fluids
In addition to wastes and excess phosphorus and potassium, dialysis also removes excess fluids.
Dialysis doesn’t work 24/7 like kidneys do. That means fluid can build up between treatments.
Most dialysis patients need to limit fluid intake—including water, juice, soup, and even ice. Symptoms of fluid overload include swelling, high blood pressure, and trouble breathing.
Here are tips to help follow a fluid restriction.
Sample Hemodialysis Diet Meal Plans
Every dialysis patient’s needs are unique, but here are examples of meals and snacks to inspire a typical day.
Dialysis Day Meal Plan
A dialysis day will be very busy, calling for a 4-5 hour treatment plus travel time to and from the clinic.
Keep this in mind when planning meals. Use a slow cooker or have easy sandwich ingredients on hand to spend less time in the kitchen worrying about what to eat.
Breakfast
- 2 eggs, scrambled with ½ c each bell pepper and onion
- Slice of sourdough toast with unsalted butter
- ½ cup peaches (fresh, frozen or canned)
- 6-8 oz coffee or tea
Snack (Pre-, During, or Post-Dialysis)
- Rice cakes with natural peanut butter (2 tbsp) or protein bar
- 4–6 oz water or ice chips if fluid is needed
Lunch
- Peanut butter and jelly sandwich on whole grain bread
- 1 cup baby carrots or celery with 1-2 Tbsp hummus
- 1 small pear
- 8-10 oz water
Snack
- Low-sodium string cheese
- Small apple with 1-2 Tbsp peanut butter
Dinner
- 4-6 oz Slow-cooker turkey meatballs in low-sodium vegetable stock
- ½ cup Mashed cauliflower or double-boiled potatoes
- 1 cup Cucumber salad with dill and lemon or vinegar
- 8-12 oz Sparkling water with lemon wedge (if within fluid goals)
- 1 oz chocolate
Non-Dialysis Day Meal Plan
Depending on your energy levels, you may feel more inclined to cook on your “off” days from dialysis. Or you may want to rest.
Whatever you choose, be sure to have some easy options on hand to throw together a balanced meal to help you feel your best.
Breakfast
- ¾ cup Oatmeal made with milk, topped with 1 cup blueberries and 1 Tbsp ground flaxseed
- ½ banana
- 6-8 oz Herbal tea or coffee
Snack
Lunch
- Chickpea (low-sodium, canned, drained and rinsed) and quinoa salad with diced red bell peppers and cucumbers, olive oil, lemon, and parsley
- Low-sodium pita bread with 1-2 Tbsp hummus
- ½ cup fresh pineapple
Snack
- 6 oz Greek yogurt (plain, low-fat) with cinnamon and 1-2 Tbsp honey
- ½ cup grapes
- 1–2 cinnamon graham crackers
Dinner
- 4-6 oz Tofu stir-fry with ½ cup each zucchini, red bell pepper, and onion
- ½ cup cooked white rice or jasmine rice
- ½ cup papaya
- 6-8 oz decaf green tea
- 1/2 cup ice cream with 1/2 cup diced strawberries
Can I eat during dialysis?
Dialysis clinics will have their own policies as to whether you are allowed to eat or not during treatment.
Even nephrology professionals still debate over whether or not eating during dialysis treatment should be allowed.
Some surveys report about 85% of dialysis clinics allowing and even encouraging eating during treatment.
Benefits of eating during dialysis primarily focus on helping people on dialysis get enough calories and prevent unintended/undesirable weight loss.
Additionally, many patients surveyed report higher satisfaction with treatment and better quality of life.
Those that argue against it claim the risks like hypotension (low blood pressure), lower dialysis adequacy, choking risks, and infection control outweigh the benefits.
If you are deciding on which dialysis clinic to go to for in-center hemodialysis, learning about their eating-during-treatment policy may be of interest to you.
Key Takeaways
Hemodialysis is a life-saving treatment for people with end stage kidney disease. Even on dialysis, there are plenty of healthy diet guidelines you can use to keep up your energy levels, feel your best, and help dialysis work as best as possible.
All macronutrients are important to include. Carbohydrates, particularly whole grains with fiber, will give you energy and support a healthy gut and blood sugar balance. Healthy fats will support heart health and give you calories to keep you energized.
Dialysis requires more protein to account for what is removed during treatment. Eating lean proteins like poultry, fish, eggs, and plant proteins like tofu, tempeh, and edamame will support your protein needs to maintain muscles and keep up your strength.
Phosphorus and potassium may need to be limited on a diet for hemodialysis patients. However, that can only be determined from your labs and with your dialysis dietitian and nephrologist.
A low-sodium diet is recommended for the heart health of most all dialysis patients. With that, a fluid restriction may be easier to follow.
Ultimately, a diet for hemodialysis patients follows many general healthy eating guidelines. If you have questions about what your own diet should look like, what you should or should not have, and any restrictions you may be concerned about, please discuss with your dialysis dietitian.
Jen Hernandez is a registered dietitian and board-certified specialist in renal nutrition. She has nearly a decade of experience with kidney disease patients in all stages - from stage 1 through kidney transplant. Jen writes on the blog of Plant-Powered Kidneys to help reach and teach more kidney patients about how they can enjoy more foods in a plant-based diet while protecting kidney health.
