Peritoneal Dialysis Diet

The diet on peritoneal dialysis is similar to that of stage 5 kidney disease, except your potassium restriction can generally be lifted (but this advice varies by individual so be sure to check with your doctor or dietitian).

Generally, people on a kidney diet need to restrict phosphorus, potassium, and sodium (salt). Once people make it to dialysis, there also needs to be a fluid restriction. In my work as a predialysis dietitian, I generally don’t see patients (not on dialysis) needing a fluid restriction, as the kidneys can filter the excess water at that stage (depending on your sodium intake).

Peritoneal dialysis, however, can be very tough on phosphorus levels. If you remember, phosphorus is a mineral in the blood that comes from some foods. Some foods are high in phosphorus and some foods are low. Phosphorus is a larger molecule, while potassium is very small. Therefore, dialysis can have trouble with moving phosphorus (unless you are on home or nocturnal dialysis and do several sessions per week). The phosphorus restriction on peritoneal dialysis also tends to be very strict. Here are some high phosphorus foods you can choose to avoid:

• Salmon, haddock, Pollock, halibut

• Shellfish

• Fish and meat with bones

• Bones in stew

• Colas (root beer may be fine)

• Beans, especially lentils

• Dairy

• Whole grains such as whole wheat bread and whole rice

• Tim Horton’s

• Phosphorus additives such as anything with phosphate or phosphoric on food labels.

The doctor may also prescribe calcium carbonate (or Tum’s) to manage phosphorus. Calcium carbonate grabs phosphorus in the gut and helps sweep it out in the stool. It is important to take this directly with food as all the action happens in the gut.

Peritoneal dialysis (PD) also sucks protein from your body. It also causes low grade inflammation requiring more protein (however, this is still better than no dialysis as the uremic toxins can wreak havoc on your body). People on PD tend to have much higher protein needs, as high as an athlete.

Maybe you think malnutrition is a 3rd world problem. However, it is rampant among patients, especially those with kidney disease. Malnourished people are less likely to survive. On PD, you have to really be focused on your nutrition and making sure you are getting enough protein, nutrients, and energy. If your legs get thinner and you notice muscle loss, that’s a huge red flag.

Sodium and fluid (water) restriction is also important on PD. Most of the sodium in people’s diet tends to be from processed food (even bread). Throwing away the salt shaker tends to help a little, but not a lot. Your sodium restriction can be from 1500-2300 mg per day, depending on your doctor or dietitian. It is important to read labels and add up your sodium intake throughout the day.

Fluid also needs to be restricted on a PD diet. Follow your doctor’s or dietitian’s advice for individualized guidance. A fluid restriction tends to include everything that is liquid-like, and everything that melts. This includes:

• Jello (gelatin desserts)

• Ice cream

• Soups

• Juice (if you have diabetes and are at risk for low blood sugar, it is important to keep some juice on hand. I recommended apple or full-sugar cranberry juice as the potassium content is more moderate)

• Water

• Coffee

• Tea

This blog is intended to be general advice and does not substitute medical advice. Please check with your doctor or dietitian to make sure you are being safe with your intake.