End stage renal disease, also known as CKD5 or Chronic Kidney Disease Stage 5, is the final and permanent stage in the progressive disorder of the kidneys. In this stage, the kidneys can no longer function independently, and medical interventions are needed.  

The key distinction between chronic kidney disease and end stage renal disease is the need for intervention. At this point in disease, nutrition and lifestyle are not enough.  

With changes in treatment also comes different nutrition recommendations. 

Dialysis is the medical treatment to remove waste and extra fluid from the blood in the event that the kidneys cannot complete the task. The treatment can be done at home, in the hospital, or at a specialized dialysis center. There are two main types of dialysis: 

Hemodialysis (HD) 

Blood is diverted to a machine to be cleaned outside of the body. This process takes 4 hours and must be done 2-3x/week.  

Peritoneal Dialysis (PD) 

A bag of fluid, called dialysate solution, is connected to the abdomen to drain. This process takes 20-30 minutes but needs to be done 3-4 times per day. 

Continuous Renal Replacement Therapy (CRRT)

This type of lifesaving dialysis occurs in the Intensive Care Unit. As the name suggests, it is a continuous treatment done in the hospital for patients that are unstable and require severe medical interventions.  

Nutrition recommendations differ for people on dialysis. If you have reached CKD stage 5 and have opted NOT to initiate dialysis of any kind, recommendations remain the same.  

• • Since your blood is being filtered regularly, you may not be required to follow the same restrictions and recommendations. At the same time, waste can buildup in your blood between sessions and make you sick.  

  • Enough calories-many people on dialysis experience a decrease in appetite which can lead to unintentional weight loss. It is important to ensure you are eating enough every day to avoid problems associated with malnutrition.  

  • Protein should be consumed in higher amounts to account for losses through dialysis. Emphasis should be placed on the quality of proteins, making sure to chose meat, poultry, fish, and eggs instead of processed meats that are high in sodium and phosphorus.  

  • Fats should be heart healthy. Limit saturated and trans fat while emphasizing ‘healthy’ fats to reduce risk of plaque build up in arteries. Swap butters for olive or avocado oil, opt to grill or bake foods instead of deep frying, trim the fat from meat protein sources, and use food labels to guide your choices.  

  • Fluid should be limited. Too much fluid can lead to uncomfortable effects during and after dialysis treatment, muscle cramps, and low blood pressure. To find out exactly how much fluid for your body, talk to your renal dietitian. Fluid refers to beverages, foods that are liquid at room temperature, and foods with high water content. That includes fruits, soups, ice creams, and jello.  

  • Sodium should be limited to control blood pressure and reduce fluid retention. Opt for fresh foods over prepared or packaged. Cook foods from scratch to control the amount of sodium, and opt for spices, herbs, and sodium free seasonings. Practice reading Nutrition Facts Labels, consuming foods with less that 15% daily value of sodium. Chose low sodium versions of foods (like broth or canned items). 

  • Phosphorus in excess amounts can pull calcium from your bones, which makes them brittle and vulnerable to breaks. It is best to limit those foods rich in phosphorus. Processed and packaged foods contain very high levels of phosphorus. As well as poultry, fish, nuts, peanut butter, beans, brown sodas, tea, and dairy products.  

  • Potassium can rise between dialysis sessions and affect your heartbeat. It is important to limit potassium intake to avoid this. Limit potassium-rich foods such as avocados, bananas, kiwis, and dried fruit. When eating foods rich in potassium, like tomatoes or raisins, make portions small. 

  • Vitamins and Minerals are essential for daily functioning. When limiting specific minerals, you are often at risk for other nutrient deficiencies. For this reason, it is recommended that many individuals on dialysis take a specially formulated multivitamin. It is best to check with your provider before starting any supplements.  

Role of a Dietitian  

• • Dialysis centers have registered dietitians (RD) skilled in helping individuals with end stage renal disease plan meals. They are specially trained in working with individuals who have kidney disease.  

  • Renal RDs can help set fluid goals, keep track of intake, and help plan out daily food intake. These professionals can also help identify high potassium and phosphorus foods and offer alternatives or suggestions. Limiting phosphorus while on dialysis can be very challenging due to the need for adequate protein.  

Monitoring  

• • Keep track of your dry weight. This will indicate your true weight once all fluid has been removed through dialysis. It is also an effective way to measure the effectiveness of your treatment, and if your body is retaining more fluid than normal.  

1. Beto J. Eating & Nutrition for Hemodialysis | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published April 4, 2019. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis/eating-nutrition