Once you start dialysis, what you eat and drink has a big effect on how you feel from day to day. Dialysis takes over part of your kidneys' work, but not all of it. Between sessions, fluid, salt, potassium and phosphorus build up in your body, and some of these can be dangerous for your heart.
Everyone's needs differ, depending on your type of dialysis, remaining kidney function, blood results and other conditions. Always follow your dietitian and nephrologist. If their advice differs from this guide, follow theirs.
Fluid and weight gain
When your kidneys no longer make enough urine, the fluid you drink stays in your body until your next session. Too much fluid causes swelling, high blood pressure and breathlessness, and strains your heart.
- Your fluid allowance is personal. Many dialysis teams base it on how much urine you still pass in a day, plus a little extra (often around 500 ml). Ask your team for your figure.
- Count everything that is liquid at room temperature: water, tea, coffee, milk, soup, gravy, porridge, ice, ice cream and jelly. Watery fruit such as watermelon counts too.
- Weigh yourself every morning. Weight gained between sessions is mostly water. International guidelines commonly aim for a gain of less than about 4% of your dry weight, for example under 2.4 kg for a dry weight of 60 kg. Your team may set a different target. Take extra care over the longer weekend gap.
To manage thirst, use a small cup, spread your allowance across the day, suck on an ice cube (it still counts) or a sour sweet, and take tablets with mealtime drinks. Cutting down on salt helps most of all.
Get help straight away if you are short of breath, cannot lie flat, or your face and legs are badly swollen. Call your dialysis centre, or call 999 and go to the nearest emergency department if it is severe.
Salt
Salt (sodium) makes you thirsty and makes your body hold on to water. As a general guide, the Ministry of Health Malaysia (KKM) advises adults to have no more than one teaspoon (5 g) of salt a day, including the salt already in food. Your dietitian will tell you your limit.
Most salt comes from sauces and processed food, not the salt shaker:
- soy sauce (kicap), oyster sauce, chilli sauce, budu, cencalok, belacan and stock cubes
- salted fish, salted eggs, ikan bilis, achar and pickles
- instant noodles, keropok, canned food, sausages and nuggets
Use onion, ginger, lemongrass, kaffir lime leaves, pepper and lime juice for flavour instead. Do not use low-sodium salt or "salt substitutes", as most are high in potassium.
Potassium
Potassium keeps your muscles and heart working, but too much can cause a dangerously irregular heartbeat. Your regular blood tests show whether you need to limit it. Call 999 if you suddenly feel very weak or numb, or your heart is pounding or beating irregularly.
Local foods high in potassium include:
- Fruit: banana, durian, jackfruit (nangka), guava, papaya, honeydew and soursop (durian belanda)
- Drinks: coconut water, fruit juices and vegetable juices
- Others: potatoes, sweet potatoes, yam (keladi), tapioca, herbal products and salt substitutes
Apples, pears and pineapple are usually lower in potassium, but portions still matter. Cutting vegetables and root crops small, boiling them in plenty of water and throwing the water away removes some of the potassium.
Do not eat star fruit (belimbing) at all, including the juice. It contains a substance that can affect the brain in people with kidney failure, even in small amounts. Get urgent help if you develop non-stop hiccups, vomiting or confusion after eating it.
Phosphorus and phosphate binders
Dialysis cannot remove all the phosphorus from your blood. High levels over time cause itchy skin, weak bones and hardened blood vessels.
High-phosphorus foods include:
- milk, cheese, yoghurt, and chocolate or malted drinks
- processed and fast food, because phosphate additives are easily absorbed
- dark fizzy drinks such as cola
- nuts, seeds and lentils (dhal)
- liver and other organ meats, bone soups, and ikan bilis or small fish eaten with the bones
If your doctor prescribes a phosphate binder, take it with food as directed. It binds phosphorus in your meal so less is absorbed, so carry some when you eat out.
Protein, energy and diabetes
Before dialysis, some people are told to cut down on protein. On dialysis, protein needs usually go up, because some protein is lost with each treatment. International guidelines suggest around 1.0 to 1.2 g of protein per kilogram of ideal body weight a day for most stable dialysis patients.
- Choose good-quality protein: fish, chicken, lean meat, eggs and tofu.
- Eat enough overall so your body does not break down muscle. Tell your team if your appetite drops or you lose weight without trying.
- Advice on peritoneal dialysis (PD) may differ. PD fluid contains glucose, which adds calories, and potassium limits are sometimes less strict.
Diabetes is the most common cause of kidney failure among people starting dialysis in Malaysia. If you have diabetes:
- Keep your blood sugar under control. High sugar makes you thirsty.
- Your insulin or diabetes tablets may need adjusting after you start dialysis. Do not change the dose yourself.
- Ask your team how to treat low blood sugar. Glucose tablets or sweets are usually better than a big glass of juice, which adds fluid and potassium.
Eating out and festive seasons
When eating out, ask for "less salt" (kurang garam) and "less gravy" (kuah sikit), skip extra soy sauce, and order small drinks. At a nasi campur stall, pick grilled or steamed dishes and leave the gravy. Teh tarik and kopi susu still count towards your fluid allowance.
Festive food is often salty and rich, but you can still celebrate:
- Hari Raya: Take the meat from rendang and masak lemak and go easy on the gravy. Limit kuih raya and nuts, and ask for a small cup at each open house. If you plan to fast during Ramadan, talk to your doctor first.
- Chinese New Year: Mandarin oranges contain potassium, so share one. Bak kwa, kuaci and nuts are salty. At a steamboat, avoid drinking the soup, as potassium and salt seep into the broth.
- Deepavali: Murukku and fried snacks are usually salty, and payasam adds fluid and phosphorus. With curries, leave most of the gravy.
- Gawai, Kaamatan and Christmas: the same principles apply. Plan your plate and count your drinks.
Tip: Talk to your dietitian before a festive season about adjusting your fluid on feast days, and keep your phosphate binders in your bag.
Next steps
- No dietitian yet? Ask your dialysis centre for a referral, or search the Malaysian Dietitians' Association directory.
- Just starting out? Read about your first dialysis session.
- Planning a trip home? See travelling on dialysis.
- Find a dialysis centre near you.