# Nutrition and diets in kidney failure and dialysis
Nutrition plays a crucial role in kidney failure and dialysis. Because the kidneys can no longer filter properly, certain substances can accumulate in the blood. This makes demands on what you eat and drink. However, it is not a one-size-fits-all prescription: dietary choices are tailored together with your healthcare provider and ideally a specialized dietitian.
Protein-rich nutrition
ResearchediPositive results in clinical studies, not yet standard treatment
This nutritional pattern assumes that dialysis patients need extra attention to protein. The dialysis process causes amino acids to be lost, and moreover, kidneys also play a role in repairing body cells. Research suggests that carefully adjusted protein intake is important to maintain muscle and bone mass and prevent more severe breakdown (protein-energy wasting).
Recent research (2026) focuses on how well dialysis patients can apply their nutritional knowledge in daily life, and on the combination of nutrition with physical activity. Studies show that physical activity combined with adapted nutrition helps prevent muscle loss (sarcopenia), which is a common complication in dialysis patients.
**Risks:** Too much protein can increase the workload on your body. It is not about as much as possible, but about an amount that is tailored to your dialysis schedule, your body composition and your kidney function. You determine this together with your healthcare provider.
Phosphorus-restricting nutrition
ProveniIncluded in official guidelines, or approved by EMA or FDA
Dialysis patients have difficulty excreting phosphorus, a mineral found in dairy, nuts, certain types of meat and processed products. Accumulation of phosphorus can cause bone demineralization and heart problems. A nutritional pattern that limits phosphorus helps prevent these complications.
This usually means less dairy, careful handling of meat and choosing less processed food. Sometimes patients also receive medications that bind phosphorus, so you don't have to do without certain foods entirely.
**Risks:** Too strictly limiting phosphorus can lead to insufficient protein intake or vitamin deficiency. It is a balance.
Low-potassium nutrition
ProveniIncluded in official guidelines, or approved by EMA or FDA
Potassium is a mineral that healthy kidneys excrete well. With dialysis, potassium can accumulate, which can cause heart rhythm disorders. A nutritional pattern that limits potassium-rich foods helps reduce this risk.
Vegetables and fruit contain a lot of potassium. This does not mean you should avoid them, but that you make conscious choices: certain vegetables can be eaten in smaller portions, or you choose lower-potassium varieties. Canned fruit (where potassium is sometimes rinsed out) can also be an alternative.
**Risks:** Strict potassium restriction can lead to vitamin deficiency and reduce the pleasure of eating. This is determined in consultation with your healthcare provider.
Low-sodium (salt) nutrition
ProveniIncluded in official guidelines, or approved by EMA or FDA
Too much sodium retains fluid in the body. Dialysis patients may already have difficulty excreting fluid, which can lead to fluid overload, swelling and blood pressure problems. Salt restriction helps with this.
This means adding less salt, but especially eating less processed food (which contains a lot of hidden salt). Freshly cooked food offers more control.
**Risks:** Fluid restriction and salt restriction go together; too strict restriction can lead to dangerous electrolyte disturbances.
Fluid restriction
ProveniIncluded in official guidelines, or approved by EMA or FDA
This is actually not a diet, but a nutritional rule that almost all dialysis patients adhere to: your fluid intake is restricted. Because your kidneys can no longer excrete water properly, too much fluid can accumulate in your body. This actually slows down the dialysis process and increases the risk of heart problems.
How much you are allowed to drink depends on how much urine you still produce and how well your dialysis works. This is determined together with your team.
**Risks:** Fluid overload can be life-threatening; too strict fluid restriction feels very burdensome and can cause dehydration. This is a delicate balance.
Mediterranean dietary pattern
ResearchediPositive results in clinical studies, not yet standard treatment
This pattern (plenty of vegetables, olive oil, fish, legumes, limited red meat) has strong health benefits for the heart and overall health. For dialysis patients, it could have benefits, especially because its focus on plant-based foods and healthy fats can lower cardiovascular risk, which is very important for dialysis patients.
Studies have not extensively tested this specifically in dialysis, but the principles (nutrition awareness, less processed food) align well with the principles of renal nutrition.
**Risks:** Without adjustments, it can result in too much potassium or phosphorus. It must therefore be adapted to your dialysis schedule.
Intermittent fasting or periodic fasting
UnproveniNo scientific evidence that it works
Intermittent fasting (long periods without food) and other fasting schedules have received attention for general health, but have not been specifically studied in dialysis patients. The risks are theoretically greater: dialysis is already a heavy burden on the body, and prolonged periods without food can cause malnutrition, muscle loss, and electrolyte disturbances.
**Risks:** This pattern has not been tested in dialysis patients and is generally not recommended without close medical supervision. It can accelerate muscle breakdown and worsen existing malnutrition.
Ketogenic diet (low-carbohydrate, high-fat)
Advised againstiProven ineffective or harmful, or dangerous in combination with your treatment
This diet severely restricts carbohydrates and increases fat and protein. For dialysis patients, this is problematic for several reasons: it can raise phosphorus and potassium (depending on choices), can be more complicated to follow given already strict dietary requirements, and dialysis patients already have increased cardiovascular risk — high fat intake without good control can worsen this.
**Risks:** It adds complexity to a diet that must already be carefully balanced. Moreover, it is insufficiently studied and the risks likely outweigh the benefits.
Protein substitutes and amino acid solutions
ResearchediPositive results in clinical studies, not yet standard treatment
For peritoneal dialysis patients, special dialysate fluids with amino acids are being studied (2026). The idea is that amino acids in the dialysate can limit loss and counteract malnutrition.
This is still experimental and part of medical optimization, not a self-chosen dietary pattern. If this becomes available, your doctor will decide about it.
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Nutrition and nutritional knowledge
Recent research (2026) shows that many dialysis patients struggle to put nutritional knowledge into practice — not because it is difficult to remember, but because incorporating it into daily cooking and eating is complex. Many patients also eat intradialytically (during dialysis), which makes dietary choices even more different.
Studies show that a combination of nutrition and physical activity works best against muscle loss and general decline. Nutrition alone is not enough.
**Important:** Dietary choices in kidney failure and dialysis are not standard — they are tailored to your dialysis schedule, your remaining kidney function, your body composition, your other diseases (especially diabetes) and your personal circumstances. A specialized renal dietitian can help you practically apply these guidelines to your own life. Following self-care guidance without consultation is risky.
_This information never replaces the judgment of a physician. Always discuss your dietary choices with your own healthcare provider or a specialized renal dietitian._