Food help for dialysis patients

Approximately 786,000 Americans are on dialysis (USRDS 2024). 70% receive hemodialysis (3 sessions/week, ~4 hours each in clinic), and 11% receive peritoneal dialysis at home. Nutrition is vital: renal restrictions are strict and rigid, but options exist. This page covers diet + Medicare ESRD + transportation + resources.

Medicare ESRD — covers dialysis regardless of age

• SSA Sec. 1881 (1972): Medicare covers dialysis and kidney transplant for ANY person with ESRD, regardless of age or income.
• Coverage start: the 4th month of dialysis, OR at the start if you do home-dialysis training, OR upon transplant.
• Coverage: 80% dialysis (Part B), 20% copay. Medigap supplemental plan or Medicare Advantage covers the copay.
• Dialysis-related medications: covered by Part B (with copay).
• Transplant: 100% covered + 36 months immunosuppressants post-transplant (extended permanently for all in 2023 by Section 402, Pub. L. 116-260).
• If you're <65: Medicare ESRD ends 12 months after last dialysis or 36 months after transplant. Switch to Medicaid or Marketplace after that.

Renal diet — the 4 pillars

1. Sodium — max 2,000 mg/day

• Stricter than general DASH.
• Avoid: deli meats, canned soups, frozen meals, soy sauce, cheese, salty snacks, fast food, BBQ/teriyaki sauce.
• Allowed: fresh herbs, salt-free spices, garlic powder, lemon juice, vinegar.
• Do NOT use potassium salt substitutes (Morton Lite, Nu-Salt, NoSalt) — they have potassium you cannot filter.

2. Potassium — max 2,000 mg/day (strict)

• Strictly avoid / limit:
  • Bananas, oranges, melons, kiwi, mango, papaya.
  • Potatoes (even "soaked"), sweet potatoes, squash.
  • Tomatoes, tomato sauces, tomato juice.
  • Spinach, chard, broccoli (cooked), avocado.
  • Dried beans, lentils (even canned).
  • Dried fruit (raisins, dates, figs).
  • Milk, yogurt, ice cream.
  • Coffee (more than 1 cup), chocolate.
  • Nuts, peanut butter.
• Allowed in controlled portions (1 portion = 100-150 mg potassium):
  • Apples, pears, grapes, cherries, blueberries, strawberries, pineapple.
  • Watermelon (½ cup).
  • Cucumbers, lettuce, zucchini, green beans, eggplant, asparagus (3 spears).
  • White rice, white pasta, white bread.
• "Potassium leaching" technique: peel and cut potatoes, soak in warm water 4 hours, drain, cook in fresh water. Reduces potassium ~50%.

3. Phosphorus — max 800-1,000 mg/day

Elevated phosphorus causes bone disease, arterial calcification. Dialysis does NOT remove it well.

• Avoid:
  • Dairy: milk, cheese, yogurt, ice cream.
  • Dark sodas (cola, root beer): contain phosphoric acid.
  • Processed meat: sausage, deli meats, hot dogs.
  • Whole grains (whole wheat, oats, brown rice).
  • Nuts, peanut butter, seeds.
  • Chocolate, beer.
  • Nutritional yeast, wheat bran.
• Read labels: avoid ingredients with "phos" in the name (disodium phosphate, phosphoric acid, hexametaphosphate). Additive phosphorus absorbs 90% vs. 60% from natural sources.
• Phosphorus binders (medications):
  • Sevelamer (Renvela), velphoro (sucroferric), auryxia (ferric citrate).
  • Take with every meal.
  • Covered by Medicare Part D.

4. Fluids — typically 32 oz (1 liter)/day

• Counts ALL fluid: water, coffee, tea, soup, juice, ice cream, gelatin, popsicles, liquid fruits (watermelon, orange).
• Your weight gain between dialysis <5% of dry weight (~2-3 kg typical).
• For thirst: suck ice (counts as ½ the fluid volume), rinse mouth with cold water, chew sugar-free gum, frozen lemon.

Protein — HIGH need on dialysis

Hemodialysis removes amino acids. You need 1.2-1.4 g/kg/day protein (vs 0.8 g/kg for healthy people). 70 kg adult = 84-98 g protein/day.

• Best protein (high quality, low phosphorus and potassium):
  • Egg white (1 white = 4g protein, 0 mg potassium, 5 mg phosphorus).
  • Chicken / turkey / fish — 3 oz = 21g.
  • Egg substitutes (Egg Beaters).
• Supplements: egg white protein powder, Procel, Pro-Stat. Covered by Medicare with nephrologist prescription.

Vitamins and supplements

• Renal-specific vitamin: Renavit, Diatx, Nephrocaps. Has B-complex + C + folic acid (dialysis removes these). NOT a regular multivitamin.
• Active vitamin D: calcitriol (Rocaltrol) or paricalcitol (Zemplar) IV in clinic.
• Iron: oral or IV in clinic for ESRD anemia.
• EPO (erythropoietin): Epogen, Aranesp for anemia. Injected in clinic.

Home-delivered meals — renal-specific programs

• Mom's Meals "Renal Friendly" — tailored frozen meals. ~$8-10 each if paying. Covered by Medicare Advantage (some plans), Medicaid HCBS waivers.
• BistroMD Renal.
• Magic Kitchen Renal.
• Trifecta Renal.
• God's Love We Deliver, Project Open Hand — free with referral.
• National Kidney Foundation Cookbook (free) — kidney.org/recipes. Easy renal recipes.

Transportation to dialysis (covered)

3x/week × 4 hours + travel — transportation is huge. Covered options:

• Medicare Advantage — many plans cover non-emergency medical transport (NEMT).
• Medicaid NEMT — covered in all states with documented medical appointment. Call your MCO.
• Dialysis center — many have contracts with Modivcare, Roundtrip, ride-share. Ask your renal social worker.
• Area Agency on Aging (AAA) — transportation for 60+. Eldercare Locator 1-800-677-1116.
• Volunteers: Lions Club, Rotary, churches. Call 211.

Financial assistance

• American Kidney Fund (AKF) HIPP — Health Insurance Premium Program: pays Medicare, Medigap, COBRA, Marketplace premiums. Apply at kidneyfund.org. Covers 65,000+ patients/year.
• AKF Disaster Relief, Heart of Giving, Pediatric Kidney Project.
• National Kidney Foundation (NKF) Kidney Cars — sells donated cars, funds go to patients.
• HealthWell Foundation, NeedyMeds, Patient Advocate Foundation — copays.
• Drug manufacturer programs: Korsuva (Cara/Vifor), Auryxia (Akebia), Velphoro (Vifor) have assistance.
• SNAP: medical deduction for 60+ or disability — dialysis transport, renal vitamins, copays count.

Home dialysis — food considerations

Peritoneal dialysis (PD) and home hemodialysis (HHD) have fewer restrictions than in-center hemo:

• PD: potassium less strict (sometimes RISES on PD), fluids much less restricted. But dialysis solution sugar adds 400-800 kcal/day — watch weight and diabetes.
• Daily HHD (5-6x/week): more liberal diet, more protein allowed.
• Request HHD/PD: better quality of life, better survival than in-center hemo. Your nephrologist + renal social worker train you.

Kidney transplant (primary goal)

• UNOS (United Network for Organ Sharing) — unos.org. Waiting list ~88,000 people (2026).
• Living donor: wait time much shorter (months vs years). Living Kidney Donor Network.
• National Kidney Registry — Voucher Program: donate now for someone in your life (spouse, child) and get a voucher for future use.
• Post-transplant immunosuppressants — covered by Medicare PERMANENTLY since 2023 (was 36 months).
• After transplant: more liberal diet, avoid grapefruit (interacts with tacrolimus), unpasteurized apple juice, other precautions.

Community resources

• National Kidney Foundation (NKF) — kidney.org. Helpline 1-855-NKF-CARES. Spanish materials. NKF Patient Information Helpline.
• American Kidney Fund (AKF) — kidneyfund.org.
• DaVita Kidney Care and Fresenius Medical Care — patient guides, recipes.
• Renal Support Network — rsnhope.org. Patient community.
• Home Dialyzors United — homedialyzorsunited.org.
• 988 Mental Health Lifeline — depression is common with dialysis.

CKD pre-dialysis → · Medicare general → · Apply for SNAP →

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