Diet for Peritoneal Dialysis

This diet may be modified in protein, sodium, phosphorus, potassium, or fluid, depending on your needs. The goals of nutrition therapy are similar to those for patients on hemodialysis. Providing enough protein to replace peritoneal losses is a priority.

USES OF THIS DIET

The diet is designed for the patient with end-stage kidney (renal) disease, who is treated by peritoneal dialysis. Treatment options include:

  • Continuous Ambulatory Peritoneal Dialysis (CAPD): Usually 4 exchanges of 1.5 to 2 liter volumes of glucose (sugar) and electrolyte-containing dialysate.

  • Continuous Cyclic Peritoneal Dialysis (CCPD): Essentially a reversal of CAPD, with shorter exchanges at night and a longer one during the day.

  • Intermittent Peritoneal Dialysis (IPD): 10 to 12 hours of exchanges, 2 to 3 times weekly.

ADEQUACY

The diet may not meet the Recommended Dietary Allowances of the National Research Council for calcium and ascorbic acid. Protein and water-soluble vitamin needs may be increased because of losses into the dialysate. Recommended daily supplements are the same as for hemodialysis patients.

ASSESSMENT/DETERMINATION OF DIET

Dietary needs will differ between patients. Parameters must be individualized.

Protein

  • Guidelines: 1.2 to 1.3 gm/kg/day OR 1.5 gm/kg/day if patient is malnourished, catabolic, or has a protracted episode of peritonitis. A minimum of 50% of the protein intake should be of high biological value.

  • Goals: Meet protein requirements and replace dialysate losses while avoiding excessive accumulation of waste products. Achieve serum albumin greater than 3.5 g/dL.

  • Evaluate: Current nutritional status, serum albumin and BUN levels, presence of peritonitis.

Sodium

  • Guidelines: Usually 90 to 175 mEq (2000 to 4000 mg), but should be individualized.

  • Goals: Minimize complications of fluid imbalance.

  • Evaluate: Weight, blood pressure regulation, and presence of swelling (edema).

Potassium

  • Guidelines: Individualized; often not restricted, and may need to be supplemented.

  • Goals: Serum K+ levels between 4.0 to 5.0 mEq/L.

  • Evaluate: Serum K+ levels, usual intake of K+, appetite.

Phosphorus

  • Guidelines: 800 to 1200 mg/day (the high protein intake results in a high obligatory P intake).

  • Goal: Serum P levels between 4.5 to 6.0 mg/dL.

  • Evaluate: Serum P levels, usual P intake, P-binding medications: type, number, dosage, distribution.

Fluids

  • Guidelines: Individualized - may not be restricted for all patients.

  • Goal: Minimize complications of fluid imbalance.

  • Evaluate: Weight, blood pressure regulation, sodium intake, and presence of edema.