Eating well on dialysis

Dialysis does a lot of the work your kidneys can no longer do — but it only runs a few hours, a few times a week. What you eat and drink between sessions decides how you feel, how safe your heart stays, and how easy each treatment is. The good news: a few simple habits carry most of the benefit.

Adapted with permission from renalcarematters.com.

Food is the biggest lever you control

On dialysis, three minerals matter most — salt (sodium), potassium and phosphorus — plus how much you drink and the kind of protein you eat. Your machine and your medicines handle the rest, but they work far better when your plate helps them instead of fighting them. You do not need to memorise a science book. You need a handful of changes you can actually keep, built around the Filipino food you already love.

This guide walks through each mineral in plain language. Nothing here replaces the plan your own care team builds with you — think of it as a map so the plan makes sense.

Salt (sodium): cut this first

If you change only one thing, change your salt. The average Filipino eats far more sodium than the kidney target — often two to three times as much — and most of it hides in condiments and processed food, not in the salt shaker. Cutting salt is the single most powerful diet change on dialysis because it does two jobs at once: it helps control your blood pressure, and it lowers your thirst. Less thirst means it is far easier to stay within your fluid limit, which means gentler, safer treatments and less strain on your heart.

A useful rule of thumb: the usual daily target is around 2,000 mg of sodium, which is roughly one level teaspoon of salt for the whole day. Salt and sodium are not the same number — about 1 gram of salt equals 400 mg of sodium — but you rarely need the math. Just aim to keep every meal light on salty seasonings and you will land close.

Why salt matters more than fluid. Many people try to fight weight gain between sessions by drinking less while still eating salty food. It rarely works, because salt is what makes you thirsty in the first place. Lower the salt and the thirst follows — then the fluid limit almost takes care of itself.

Where salt hides in Filipino food

The salt in our diet is mostly invisible. It is not the rice or the fresh fish — it is the seasoning culture wrapped around them. The heaviest offenders are the ones we reach for without thinking:

Condiments: patis, toyo and bagoong. A single tablespoon of patis can carry more sodium than your kidney target allows for an entire meal.
Instant mixes and cubes: sinigang mix, Magic Sarap, bouillon cubes, powdered adobo. One sinigang sachet can use up three-quarters of a whole day's sodium budget in a single pot.
Instant noodles: one pack of pancit canton or cup noodles can spend nearly your entire day's sodium — mostly from the seasoning packet.
Processed and canned meats: corned beef, Spam, luncheon meat, hotdogs, tocino, longganisa, tapa, tinapa and daing.
Chichirya and fast food: chips, crackers, and most carinderia or fast-food plates, which often carry two to three times the salt of the same dish cooked at home.

Notice what is not on that list: plain rice, fresh fish and meat, fresh vegetables and fruit are all naturally very low in sodium. The problem is almost never the food itself — it is what we pour, sprinkle or stir into it.

Smart swaps: same dishes, less salt

You do not have to give up your favourite ulam. The fastest way to cut salt is to make the same dishes with smarter ingredients, keeping the flavour but dropping most of the sodium. A few swaps that work:

Season eggs and fried rice with calamansi, crushed garlic and black pepper instead of patis. Add just a few drops of patis at the very end if you still miss it.
Make sinigang sour the old way — with fresh sampalok, kamias or green mango — instead of a sachet.
Replace bouillon cubes with your own homemade broth: simmer chicken or pork bones with onion, ginger and pepper, then strain and freeze in cup-sized portions.
Cook adobo with half the toyo, double the vinegar, and extra garlic and bay leaf.
Trade corned beef or daing for fresh meat or fresh bangus, grilled or baked with calamansi, garlic and pepper.
For dipping, use calamansi, garlic and chili and only a teaspoon of toyo — not toyomansi by the bowl.

Cooking and eating out without drowning in salt

Filipino cooking rests on three flavour pillars: salty, sour, and savoury-aromatic. When you ease off the salty pillar, you do not lose flavour — you lean harder on the other two, which add almost no sodium. Practical habits that make low-salt food still taste Filipino:

Lean on acid: calamansi, suka, sampalok and kamias sharpen flavour the way salt does, without the sodium.
Use heat and aromatics: plenty of garlic, onion, ginger, leeks, bay leaf, black pepper and sili labuyo, bloomed in oil first for maximum aroma.
Salt at the table, not the pot: a tiny pinch on the surface at serving time tastes saltier than a much larger amount cooked all the way through.
Rinse canned goods: running water over canned tuna, sardines or beans for about a minute washes away a good part of the sodium.
Grill, bake, inihaw: dry high-heat cooking concentrates natural flavour so you reach for less salt.

Eating out is part of life, not something to avoid entirely — just manage it. Choose grilled and steamed dishes over breaded, brined or soup-based ones. Ask for sauce and toyo on the side and dip lightly instead of pouring. And go easy on soup broths, which are often the saltiest thing on the menu. Two gentle phrases go a long way: "Konting toyo lang po" and "Pakitabi lang po ang sauce."

Reading labels — and a warning about "salt substitutes"

Every packaged food in the Philippines lists sodium per serving. A quick way to judge a product: under about 140 mg per serving is low and easy to buy; anything above roughly 400 mg per serving is high and should be used sparingly. Watch two common traps — check the servings per container (the front number may be for a fraction of the can), and remember that "reduced sodium" is not the same as low sodium; it only means less than the original, which may still be a lot.

Important: avoid "low-sodium salt" and most salt substitutes. Products like LoSalt, Pansalt and "diet" or "heart-healthy" salts replace sodium with potassium chloride. For someone on dialysis, that can push potassium to dangerous levels very quickly. Always read the ingredient list — if you see "potassium chloride," do not use it. Your safe flavour boosters are herbs, garlic, and citrus, not a substitute salt.

⬇ Download the Sodium & Salt Guide (PDF)

A printable reference: daily sodium targets by CKD stage, a high / moderate / low-sodium Filipino-food table, a 7-day one-change-a-day reduction plan, and why salt substitutes are dangerous on dialysis.

Potassium: the mineral that guards your heartbeat

Your heart needs potassium to beat steadily — but only within a narrow range. Healthy kidneys clear the extra; on dialysis, potassium can slowly build up in your blood between sessions. When it climbs too high, it can disturb your heart's rhythm with little or no warning — sometimes the first sign is a serious one. That is why potassium deserves respect even when you feel completely fine.

Potassium rises most during the long gap — the extra day between your last session of the week and your next one. That is exactly when diet discipline matters most. Many everyday foods are potassium-rich, and your team will tell you which ones to limit and how to prepare others. As a general picture, these are the foods to be mindful of:

Some fruits such as banana, orange, and dried fruit, and their juices.
Root crops and starchy vegetables like potato, kamote and squash.
Coconut water (buko juice), and drinks or supplements labelled "electrolyte" or "isotonic."
Tomatoes and tomato-based dishes, and beans and nuts in larger amounts.

You do not have to give these up forever. Portion size matters, and a cooking trick called leaching — peeling, cutting and boiling certain vegetables in plenty of water, then draining — can lower their potassium. Your dietitian will show you which foods are worth the effort and how much of each is safe for you.

Two habits that keep potassium safe. Skip salt substitutes (they are loaded with potassium), and go to every dialysis session for the full prescribed time — missing or shortening treatments is one of the most common reasons potassium climbs into the danger zone.

⬇ Download the Potassium Food Guide (PDF)

A printable reference: high, moderate and low-potassium Filipino foods by CKD stage, the warning signs of hyperkalemia, and the cooking trick (leaching) that lowers potassium in vegetables and root crops.

Phosphorus: the hidden one that protects your bones

Phosphorus is the quiet troublemaker. Dialysis does not remove it very well, so extra phosphorus tends to build up over time. When it does, your body pulls calcium out of your bones to compensate — which slowly weakens bones and lets calcium settle in your blood vessels, stiffening them. You will not feel any of this happening, which is exactly why it is easy to ignore until the damage is done.

Phosphorus hides in two places. The natural kind is in protein foods and dairy. The more troublesome kind is the added phosphate in processed food — it is absorbed almost completely by your body and is very hard to spot on a label. Practical steps:

Choose fresh, home-cooked food over processed and "instant" products whenever you can — the same habit that cuts your salt also cuts hidden phosphate.
Go easy on colas and dark soft drinks, which often contain phosphate additives.
Keep dairy and processed cheese to the portions your dietitian sets.
On labels, watch for ingredients with "phos" in the name (such as phosphoric acid or sodium phosphate) — these are added phosphates worth avoiding.

Take your phosphate binders with food. If your doctor has prescribed phosphate binders, they only work when you take them with your meals and heavy snacks — they trap phosphorus from the food you are eating right then. Taken on an empty stomach, they do almost nothing. Match the timing to your meals exactly as directed.

⬇ Download the Phosphorus Food Guide (PDF)

A printable reference for the fridge: a Filipino-food phosphorus heat-map (high / moderate / low), the phosphate binders available here and how to take them, how to spot hidden phosphate on labels, and simple cooking tricks that lower phosphorus.

Fluid: what you drink counts too

Between sessions, any fluid you take in stays in your body until dialysis removes it. Too much, too fast, and you gain weight in water — which strains your heart, can make you breathless, and forces harder, more uncomfortable treatments. Your team will give you a personal daily fluid limit; the single best way to keep it is, once again, to lower your salt so you are simply less thirsty. Remember that "fluid" also includes soup, ice, gelatin, and juicy fruit — not just water in a glass. Sipping slowly, using a smaller cup, and rinsing your mouth or sucking on a slice of calamansi can all ease a dry mouth without adding much fluid.

Protein: enough, and the right kind

This is where dialysis is different from earlier kidney disease. Before dialysis, patients are often told to limit protein. Once you are on dialysis, the treatment itself removes some protein from your body, so you usually need to eat more — good-quality protein at every meal helps you stay strong, heal, and keep your muscles. Fresh fish, chicken, meat and egg are excellent choices; the aim is to get them without the heavy salt and phosphate that come with the processed versions. A grilled bangus beats a canned or cured one on every count. How much protein you need is specific to you, so let your dietitian set the amount — this is not something to guess at.

Your renal dietitian builds the real plan

Everything above is the map. The actual plan — your numbers, your portions, which foods to limit and which to enjoy — is built for you, around your lab results, your medicines, your budget and the food you actually like to eat. Our renal dietitians do this every day, in plain language and with real Filipino meals in mind. Bring your questions, your usual grocery list, even photos of what you cooked this week. The goal is not a lecture or a list of forbidden foods — it is a way of eating you can live with, that keeps you feeling well between sessions.

Talk to our dietitian

Adapted with permission from renalcarematters.com. Medically reviewed by a nephrologist. This guide is educational and not a substitute for consultation.