Nutrition and Home Hemodialysis

Diet recommendations for patients with renal disease remain complex as guidelines have changed over the years with emerging research. Home hemodialysis (HHD) is associated with more favorable clinical outcomes compared to in-center hemodialysis (standard 3 weekly sessions). Patients on HHD are also in a unique position of having more convenient dialysis times and so may have less disturbance in daytime eating patterns. The limited evidence on nutrition and HHD demonstrates that the increased frequency and total dialysis time of HHD increases phosphate removal, so much that it becomes unnecessary to add phosphate to dialysate. In addition, increased dialysis time facilitates the elimination of waste products, so HHD patients might not need to restrict potassium and fluids as much as those on conventional hemodialysis. Overall, a less restrictive diet provides more flexibility, control, and improved quality of life for patients on dialysis. However, because of the limited information and at times, confusing or conflicting nutritional guidelines, careful and comprehensive nutritional assessments with a multidisciplinary clinical team are crucial to both maintaining quality of life and preventing health complications in this vulnerable population. In this chapter, we briefly discuss current guidelines on diet in renal disease, summarize our understanding of electrolytes in hemodialysis, and focus on the current evidence on nutrition and diets for patients on HHD. There is limited information on the nascent field of nutrition and HHD, so much of our understanding is extrapolated from nutrition in conventional hemodialysis.