Dialysis and Energy: Are You Getting Enough Calories?
"Unraveling the Myths: New research reveals that dialysis patients may not need extra calories, challenging common dietary advice."
If you're undergoing dialysis, you've likely heard that you need to increase your calorie intake. This advice stems from the belief that dialysis and related conditions increase energy expenditure. However, recent research suggests that this might not always be the case, and in some situations, increasing calories could lead to unwanted weight gain.
Balancing nutrition during dialysis is crucial. Underfeeding can increase mortality, while overfeeding can also be harmful. Healthcare professionals often prescribe high-calorie diets, assuming that conditions like metabolic acidosis, insulin resistance, and inflammation increase energy expenditure. But what if the opposite is true for many patients?
This article explores the latest research on the energy needs of dialysis patients, examining resting energy expenditure (REE) and physical activity levels. We'll clarify whether you actually need extra calories, how to assess your individual needs, and provide practical tips for maintaining a healthy weight during dialysis.
Why Calories Matter
For people receiving dialysis, getting enough calories is an important part of maintaining nutritional health. Energy needs can vary with health status, treatment demands, appetite, and dietary restrictions. A dialysis care team can help assess whether food intake is supporting energy needs and overall nutrition.
Estimating Energy Needs
Energy requirements generally need to be estimated before nutritional care is planned for patients undergoing hemodialysis, but the recommended caloric intake has not been conclusively established because available studies have not included sufficiently large samples. The 2020 CKD Guideline frames medical nutrition therapy around assessing, preventing, and treating protein-energy wasting, mineral and electrolyte disorders, and other metabolic complications. Dual-energy X-ray absorptiometry, or DXA, is considered a gold-standard direct method for assessing body composition in CKD, yet it is labor intensive, expensive, and affected by factors such as hydration status. Recent review work has also examined strategies including oral nutritional supplements and intradialytic parenteral nutrition.
How Dialysis Nutrition Evolved
The history of dialysis nutrition has developed alongside advances in renal replacement therapy. Long-term dialysis, kidney transplantation, new medications, and laboratory assay methods helped move chronic kidney disease treatment forward over the past eight decades. Work by Kopple and colleagues in 1969 and 1986 supported the hypothesis that dialysis patients may have higher protein and possibly energy needs than the normal population. As dialysis technology and the demographics of the dialysis population changed, ideas about dietary needs and restrictions changed as well.
Do Dialysis Patients Really Need More Calories?
A comprehensive review analyzed numerous studies on energy expenditure in dialysis patients. The surprising finding? Many patients on dialysis have resting energy expenditures comparable to healthy adults. This means that the stress of dialysis and uremic toxins might not always lead to increased energy needs as previously thought.
- Comparable REE: Studies showed no significant difference in resting energy expenditure between dialysis patients and healthy controls in many cases.
- Reduced Activity: Dialysis patients generally exhibit lower physical activity levels.
- Muscle Mass: Decreased physical activity is often related to reduced muscle mass, impacting overall energy needs.
Current Nutrition Research
Recent research is examining ways to address malnutrition in people receiving dialysis. A systematic review published on November 5, 2025, evaluated nutritional strategies such as oral nutritional supplements and intradialytic parenteral nutrition. A separate 2025 quality-improvement project focused on providing timely nutrition for patients with early in-center hemodialysis appointments without disrupting the daily dialysis schedule. Current overviews also synthesize practical nutritional principles from KDOQI, ESPEN, and KDIGO guidance.
When Dietary Goals Conflict
Hemodialysis patients can face difficulty following dietary guidance consistently. A 2025 study compared dietary intake with disease-specific guidelines, assessed overall diet quality, and examined the relationship between dietary potassium intake and serum potassium concentrations. The National Kidney Foundation emphasizes that diet is an important part of care for people receiving hemodialysis. These demands can make it challenging to balance adequate calories with other treatment-related dietary requirements.
Calories Within the Bigger Diet
The NIDDK explains hemodialysis nutrition through several connected components, including fluids, potassium, phosphorus, protein, sodium, calories, and vitamins and minerals. This broader framework shows why calorie intake cannot be considered entirely separately from the rest of the dialysis diet. A study of maintenance hemodialysis patients measured dietary energy requirements by examining energy intake alongside changes in body composition. Together, these sources point to the importance of evaluating calories in relation to both dietary composition and measured changes in the body.
Practical Tips for Managing Your Energy Needs on Dialysis
Managing your energy needs during dialysis requires a personalized approach. Instead of blindly following general recommendations, work closely with your healthcare team, including a registered dietitian, to assess your individual needs and adjust your diet accordingly.
A Personalized Balance
Adequate calorie intake during dialysis is not a one-size-fits-all goal. Dietary choices must be balanced with the other nutritional and metabolic concerns associated with kidney disease and dialysis. Because energy needs and food tolerance can differ, individualized assessment and ongoing follow-up are important.
The Next Era of Dialysis Nutrition
Research is moving toward both better dialysis treatments and more effective nutritional care. Stanford experts describe advances in kidney failure treatment that could offer alternatives to the challenges of regular dialysis. A global mapping of hemodialysis nutrition research found that translating evidence into routine practice remains uneven across settings and reviewed publication and collaboration trends over nearly two decades. Recent work also highlights that numerous dietary restrictions can conflict with the need for high energy and protein intake, making adherence a continuing research and care priority.
Managing Competing Needs
Protein-energy wasting is one of the broader nutritional challenges associated with hemodialysis. A reported case involving a 72-year-old man with protein-energy wasting and mild phosphoremia used targeted nutritional intervention focused on high-biological-value protein while maintaining phosphorus control. Another review describes a shift toward personalized nutrition interventions designed not only for metabolic control but also for clinically meaningful outcomes within integrated renal care. Reported interventions include nutritional supplements, intradialytic parenteral nutrition, and exercise.
Nutrition in Daily Life
Nutrition problems can affect people receiving different forms of dialysis in real-world settings. A prospective self-control study across five hospitals in China evaluated overnight-dwelled amino acid-based peritoneal dialysis in malnourished continuous ambulatory peritoneal dialysis patients. Dialysis patients may also be at risk for deficiencies of water-soluble vitamins, particularly vitamin B6 and folic acid, because of poor intake or nutrient losses during dialysis. These concerns show why nutritional care must account for both treatment effects and a patient's ability to maintain adequate intake.
Here are some practical tips to help you maintain a healthy weight and optimize your nutrition:
<ul> <li><b>Track Your Food Intake:</b> Keep a food diary to monitor your calorie consumption and identify areas for improvement.</li> <li><b>Monitor Your Weight:</b> Regularly weigh yourself to track weight trends and make necessary adjustments to your diet.</li> <li><b>Assess Your Activity Level:</b> Consider using a pedometer or fitness tracker to monitor your physical activity.</li> <li><b>Consult a Dietitian:</b> A registered dietitian can help you create a personalized meal plan based on your individual needs and preferences.</li> <li><b>Address Comorbidities:</b> Manage any underlying health conditions that may affect your energy expenditure.</li> </ul>