Why do people on dialysis need more protein?

December 31, 2025 •

4 min read

Studies have shown that dialysis patients with higher serum albumin levels experience better health outcomes and fewer hospitalizations. This is one of several critical reasons why people on dialysis need more protein in their diet, as the treatment process itself contributes to significant protein and amino acid losses.

Quick Summary

Dialysis patients require a higher protein intake to replace nutrients lost during treatment, combat inflammation, and prevent muscle wasting. High-quality protein supports tissue repair, strengthens the immune system, and helps manage complications like fatigue and anemia. Meeting these increased needs is vital for overall health and recovery.

Key Points

Dialysis Causes Protein Loss: Both hemodialysis and peritoneal dialysis remove essential proteins and amino acids from the body, requiring a higher intake to compensate.
Combating Protein-Energy Wasting: Dialysis patients are in a hypercatabolic state, meaning they break down muscle protein faster. Increased protein intake helps prevent severe muscle loss.
Supporting Immune Function: A robust protein intake helps maintain a strong immune system, which is critical for patients who are more susceptible to infection and inflammation.
Managing Complications: A high-protein diet can help improve symptoms like fatigue and anemia, both of which are common in dialysis patients.
High-Quality Protein is Key: Patients are advised to consume high-quality proteins from sources like eggs, lean meats, and fish, which are more efficiently utilized by the body.
Working with a Dietitian is Crucial: Due to the complexities of managing other nutrients like phosphorus and potassium, dietary adjustments for dialysis patients should always be supervised by a renal dietitian.

Understanding Protein and Its Role in Dialysis

Protein is a vital macronutrient composed of amino acids, the building blocks for every cell, tissue, and organ in the human body. It is essential for tissue repair, immune function, and maintaining fluid balance. For individuals with healthy kidneys, managing protein intake involves processing and eliminating waste products, primarily urea, from the breakdown of protein. However, this process changes dramatically for those with kidney failure who depend on dialysis.

The Mechanisms Behind Increased Protein Needs

Several key factors contribute to why people on dialysis need more protein than healthy individuals or those with early-stage kidney disease:

Losses During Dialysis: Both hemodialysis and peritoneal dialysis remove waste products and excess fluid from the blood. Unfortunately, this process also strips the body of valuable nutrients, including essential amino acids and albumin, a crucial blood protein. For instance, a single hemodialysis session can remove 6–12 grams of amino acids, while peritoneal dialysis can cause daily albumin losses. This continuous nutrient loss must be replenished through dietary intake.
Protein-Energy Wasting (PEW): Patients with end-stage renal disease (ESRD) and those on dialysis frequently experience a hypercatabolic state, meaning their bodies break down muscle protein faster than usual. This can be driven by a combination of factors, including inadequate calorie intake, underlying inflammation, and resistance to anabolic hormones like insulin. The result is a condition called protein-energy wasting, characterized by muscle loss and poor nutritional status. Increasing protein intake helps counteract this catabolic state and rebuild lost muscle mass.
Systemic Inflammation: Chronic inflammation is a common complication of ESRD and dialysis. This inflammation contributes significantly to protein breakdown and malnutrition. A higher protein intake helps the body respond to and recover from this state of constant stress.
Metabolic Acidosis: Failing kidneys are unable to excrete acid efficiently, leading to metabolic acidosis. This acidic environment promotes further protein catabolism and muscle wasting. While dialysis helps correct this imbalance, an adequate protein supply is still necessary to counteract its effects.
Support for Anemia: Anemia is prevalent in dialysis patients due to reduced erythropoietin production by the kidneys. Proteins and amino acids are vital for producing red blood cells, so a higher protein diet helps support the body's efforts to manage anemia.

Comparing Protein Requirements

Protein requirements differ significantly depending on kidney function. Here is a comparison of typical protein recommendations for a healthy adult versus a dialysis patient.


Condition	Protein Intake (g/kg/day)	Considerations
Healthy Adult	~0.8	Standard dietary needs; kidneys manage protein waste efficiently.
Non-Dialysis CKD (Stages 3-5)	0.6–0.8	Lower protein to reduce waste buildup and slow progression.
Maintenance Hemodialysis (HD)	1.1–1.4	Higher intake to replace protein and amino acids lost during treatment.
Peritoneal Dialysis (PD)	1.0–1.2	Higher intake due to continuous protein loss into the dialysate fluid.

It is crucial for patients to work with a renal dietitian to determine their specific protein needs, which can vary based on body size, nutritional status, and treatment type.

How to Increase Protein Intake Safely

Increasing protein intake for dialysis patients requires careful planning to manage other dietary restrictions, such as limiting potassium and phosphorus. Here are some strategies:

Prioritize High-Quality Proteins: These produce less nitrogenous waste and are easily absorbed. Excellent sources include lean meat, poultry, fish, and eggs. For example, a 3-ounce serving of cooked chicken breast or a large egg are both high-quality options.
Utilize Dialysis-Friendly Supplements: When appetite is poor or dietary protein is insufficient, specially formulated nutritional supplements can be beneficial. These are often low in potassium and phosphorus but high in protein. Examples include protein shakes or powders designed for renal patients. Always consult your care team before starting any supplement.
Incorporate Protein into Every Meal: Aim to include a high-quality protein source at each meal and with snacks. A hard-boiled egg for a snack or adding cooked chicken to a salad can help boost intake throughout the day.
Cook Smart: Boiling certain vegetables and meats can help reduce their potassium content, as some potassium leaches into the cooking water. Discarding the water and eating the boiled food is a helpful strategy.
Time Your Snacks: Having a bedtime snack can prevent the body from breaking down muscle protein for energy overnight. Small, protein-rich snacks like a protein bar or a small amount of cottage cheese can help.

The Importance of Team-Based Care

Managing a renal diet is complex and should not be undertaken alone. Working closely with a healthcare team is essential. A nephrologist oversees overall treatment, while a registered dietitian specializing in renal care provides individualized meal plans. Regular blood tests are necessary to monitor levels of protein, potassium, and phosphorus to ensure the diet is effective and safe. By combining a high-protein diet with regular dialysis treatments and medical supervision, patients can effectively manage their condition and enhance their quality of life.

Conclusion

For those on dialysis, a higher protein intake is a medical necessity, not a dietary choice. It is the body's defense against the continuous loss of vital nutrients during treatment and the systemic inflammation and muscle wasting that can occur with advanced kidney disease. By focusing on high-quality protein sources and potentially incorporating renal-friendly supplements under a dietitian's guidance, patients can protect their health, maintain muscle mass, and improve their overall energy levels. This targeted nutritional strategy is a cornerstone of comprehensive dialysis care and is crucial for improving long-term outcomes.

Frequently Asked Questions

For most adults on hemodialysis or peritoneal dialysis, the protein recommendation is between 1.0 and 1.2 grams per kilogram of ideal body weight per day. This is significantly higher than the recommendation for healthy adults.

Before dialysis, a low-protein diet reduces the workload on the failing kidneys by minimizing the production of nitrogenous waste. Once dialysis begins, the treatment removes this waste, and a higher protein intake is needed to replace the proteins and amino acids lost during the procedure itself.

Excellent high-quality protein sources for dialysis patients include eggs, lean meat (chicken, turkey), fish, and certain dairy products like cottage cheese, but be mindful of phosphorus content. Plant-based options include tofu and some legumes, though a dietitian should guide their inclusion due to mineral content.

Protein supplements can be a safe and effective way for dialysis patients to meet their increased protein needs, especially when appetite is poor. However, it is vital to choose supplements specifically designed for renal patients, which are typically low in potassium and phosphorus. Always consult a renal dietitian before starting any new supplement.

Yes, many protein-rich foods, particularly animal proteins and processed foods, are also high in phosphorus. This is why managing phosphorus is crucial. Renal dietitians can help create a meal plan that provides enough protein while controlling phosphorus, often with the help of prescribed phosphate binders.

Inadequate protein intake can lead to serious complications, including protein-energy wasting, muscle loss, weakened immune function, slow wound healing, and anemia. Malnutrition is a significant risk factor for poor health outcomes and increased hospitalization in this population.

High-quality protein contains all the essential amino acids your body needs to function, which is particularly important for rebuilding and repairing muscle tissue. Additionally, high-quality protein from animal sources tends to produce less waste for the kidneys to process during dialysis compared to lower-quality plant proteins.