People on chronic dialysis can lead fulfilling lives, but they have many responsibilities, particularly those associated with managing their diabetes or other complications. Concerns common to both types of dialysis include:

• Diet. People on dialysis have many special dietary needs. A dietician can help. Generally, an individual’s diet is more restricted with hemodialysis than with peritoneal dialysis. A closely controlled diet is necessary because hemodialysis is performed less frequently and more wastes gather in the body between treatments. A physician may prescribe specially designed vitamins and minerals to help with dietary requirements. Patients must avoid over-the-counter vitamins, supplements and medications without a nephrologist’s recommendation because they can provide dangerous levels of minerals and other substances. Dietary concerns include:
  
  
• • Protein. Because protein breaks down into the waste product blood urea nitrogen (BUN), predialysis patients are often put on a low-protein diet to keep the kidneys working as long as possible. After dialysis begins, however, emphasis is placed on eating high-quality proteins that produce less waste in the blood (e.g., meat, fish, poultry and egg whites).
    
    
  • Potassium. High-potassium foods can harm the heart by making it beat too fast. These include milk, yogurt, sardines, clams, and many fruits and vegetables including bananas, avocados, oranges, melons and dried fruits. Potatoes and other potassium-rich vegetables can be improved by peeling them, soaking them in water for a few hours and rinsing them.
    
    
  • Phosphorus. Excess phosphorus can weaken the bones and cause itchy skin (pruritus). High-phosphorus foods include milk, cheese, colas, nuts, dried beans and peas.
    
    
  • Fluids. It is important for dialysis patients to monitor daily consumption of liquids, including those found in foods. These individuals must follow the limits recommended by the physician or dietician. Consuming too much fluid can cause high blood pressure (hypertension), tax the heart and make dialysis less effective.
    
    
  • Salt. Too much sodium can raise blood pressure and result in drinking too much fluid. Many canned goods and processed foods are high in salt.
    
    
• Depression and stress. Emotional and psychological difficulties go hand in hand with the upheavals caused by dialysis. Often the toll on relationships, self-image and finances is heavy. Social workers, counselors, therapists and support groups can help with emotional support.
  
  
• Expense. Dialysis costs tens of thousands dollars a year. Medicare pays 80 percent for recipients requiring regular treatment. Medicaid, private insurance or state aid usually covers the remaining cost. A social worker can provide more information about financial assistance. People relying on home dialysis units, especially those in regions prone to hurricanes or other causes of power outages, may need to consider buying a generator.
  
  
• End-of-life decision making. Because of concerns about quality of life and other matters, one-fourth of the people on dialysis choose to end treatment. Unless a kidney transplant is available, death normally results within weeks. People undergoing dialysis should consider in advance such matters as living wills and power of attorney. Most people on dialysis, however, find the extension of life outweighs the inconveniences.