How to gain weight

Hello all. Father is on hemodialysis, and is very thin. Needs to gain weight. It is recommended to eat more protein.
We have additionally tried Nepro, but it “goes right thru”. Any other ideas ? Should we concentrate on the protein
or the carbohydrates ?

Thank you

Hi. Thank you for your message. It sounds like you are trying a lot of things to help your father gain weight, but not having a lot of luck. When you mentioned that it “goes right thru” do you mean that he has diarrhea? Has this been going on a while or is it only related to the Nepro? If he is having a lot of diarrhea he may not me absorbing the nutrients from his food. This is definitely something to discuss with the physician.

When a patient on dialysis in underweight it is important for him to eat enough protein and calories. Calories come from carbohydrate, protein and fat. This means he should be eating three well balanced meals in addition to some snacks. If he can not inish his meals he may need to eat small meals more often. Also, you may want to speak to your father’s dietitian about other supplements that he may tolerate better than Nepro. Depending on his lab results there are other supplements that he could try to help increase his calories and protein. Please let me know about his progress. Thank you.

LeeAnn Smith, MPH, RD

I am not a dietician, but a hemo dialysis patient (x5 years), and have had issues with this as well. I have found personally, that my apetite is significantly less then it once was, which makes weigt gain nearly impossible. I completely agree with LeeAnn, that eating often is the key. My mother worries so much about me, thinking that I eat so little at meals, probably about the same as my 5 year old… but the fact is, I eat small portions, but I eat OFTEN. Additionally, ironic as it seems, increasing my fibre intake (while not recommended in large quantities due to phosporus) has really helped ease diarrhea. I try to eat half a bran muffin each morning, and it has helped a lot. Does your dad eat eggs? It would depend on his cholesterol levels, etc… but eggs are a big part of the protein I consume, as meat is hit and miss for me. A meat source that I tolerate very well (might be worth a try), is lean ground beef. If his phosphorus levels are well under control, and he has room to manoevre, yogurt (also considered fluid), and cheese will also increase his protein intake. I have been able to maintain my weight for several years, excluding of course, when the stomach flu comes home from kindergarden!

All the best,


The entire time I was on 3x in-center txs, I was underweight by about 10 lbs. I humored myself that well at least I didn’t have to go on a diet and had the model look. Not being able to eat freely this is how I was affected. I never touched Nepro as it didn’t appeal to me at all and would have taken up my fluid limit. Despite being underweight, my albumin, main marker for protein, was always over 40. Also, if I ate anymore, my phos and potass would go too high.

One very good solution is simply getting better dialysis. When I started doing txs at home 6x on the NxStage machine, I was able to eat more normally, because the fluid and toxins were coming off 6x. Just about everyone I know on SDD has gained weight, because one has a better appetite with frequent dialysis and also because with dialysis 6x it is possible to eat more phos foods that affect weight gain. One can also eat more potass foods. Better appetite and more total foods = weight gain. If your dad could get the top treatment, nocturnal dialysis, done at night while he sleeps at a very gentle speed, then he would have no diet restrictions at all and would feel the best possible. I don’t know his age, but there are patients in their 80’s who successfully do this treatment. Check out the NxStageUsers Forum for more info on how to get better txs.

We have LOTS of information here, too, about how to get better treatments. You can start by reading descriptions of the 5 types of home dialysis here:, and read our Topic of the Month articles under Cutting Edge Info here:

Kidney Mom,

Thank you for your post. You have great insight and a lot of knowledge about how to eat well on the renal diet. The tip about ground beef and eggs is a good one. Some of my patients mention the same thing - that these two protein foods are well tolerated compared to other protein sources. Dairy products like yogurt and cheese are not typically recommended as protein sources due to the high phosphorus and potassium content. Although, dairy is often well tolerated, so this should be assessed on a case by case basis by the patient and his/her dietitian. A patient with well controlled phosphorus and potassium may be able to eat some dairy servings. Again, thank you for your input. Hope to hear from you soon.

LeeAnn Smith, MPH, RD

Hi LeeAnne,

Only too happy to help. So much of this whole process is overwhelming at the beginning. I am happy to offer what I have learned (truly trial and error) over the years. I only wish I had more time to spend here. Between family life, a 5 year old, and dialysis, I keep busy!

I definetly concur with speaking to your dietician before implementing any changes to your diet - I apologize if that was not clear.