When has chronic renal diseases, need to make changes in the diet, including:
- Limiting fluids
- Eating a low-protein diet (this may be recommended)
- Restricting salt, potassium, phosphorous, and other electrolytes
- Getting enough calories if you are losing weight
Function
The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients who are on dialysis. The special diet is important because dialysis alone does not effectively remove ALL waste products. These waste products can also build up between dialysis treatments.
Most dialysis patients urinate very little or not at all. Therefore, fluid restriction between treatments is very important. Without urination, fluid will build up in the body and lead to excess fluid in the heart, lungs, and ankles.
Recommendations
Ask for a referral to a registered dietitian for diet information about kidney disease. Some dietitians specialize in kidney diets. Your dietitians can help you create a diet to fit your specific needs.
The Kidney Foundation has chapters in most states. It is an excellent resource for programs and educational materials to help people with kidney disease and their families.
Your daily calorie intake needs to be high enough to keep you healthy and prevent the breakdown of body tissue. Ask your doctor and dietitian what your ideal weight should be, and weigh yourself every morning.
CARBOHYDRATES
If you are overweight or have diabetes, you may need to limit the amount of carbohydrates you eat. Talk with your doctor, nurse, or dietitians.
Otherwise, carbohydrates are a good source of energy for your body. If your health care provider has recommended a low-protein diet, you may replace the calories from protein with:
- Fruits, breads, grains, and vegetables. These foods provide energy, as well as fiber, minerals, and vitamins.
- Hard candies, sugar, honey, and jelly. If needed, you can even eat high-calorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas.
FATS
Fats can be a good source of calories. Make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to help protect your arteries. Talk to your doctor, nurse, or dietitian about fats and cholesterol that may increase your risk for heart problems.
PROTEIN
Low-protein diets may be helpful before dialysis. Your doctor or dietitian may recommend a moderate-protein diet (1 gram of protein per kilogram of body weight per day).
Once you start dialysis, you will need more protein. In fact, a high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended. This will help you replace muscles and other tissues that you lose.
People on dialysis should eat 8 – 10 ounces of high-protein foods each day. Your doctor, dietitian, or nurse may suggest adding egg whites, egg white powder, or protein powder.
CALCIUM AND PHOSPHOROUS
Calcium and phosphorous, two other important minerals in the body, are also monitored closely. Even in the early stages of chronic kidney disease, phosphorous levels in the blood can become too high. This can cause:
- Low calcium (this causes the body to pull calcium from your bones, which can make your bones weaker and more likely to break)
- Itching
You will need to limit the amount of dairy foods that you eat. This includes milk, yogurt, and cheese. Some dairy foods are lower in phosphorous, including tub margarine, butter, cream cheese, heavy cream, ricotta cheese, brie cheese, sherbet, and nondairy whipped toppings.
Fruits and vegetables contain only small amounts of phosphorous.
You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body. If dietary measures to lower phosphorous are not enough, your doctor may recommend “phosphorous binders.”
FLUIDS
In the early stages of chronic kidney disease, you do not need to limit how much fluid you drink. As your kidney disease becomes worse or when you are on dialysis, you will need to watch how much you drink. In between dialysis sessions, fluid can build up in the body.
Your doctor and dialysis nurse will let you know how much you should drink every day. Do not eat too much of foods that contain a lot of water, such as soups, Jell-O, popsicles, ice cream, grapes, melons, lettuce, tomatoes, and celery.
Use smaller cups or glasses and turn over your cup after you have finished it.
Tips to keep from becoming thirsty include:
- Avoid salty foods
- Freeze some juice in an ice cube tray and eat it like a popsicle (you must count these ice cubes in your daily amount of fluids)
- Stay cool on hot days
SALT OR SODIUM
Reducing sodium in your diet helps you control high BP keeps you from being thirsty, and prevents your body from holding onto extra fluid. A low-salt diet is usually needed.
Look for these words on food labels:
- Low-sodium
- No salt added
- Sodium-free
- Sodium reduced
- Unsalted
Check all labels to see how much salt or sodium foods contain per serving. Also, avoid foods that list salt near the beginning of the ingredients. Look for products with less than 100 mg of salt per serving.
Do not use salt when cooking and take the salt shaker away from the table. Most other herbs are safe, and you can use them to flavor your food instead of salt.
DO NOT use salt substitutes because they contain potassium. People with chronic kidney disease also need to limit their potassium.
POTASSIUM
Normal blood levels of potassium help keep your heart beating steadily. However, too much potassium can build up when the kidneys no longer function well. Dangerous heart rhythms may result.
Potassium is found in many food groups, including fruits and vegetables. Choosing the right item from each food group can help control your potassium levels.
When eating fruits:
- Choose peaches, grapes, pears, cherries, apples, berries, pineapple, plums, tangerines, and watermelon
- Limit or avoid oranges and orange juice, nectarines, Kiwis, raisins or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines
When eating vegetables:
- Choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green and wax beans, lettuce, onion, peppers, watercress, zucchini, and yellow squash
- Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, avocado, and cooked spinach
IRON
Patients with advanced kidney failure usually need extra iron.
Many foods contain extra iron (liver, beef, pork, chicken, lima and kidney beans, iron-fortified cereals). Because of your kidney disease, talk this over with your doctor, nurse, or dietitian.
What To Eat If You Have Chronic Kidney Disease
The National Kidney Foundation suggests guidelines for renal dietitians who are preparing and teaching special diets for persons with kidney disease. This article will help you plan your meals and eating in order to slow or halt the progression of kidney disease. Specifically, if the amount of protein eaten is limited, it may help alleviate the symptoms of uremia, such as nausea, vomiting, bad taste and weight loss.
PROTEIN
Protein may be limited to 0.6 grams per kilogram ideal body weight per day. If the patient simply cannot adhere to this restriction, then 0.75 grams per kilogram ideal body weight per day. For your information, the Recommended Dietary Allowance (RDA) for protein in healthy persons is 0.8 grams per kilogram body weight per day. One can see there is very little difference in the normal diet for healthy individuals and the diet that is recommended to delay the progression of kidney disease. People probably eat twice the amount of protein needed to be healthy.
Here is an example of how the protein in the diet would be figured:
A man 5’7″ tall and 150 pounds (70 kilos)
0.6 grams X 70 kilos = 42 grams protein per day
0.75 grams X 70 kilos = 52 grams protein per day
Here are some samples of protein in foods:
1 egg = 7 grams protein
1 chicken thigh = 14 grams protein
8 ounces skim milk = 8 grams protein
1 slice bread = 2 grams protein
1 cup cooked rice = 4 grams protein
1/2 cup corn = 2 grams protein
CALORIES
According to the National Kidney Foundation Guidelines, calories in this special diet should be 35 calories per kilogram per day for those less than 60 years of age and 30 calories per kilogram per day for those over 60 years of age. Calories are found in carbohydrates, protein, fats and alcohol. As alcohol is not a necessary nutrient, it is not recommended. People with diabetes may need to eat more calories from carbohydrates to prevent weight loss. The medication to control blood sugar may need to be adjusted and/or increased.
POTASSIUM
Potassium is not usually restricted until urine output begins to decrease. Sometimes people with diabetes may need to have potassium limited. Foods high in potassium are:
Bananas, Oranges, Orange Juice, Milk, Prunes, Prune Juice, Tomato Juice, Tomato Sauce, Nuts, Chocolate, Dried Peas and Beans
SODIUM AND BLOOD PRESSURE
High sodium foods can increase blood pressure. High blood pressure is one of the major causes of kidney disease. New research tells us strict blood pressure control is important. Ask your doctor what your target blood pressure should be. A person may require more than one high blood pressure medicine. The first line of high blood pressure medication is called an “ace inhibitor.” This may improve a condition known as “proteinuria” or protein in the urine. This can affect diabetics and non-diabetics with high blood pressure. Some persons need a diuretic or “water pill” to help control high blood pressure. High sodium foods to avoid include: Salt, Bacon, Ham, Corned Beef, Pepperoni, Sausage, Pizza, Chinese Food, Fast Foods, Pickles, Cheese, Soy Sauce, Canned Soups, Potato Chips, Fritos, Cheetos
FLUID RESTRICTION
There is usually no restriction in the amount of fluids you can drink until severe kidney disease (Stage 4 or 5) is reached. The amount of urine your kidneys can make will usually not decrease until it is almost time to begin dialysis. It is called “kidney failure” because eventually the kidneys fail to make urine.
PHOSPHORUS
Phosphorus is a mineral found in almost all foods. Normal kidneys will balance the amount of phosphorus in our bodies. However, when the kidneys fail to eliminate this in the urine, the phosphorus will increase in the blood. High phosphorus foods will need to be limited and/or avoided. A medication called a phosphate binder (such as Oscal, Phoslo and Tums) may be ordered by your physician to be taken every time you eat. This medication will bind the phosphorus in the food and eliminate it in the stool. Control of phosphorus is very difficult for kidney disease patients. Ignoring this problem can lead to bone disease with pain in the back and joints. High phosphorus foods to eliminate are: Milk (any kind) – Start learning to use a milk substitute like Cremora (powdered) or Coffeemate (liquid) – Beans (red, black, white), Black Eyed Peas, Lima Beans, Nuts, Chocolate, Yogurt, Cheese, Liver, Sardines, Desserts made with milk
ANEMIA
Healthy kidneys make a hormone that helps make red blood cells. One of the symptoms of kidney disease is anemia, which causes weakness, tiredness and shortness of breath. Your kidney doctor may give you an injection called “Procrit.” This may help improve your anemia. The doctor may also order iron injections because in order to make red blood cells, you will need enough iron. Unfortunately, in some people the special diet will not provide enough iron and iron pills would be taken.
VITAMINS
Diseases of the heart and blood vessels remain the number one health problem in the U.S. Recently, a new risk factor has been identified in kidney disease patients. It is an amino acid called homocysteine. Over 75 percent of dialysis patients have increased homocysteine levels. Too much homocysteine in the blood has been found to be associated with increased risk of heart disease, stroke and blood vessel disease. Studies have shown that homocysteine levels in the blood are strongly influenced by these specific vitamins: Folic Acid, Vitamin B12 and Vitamin B6. The American Heart Association has indicated that a reasonable therapeutic goal should be less than 10 micromoles per liter. Ask your kidney doctor if you should be taking a special vitamin to help prevent high levels of homocysteine.
DIABETICS
Since about 40 percent of all kidney disease patients are diabetic, it is important to know about good control of your blood sugar. There is a special blood test called a “hemoglobin A1C.” This test tells what your blood sugars have been in the past two to three months. The normal range is 4.5 to 6.0 percent. Poor control of blood sugar contributes to the progression of your kidney disease. Be sure to ask your doctor how you are doing with blood sugar control. It may be necessary to be referred to a diabetes educator for help.
Sample Menu: 40-50 grams protein
(For non diabetic man 5’7″ tall and 150 pounds (70 kilos) with CKD)
BREAKFAST
• 1/2 cup (4 ounces) orange juice • 1 English muffin or 2 slices bread
• At least one tablespoon margarine with jelly
• Coffee or tea with non-dairy creamer and sugar
SNACK
2 canned pear halves in heavy syrup
LUNCH
• 2 slices white bread • At least 2 tablespoons mayonnaise with lettuce and tomato
• 1 ounce chicken (such as a small thigh) or 1 hard boiled egg
• 2 canned peach halves in heavy syrup
• 7-UP, lemonade or Hawaiian Punch
SNACK
• Baked apple with 1/2 cup non-dairy whipped topping
DINNER
• 3-4 ounces steak (weigh after cooking, without bone) , sauté in tablespoons olive oil
• 1 small baked potato with at least 2 tablespoons margarine
• 1/2 cup fresh green beans, carrots or broccoli with margarine
• Lettuce, onions, cucumbers, green pepper
• At least 2 tablespoons olive oil with vinegar or lemon
• 1/8 apple or cherry pie with 1/2 cup fruit sorbet (this is not sherbet)
• Iced tea with sugar and lemon or Sprite
SNACK
• 1 small banana and 10 vanilla wafers
• Coffee or tea with non-dairy creamer and sugar
Eating Vegetarian Foods While Living With Kidney Disease
Historically, vegetarianism has been met with skepticism in chronic kidney disease (CKD) patients. However, we now know that with careful planning vegetarianism, or even part-time vegetarian eating is not only safe, but also beneficial to CKD management.1,2 Research shows eating vegetarian proteins can actually slow down the progression of kidney disease and other complications associated with this disease.1,2
Nutrition management focuses on decreasing waste product build up from digested foods, which would normally leave the body as urine. The primary goals of planning a diet with plant-based foods are three fold: 1.) obtaining the appropriate amount of plant protein to meet protein needs while minimizing waste product build up in the blood 2.) maintaining sodium, potassium and phosphorus balance and 3.) maintaining good nutrition. The following information is meant to be an initial guide to those with early kidney disease (30-50 percent of normal kidney function) and not receiving dialysis treatments. More careful follow up is recommended, especially when kidney function decreases below 30 percent or when regular dialysis treatment is required.
Quality Protein
People with CKD should modify the amount of protein they eat.1 Since plant proteins are less demanding on kidney clearance, this restriction does not need to be as severe as with animal protein diets.8 Keeping to .8 gram (g) of protein per kilogram (kg) body weight is recommended, with approximately two-thirds of this protein coming from quality plant protein or animal/plant combination, such as the following:4
Quality Protein
Serving Size = 7 g protein
Egg
1
Meat analogues
(processed soy foods)
2 oz.
Seitan
(Wheat gluten)
1 oz.
Beans, dried cooked
1/2 cup
Tofu
1/4 – 1/2 cup
Tempeh
1/4 cup
Nut Butters
2 tablespoons
Meat, Fish, Poultry
1 oz.
EXAMPLE:
- Your weight: 70 kg
- Your total protein needs: 70 x .8 = 56 grams
- Amount needed from quality protein sources: 56 x 2/3 = 37 grams
(1 pound = 0.4535924 kilogram)
A mixture of these protein sources should be eaten to ensure receiving an adequate balance of all essential amino acids (meat, fish and poultry are optional sources).5-8 Soy protein has been shown to be particularly beneficial in minimizing some complications associated with kidney disease. This includes proteinuria (protein loss in the urine) and minimizing hyper filtration (excess filtering of the kidney causing more kidney damage).9-12 Try to include at least one serving of soy protein per day, such as tofu, tempeh or a milk substitute, soymilk.
Sodium, Potassium, & Phosphorus
Sodium
Though vegetarian foods are healthy in general, some can be very high in sodium. A few foods to avoid for limiting sodium in plant-based foods include:8
- Convenience foods such as frozen meals, canned soup, dried soups, miso or packaged vegetable broths
- Soy-based cheese
- Processed dairy cheese
- Meat analogues — this includes such foods as tofu hot dogs, veggie burgers or other canned or frozen soy products
- Salt, soy sauce, tamari sauce or any spices that contain the words sodium or salt
Potassium
In general, potassium does not need to be restricted unless the function of the kidney decreases to less than 20 percent. Routine blood testing is the best way to know your potassium requirements. An estimated two-thirds of diet potassium comes from fruits,
vegetables and juices. So initially, the easiest way to limit this mineral will be to minimize fruit and vegetable selections to five servings per day.
A potassium serving size:
1/2 cup fresh fruit, canned fruit or juice
1 cup fresh vegetables
1/2 cup cooked vegetables
If this does not decrease your serum potassium to the normal range, limit these foods:
High Potassium
Limit 1 per day
Textured vegetable protein
1/4 cup
Soy flour
1/4 cup
Nuts and Seeds
1/4 cup
Dried, cooked beans or lentils
1 cup
Dried cooked soybeans
1/2 cup
Tomato products
1/4 cup
Potatoes
1/2 cup
Dried fruit
1/4 cup
Tropical fruit
1/2 cup
Melons
1/2 cup
If you use a lot of beans or textured vegetable protein, alternative protein selections may be needed in order to keep potassium levels from going too high. This will mean using more tofu, tempeh, seitan and eggs or if you prefer some meat, fish or poultry to meet protein needs.
Phosphorus
Some plant proteins are high in phosphorous, but because of the high phytate content (a naturally occurring compound which blocks phosphorous absorption) these foods alone usually do not increase serum phosphorous levels.8 This includes dried cooked beans and nuts. Dairy products are the main source of concentrated phosphorus.14 This will mean decreasing dairy products to one serving or less per day. For the vegan a few other high phosphorus foods are worth noting:
High Phosphorus
Limit 1 per day
Milk
1 cup*
Cottage Cheese
2/3 cup
Cheese
2 ounces
Pudding or custard
8 ounces
Yogurt
8 ounces
Soy cheese
4 ounces
Soy yogurt
(non fortified)
12 ounces
*Non-dairy creamer, rice milk and up to two cups of soymilk per day can be used as a replacement for milk
Good Nutrition
A plant-based diet is often lower in calories and higher in fiber than an animal-based diet. As a result, you need to be careful you do not lose weight. Here are some ideas to help add healthy calories to your eating plan:
- Soy shakes: Make shakes with soymilk, tofu, rice milk and non-dairy frozen dessert.
- Adding fats: Use more oils such as olive oil, peanut oil or canola oil in cooking. Drizzle flaxseed oil on food after it is cooked, or mixed with salad dressing over lettuce.
- Snacks: Eat small frequent meals if you fill up quickly.
- Sweets: Even though a high sugar diet is not the best choice for food, on occasion these calories can be beneficial to avoid weight loss. Good choices are jellybeans, hard candy, sherbets or sorbet.
Vitamins and Minerals
Supplementation of vitamins and minerals in kidney disease needs to be treated on an individual basis. Most people will require a water-soluble vitamin without fat-soluble vitamins or minerals. Mineral levels will need to be checked individually to determine if a supplement is needed. High dosages of any vitamin and or mineral in kidney disease are discouraged since the poor clearance from you kidney can cause toxic levels in the blood.15
Foods to Avoid With Kidney Problem
The kidneys control a variety of metabolic processes, including flushing waste materials from the body and controlling blood pressure When the kidneys don’t function properly, they may begin to break down, leaving the body vulnerable to numerous problems, some being potentially very serious. Maintaining good renal function contributes to your overall good health If you know you have chronic kidney disease (CKD), or have received blood tests indicating potential renal dysfunction, you can help your kidneys function with greater efficiency by reworking your dietand avoiding specific foods.
Fruits, Vegetables and Legumes
Reducing potassium intake is only necessary if your kidney function drops to below 20 percent, according to the Association of Kidney Patients. Cut back on the amount of fruits and vegetables you consume to reduce potassium. Eat no more than a total of five servings of fruits and vegetables per day. This includes limiting the amounts of textured vegetable protein (TVP) and legumes (beans) for vegetarians.
Animal Proteins
The American Association of Kidney Patients recommends reducing animal proteins which are high in purines that convert to uric acid in the kidneys. Urine then becomes too acidic, which leads to the formation of uric acid crystals that are deposited in the kidneys as kidney stones. Uric acid crystals also deposit in joints, causing gouty arthritis. Replace poultry, red meats and fish with vegetarian sources of protein, such as soy or legumes, combined with whole grains to form complete proteins.
High Oxalate Foods
Limit foods high in oxalic acid, recommends the National Kidney Foundation, to avoid developing a variety of kidney stones. These foods include instant coffee, tea, Concord grapes, tofu, beets, berries, peanuts, oranges, sweet potatoes, beans, chocolate, dark leafy green vegetables and draft beer.
Canned, Processed, Frozen and Fast Foods
The kidneys’ role in maintaining blood pressure is closely involved with the body’s sodium balance. One of the causes of kidney disease is hypertension, and it is also one of the side effects of kidney disease. Too much sodium intake can trigger high blood pressure, with renal function going haywire, according to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Lower salt intake and all foods that are high in sodium, all canned foods (unless they are labeled “low sodium”), canned and dried soups, vegetable broths, soy-based cheeses, convenience foods, chips, fast foods, boullion, frozen meals, hot dogs, processed cheese slices, salt, soy sauce, processed meats, pickled foods, tamari, ketchup, marinades and anything that has the words “sodium added” on the label.
Chocolate, Dairy and Nuts
The body’s electrolyte balance is controlled by the kidneys. If they are not working properly due to disease or other conditions impacting their function, electrolytes must be reduced to avoid straining the kidneys. Phosphorus blocks the absorption of calcium, so reducing the following high-phosphorus foods will help retain needed calcium, recommends the American Association of Kidney Patients. Cut back on cocoa, nuts, chocolate, vegetables, carbonated drinks and dairy products. Eat only one portion of these foods per day, especially cottage cheese, yogurt, milk, soy cheese, soy yogurt and hard cheeses, which are high in phosphorus.
Nutrition for Later Chronic Kidney Disease in Adults
As kidney disease progresses, nutritional needs change as well. If you have reduced kidney function, your doctor may recommend that you change your diet to protect your kidneys.
You can prevent or delay health problems from chronic kidney disease (CKD) by eating the right foods and avoiding foods high in phosphorus, potassium, and sodium. Eating too much protein can also burden the kidneys and speed the progression of CKD. Protein foods like meat and dairy products break down into nitrogen and creatinine, waste products that healthy kidneys remove from the blood. But diseased kidneys can’t stop waste products from building up in the blood and causing health problems.
With reduced kidney function, you may need to start paying attention to the protein, phosphorus, sodium, and potassium content of the foods you eat. Learning about your food will help you understand what changes you need to make.
Calories
Calories are units of energy provided by food. Work with your dietitian to determine how many calories you need each day to maintain a healthy weight.
As CKD progresses, you may find that foods do not taste the same, and you may lose your appetite. Your dietitian can help you find healthy ways to add calories to your diet if you are losing too much weight.
Protein
Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs, and blood. They help fight disease and heal wounds. But proteins also break down into waste products that must be cleaned from the blood by the kidneys. Eating more protein than your body needs may put an extra burden on the kidneys and cause kidney function to decline faster.
Doctors have long recommended that patients with CKD eat moderate or reduced amounts of protein. Some worried, however, that restricting protein would lead to malnutrition in many patients. In the 1990s, a major clinical trial measured the benefits and dangers of protein restriction for kidney patients. The Modification of Diet in Renal Disease (MDRD) Study assigned groups of CKD patients to diets with different levels of daily protein intake. The study found that patients who succeeded in reducing their daily protein intake by 0.2 grams for each kilogram of body weight for 1 year had healthier levels of bicarbonate, phosphorus, and urea nitrogen in their blood.
For example, a man who weighs 154 pounds (70 kilograms) and who normally eats 56 grams of protein a day would have to reduce his protein intake to 42 grams a day. To cut back on protein, he might eat oatmeal at breakfast (6 grams of protein) instead of a bacon, egg, and cheese sandwich (18 grams of protein).
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