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).

The typical American diet contains more than enough protein. Most people can get the protein they need by eating two 3-ounce servings of meat or meat substitute each day. Learning about portion sizes can help you limit your protein intake.

Talk with your dietitian about the amount of protein and the sources of protein in your diet. Animal sources such as egg whites, cheese, chicken, fish, and red meats contain more of the essential amino acids your body needs. A well-balanced vegetarian meal plan can also provide these nutrients. Your dietitian can suggest ways to make small adjustments in your eating habits that can result in significant protein reduction. For example, you can make sandwiches using thinner slices of meat and filling out the sandwich with lettuce, pickles, cucumber slices, apple slices, and other garnishes.

Protein Content of Foods

High-Protein Foods	Lower Protein Alternatives
Ground beef Halibut Salmon Tuna Chicken breast Chili con carne	Egg substitutes Shrimp Tofu Imitation crab meat Chicken drumstick Beef stew

Fat

Fat provides energy, helps produce hormone-like substances that regulate blood pressure and other heart functions, and carries fat-soluble vitamins. You need fat in your diet, but some fats are healthier than others. Saturated fats and trans-fatty acids can raise your blood cholesterol levels and cause clogging of blood vessels.

Talk with your dietitian about healthy and unhealthy sources of fat. Saturated fats are found in animal products like red meat, poultry, whole milk, and butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercial baked goods like cookies and cakes and in fried foods like doughnuts and french fries.

Your dietitian can suggest healthy ways to get fat into your diet, especially if you need more calories. Vegetable oils like corn or safflower oil are healthier than animal fats like butter or lard. Avoid hydrogenated vegetable oils because they are high in trans-fatty acids. Monounsaturated fats-olive, peanut, and canola oils-are healthy alternatives to animal fats.

Sources of Fats

Bad Fats	Good Fats
Saturated fats Red meat Poultry Whole milk Butter Lard	Monounsaturated fats Corn oil Safflower oil Olive oil Peanut oil Canola oil
Trans-fatty acids Commercial baked goods French fries Doughnuts
Hydrogenated vegetable oils

Sodium

Sodium is found in ordinary table salt and many salty seasonings like soy sauce and teriyaki sauce. Canned foods, some frozen foods, and most processed meats have large amounts of table salt. Snack foods like chips and crackers are also high in salt.

Too much sodium in your diet can be harmful because it causes your blood to hold fluid. The extra fluid raises your blood pressure and puts a strain on your heart and kidneys. Talk with your dietitian about ways to reduce the amount of sodium in your diet. Look for the sodium content on the nutrition labels of the foods you buy. Choose “sodium-free” or “low-sodium” food products. Aim to keep your daily sodium intake less than 1,500 milligrams.

Try alternative seasonings like lemon juice, salt-free seasoning mixes, or hot pepper sauce. But avoid salt substitutes that use potassium.

Sodium Content of Foods

High-Sodium Foods	Lower-Sodium Alternatives
Salt Canned vegetables Hot dogs Packaged rice with sauce Packaged noodles with sauce Frozen vegetables with sauce Canned soup Tomato sauce Snack foods	Salt-free herb seasonings Frozen vegetables Plain rice Plain noodles Unsalted pretzels Unsalted popcorn

Potassium

Potassium is found in many fruits and vegetables, such as bananas, potatoes, avocados, and melons. Check your blood tests to make sure that your potassium level stays in the normal range. If it begins to climb, talk with your dietitian about ways to limit the amount of potassium you eat. You may need to avoid some fruits and vegetables. You can reduce the potassium content of potatoes by soaking them in water for several hours before cooking.

Potassium Content of Foods

High-Potassium Foods	Lower-Potassium Alternatives
Oranges and orange juice Melons Apricots Banana Kiwi Potatoes Tomatoes Sweet potatoes Cooked spinach Beans (baked, kidney, lima, pinto)	Apples and apple juice Cranberry juice Canned fruit Strawberries, blueberries, raspberries Plums Pineapple Cabbage Cauliflower Mustard greens Broccoli

Phosphorus

Phosphorus is a mineral found in many foods. Too much phosphorus in your blood pulls calcium from your bones. Losing calcium will make your bones weak and likely to break. Too much phosphorus may also make your skin itch. Foods like milk and cheese, dried beans, peas, colas, canned iced teas and lemonade, nuts, and peanut butter are high in phosphorus. Talk with your dietitian about how much phosphorus you should have in your diet.

As your kidney disease progresses, you may need to take a phosphate binder like sevelamer hydrochloride (Renagel), calcium acetate (PhosLo), or calcium carbonate (Tums) to control the phosphorus in your blood. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool.

Phosphorus Content of Foods

High-Phosphorus Foods	Lower-Phosphorus Alternatives
Dairy foods (milk, cheese, yogurt) Beans (baked, kidney, lima, pinto) Nuts and peanut butter Processed meats (hot dogs, canned meat) Cola Canned iced teas and lemonade Bran cereals Egg yolks	Liquid non-dairy creamer Sherbet Pasta rice Rice and corn cereals Popcorn Green beans Lemon-lime soda Root beer Powdered iced tea and lemonade mixes

Fluids

As your kidney disease progresses, you may need to limit how much you drink because your kidneys can't remove the extra fluid, so it builds up in your body and strains the heart. Tell your doctor if you notice you are making either less urine or more urine or if you have any swelling around your eyes or in your legs, arms, or abdomen.

Keep Track of Test Results

If you have CKD, your doctor will order regular blood tests. Many patients find that keeping track of their test results helps them see how their treatment is working. Ask your doctor for copies of your lab reports and ask to have them explained. Note any results that are out of the normal range. When you learn how to read your reports, you will see how the foods you eat affect your kidneys. Talk with your doctor or your dietitian about what you can do to make healthier food choices. Remember that you are the most important member of your health care team.