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Diet - chronic kidney disease
Definition
When you have chronic kidney disease, you need to make changes in your 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
Your recommended diet may change over time if your kidney disease gets worse, or if you need dialysis.
Alternative Names
Renal disease - diet; Kidney disease - diet
Function
The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients who have chronic kidney disease or who are on dialysis. Patients who are on dialysis need this special diet to limit the buildup of waste products in their body. These waste products can also build up between dialysis treatments.
Most dialysis patients urinate very little or not at all. Limiting fluids 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 dietitian can help you create a diet to fit your 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 dietitian.
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 you start 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 to eat 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 you eat, because they contain large amounts of phosphorous. 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, but may contain large amounts of potassium.
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. Ask your doctor, nurse, or dietitian.
If diet changes 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 liquid you drink. In between dialysis sessions, fluid can build up in the body. Too much fluid will lead to shortness of breath, an emergency that needs immediate medical attention.
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 blood pressure, keeps you from being thirsty, and prevents your body from holding onto extra fluid. You will probably need to eat a low-salt diet.
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, which can lead to death.
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 also have anemia \ and 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.
References
Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010;362:56-65.
National Kidney Foundation. Dietary Guidelines for Adults Starting on Hemodialysis. 2009. Accessed September 22, 2009.
Eat right to feel right on hemodialysis. NIH Publication No. 08-4274. September 2, 2010. Accessed August 2, 2011.
Mitch WE. Chronic kidney disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 131.
Reviewed By: Herbert Y Lin, MD, PhD, Nephrologist, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
