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DOCTOR AIMEE VERGARA
EXECUTIVE DIRECTOR
SPECIALIZES IN PEDIATRIC NEPHROLOGY

DIET. CHRONIC KIDNEY DISEASE
You may need to make changes to your diet when you have chronic kidney disease. These changes include:
LIMITING FLUIDS
Eating a low-protein diet
Limiting salt, potassium, phosphorous, and other electrolytes
Getting enough calories if you are losing weight
You may need to alter your diet more if your kidney disease gets worse, or if you need dialysis.
FUNCTION
The purpose of this diet is to keep the levels of electrolytes, minerals, and fluid in your body balanced when you have chronic kidney disease or are on dialysis. People on dialysis need this special diet to limit the buildup of waste products in the body.
Limiting fluids between dialysis treatments is very important because most people on dialysis urinate very little. Without urination, fluid will build up in the body and cause too much fluid in the heart, lungs, and ankles.

RECOMMENDATIONS
Ask your doctor to refer you to a registered dietitian to help you with your diet for kidney disease. Some dietitians specialize in kidney diets. Your dietitian can also help you create a diet to fit your other health needs.
The Kidney Foundation has chapters in most states. It is a good place for people with kidney disease and their families to find programs and information. You need to take in enough calories each day to keep you healthy and prevent the breakdown of body tissue. Ask your doctor and dietitian what your ideal weight should be. Weigh yourself every morning to make sure you are meeting this goal.

CARBOHYDRATES
If you do not have a problem eating carbohydrates, these foods are a good source of energy. 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 protect your heart health. 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. 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
The minerals calcium and phosphorous will be checked often. Even in the early stages of chronic kidney disease, phosphorous levels in the blood can get 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 about how best to get these nutrients.
Your doctor may recommend medicines called "phosphorous binders" if diet changes alone do not work to control the balance of this mineral in your body.

FLUIDS
In the early stages of kidney failure, you do not need to limit the fluid you drink. But, as your condition gets worse, or when you are on dialysis, you will need to watch the amount of liquid you take in.
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. It also keeps you from being thirsty, and prevents your body from holding onto extra fluid. It is likely that you will need to cut down the sodium in your 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
People 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). Talk to your doctor, nurse, or dietitian which foods with iron you can eat because of your kidney disease.
Alternative Names
Renal disease - diet; Kidney disease - diet

REFERENCES

Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med

National Kidney Foundation.Dietary Guidelines for Adults Starting on Hemodialysis
NIH Publication No. 08-4274. September 2, 2010. Accessed August 2, 2011.Eat right to feel right on hemodialysis

Mitch WE. Chronic kidney disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

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