Nutrition Tips for Managing Renal Disease Effectively

Importance of Nutrition in Kidney Disease

Kidney disease, also known as chronic kidney disease (CKD), is a condition that damages the kidney over time and ceases its functioning. Depending on GFR values, CKD is divided into five stages. 

• Stage 1: GFR values above 90 with some symptoms.
• Stage 2: GFR values between 60 and 89 with more kidney damage than stage 1.
• Stage 3a: GFR values between 45 and 59
• Stage 3b: GFR values between 30 and 44
• Stage 4: GFR values between 15 and 29 with more kidney damage and severe symptoms.
• Stage 5: GFR value below 15 with complete kidney damage.

 

Dietary changes are essential in chronic kidney disease to slow the progression of the disease. However, the limitations of CKD include restricting diets that are low in protein, sodium, potassium, phosphorus, and fluid intake. 

The main purpose of limiting diet is to maintain a healthy electrolyte balance and fluids in the body. A healthy diet also delays CKD disease progression and affects how well kidney disease treatment works.

Furthermore, good nutrition and a well-balanced diet help people with kidney disease stay healthy by providing an adequate amount of protein, calories, vitamins, and minerals. A healthy diet also helps to prevent infections, provide energy, maintain a healthy body weight, and ensure the required muscle mass and strength. Therefore,  nutritional management with dietary modification lowers the risk of CKD progression. 

1. Key Nutrients to Monitor in Kidney Disease 

People with kidney disease must monitor their nutrient intake, including sodium, potassium, phosphorus, calcium, and protein. It is necessary because consuming the right amount of these nutrients helps manage the accumulation of fluid and waste in blood circulation. It decreases the load on the kidney and eliminates additional fluid and waste with less effort. As the kidney condition worsens, some other nutrients may also be restricted. Below are some recommended nutrients to monitor in kidney disease.

Protein: Types and Recommended Amounts 

Protein is a macronutrient that must be consumed in the right amount to prevent kidney damage. It is necessary to build muscle mass, repair tissue and fight infection. The recommended dietary allowance (RDA) of protein for normal adults is 0.8g per kg of body weight. The amount of protein is restricted in kidney disease patients. 

There are two types of protein: plant-based and animal-based proteins. Both forms of protein have advantages and disadvantages. However, plant-based proteins are kidney-friendly and doctors recommend them for kidney patients. Diets high in plant-based protein reduce the risk of heart disease, kidney disease, stroke, and early death.

Plant-based proteins, including nuts, beans, lentils, legumes, and chickpeas, are easier for kidneys and cause less pressure than animal proteins like meat and dairy products. This is because plant-based proteins produce less acid in the body than animal-based proteins, which damages the kidneys. 

However, recommended protein intake is essential according to body weight. A large amount of protein intake, especially in supplemental form, burdens the kidneys, and a low amount causes weakness and muscle loss and increases the body's acid load. 

Therefore, the right amount of protein intake for kidney disease patients depends on their age, body weight, protein content in the urine, and GFR values. According to the American Kidney Fund, the recommended protein intake for CKD patients is as follows:

• For CKD stages 1 and 2, the daily recommended amount for the average male is 8 oz. (56 g) and 6 to 7 oz. (about 46g) for an average female of lean protein. 
• For people with CKD stage 3-5 (people with non-dialysis) who do not have diabetes, a daily protein intake of 0.25 to 0.27 g per pound of body weight is recommended. The person with CKD stage 3- 5 should aim for a range of 33-36 grams of protein per day.
• However, for individuals with CKD stage 5 (on dialysis), 0.45 to 0.55 g of protein per pound of body weight should be consumed daily. So, a person should consume 59-73 g of protein per day.

Sodium: Managing Intake for Heart Health 

Increased blood pressure and kidney diseases are interlinked. Diabetes and hypertension are the leading causes of chronic kidney disease (CKD). Healthy kidneys are responsible for controlling blood pressure and the amount of sodium in the body. 

However, damaged kidneys are unable to control the amount in the blood, which causes fluid buildup, swelling, increased blood pressure, and strain on the heart. 

The recommended amount of sodium for healthy individuals is 2200mg/day, but the amount decreases in kidney disease patients. The average amount for kidney disease patients is 1500-2000 mg/day. However, the exact amount of sodium depends on the patient's medical history and kidney functioning.

• Limiting sodium in the diet helps to limit the amount of protein in the urine and prevent swelling. It is recommended that kidney patients follow these instructions before consuming any food.
• Read labels for packaged foods that are low in salt and sodium-free foods.
• Avoid processed food
• Consume foods that are cooked at home
• Rinse canned foods gently to remove extra sodium
• Avoid salt substitutes that contain potassium, which are not safe for kidney patients.

Why Should Kidney Patients Monitor Sodium Intake? 

Kidney patients must strictly monitor sodium intake because damaged kidneys cannot filter blood and excess sodium from the body.  An excess amount of sodium intake for kidney disease worsens kidney health and causes other health conditions such as

• Increased blood pressure
• Fluid buildup 
• Increased extracellular volume
• Edema (swelling in legs, hands and face)
• Heart failure
• Discomfort during dialysis.

Potassium: Importance of Monitoring Levels 

Potassium is an important mineral that plays a major role in body functions. It helps nerves, muscles, and the heart function properly. An adequate amount of potassium in the diet also helps move nutrients and waste around the body's cells. However, it is well said that maintaining a balanced diet is essential, and excess of anything is bad for health. Excess potassium is dangerous for health, especially for kidney patients. The required amount of potassium for renal patients depends on the functioning of the kidney and medicine intake. 

However, animal-based potassium is more readily absorbed than plant-based potassium. Moreover, increased blood sugar also raises potassium levels. Milk, meat, bananas, orange juice, cantaloupe, dried fruits, winter squash, and salt alternatives contain high levels of potassium.

The normal potassium values for an adult healthy individual range from 3.5 to 5.2 mEq/L (3.5 to 5.2 mmol/L). According to the American Kidney Fund, the recommended daily potassium intake for people with kidney disease depends on the stage of the disease and whether they are on dialysis: 

• CKD Stage 1 or 2: 4 grams of potassium per day 
• CKD Stage 3 or 4: 2 to 4 grams of potassium per day 
• Stage 5 on Hemodialysis: 2,500 to 3,000 mg of potassium per day 
• Peritoneal dialysis: Slightly more potassium than hemodialysis

Hence, limiting potassium intake is recommended for kidney patients to prevent other complications. Here are some strategies for managing potassium levels in the diet.

 

• Watch potassium intake in the food.
• Avoid certain salt substitutes, such as potassium chloride.
• Avoid herbal remedies or supplements that raise potassium levels.
• Take diuretics or potassium binders as recommended by a healthcare provider.
• Get regular checkups and perform frequent blood testing to keep track of potassium levels.
• Follow the appropriate treatment plan to keep potassium levels in a healthy range.

Phosphorus: Understanding Dietary Sources 

High phosphorus levels in kidney disease patients start to build up in the blood and cause bones to weaken. This can also cause bone diseases and even osteoporosis. Therefore, it is recommended that they limit the amount of phosphorus in their foods. However, the normal recommended values for potassium for an adult range from 3.5 to 5.2 mEq/L (3.5 to 5.2 mmol/L) which makes 800-1200 mg per day.

Sources of Phosphorus to Restrict in CKD

Phosphorus is mainly found in dairy products such as milk, cheese and yogurt. These foods are high in phosphorus, and kidney patients need to restrict them from their diets.

• Dried beans.
• Greens.
• Broccoli.
• Mushrooms.
• Brussels sprouts.
• Bran.
• Wheat cereals.
• Oatmeal.
• Granola.
• White or Italian bread 
• Low-salt crackers 
• Soft drinks

Substitute of High-Phosphorus Food Allowed for CKD

These foods are low in phosphorus and should be consumed as an alternative to the above items.

• Fresh fruits and vegetables.
• Rice milk, unenriched.
• Breads.
• Pasta.
• Rice.
• Fish.
• Corn and rice cereals.
• Soda without phosphate additives.
  
  

2. Dietary Considerations for CKD Stages 

Early Stage CKD 

Dietary restrictions for early CKD stages include limiting meat and dairy products to achieve a moderate protein intake. These are some recommendations to maintain a balanced lifestyle at the early stages of CKD, stages 1 and 2.

• Consume high-fiber food items such as fresh fruits, vegetables, and whole grains, including whole-grain bread and high-fiber cereal.
• Limit dairy items such as milk, yoghurt, frozen dessert or cream.
• Limit red meat intake and consume lean poultry up to 6 ounces based on dietary requirements.
• Do not consume processed food, and limit foods that are high in sodium and phosphorus.
• Limit calorie intake and maintain a healthy body weight

Managing blood pressure is also essential in the early stages of CKD. It reduces the risk of CKD progression and heart disease. Moreover, kidney function markers such as albumin-creatinine ratio (uACR) help to indicate kidney functioning. So, uACR levels less than 30mg/g show a sign of albuminuria.

As there are fewer symptoms in CKD stage 1 and 2, changes may not be prominent. Therefore, small modifications in the diet and blood pressure management help preserve kidney function for a longer period.

Advanced Stage CKD 

In the advanced stages of CKD, it is important to maintain a healthy diet, manage fluid restriction, and maintain electrolyte balance. 

Fluid Restriction: In advanced stages, the kidneys are unable to remove excess fluid, which leads to fluid accumulation. Therefore, it is recommended to limit fluid intake, which decreases the kidney load. The exact restriction of fluid is based on the severity of the CKD stage, urine output, and level of kidney functions.

Electrolyte Balance: To maintain electrolyte balance, restricting foods high in potassium helps to avoid hyperkalemia and reduces heart damage. Reducing sodium and phosphorus helps manage increased blood pressure and prevents fluid retention and mineral imbalances.

Medical Nutrition Therapy for Advanced Stages of CKD: MNT focuses on managing the symptoms of CKD by balancing protein, fluid, sodium, potassium, and phosphorus intake to support kidney function and reduce its complications. 

• Protein: Limit protein intake to reduce waste buildup (0.6-0.8 g/kg/day pre-dialysis). For dialysis patients, increase protein to 1.2-1.3 g/kg/day to prevent malnutrition.
• Fluid: Restrict fluids to avoid overload. Intake depends on urine output and dialysis needs.
• Sodium: Lower sodium intake (under 2,000 mg/day) to control blood pressure and minimise fluid retention.
• Potassium and Phosphorus: Monitor and restrict potassium (bananas, potatoes) and phosphorus (dairy, nuts) to avoid imbalances that affect heart and bone health.

Dialysis

Dialysis patients are required to take more protein(often around 1.2-1.3 g/kg/day because the amount of protein decreases during dialysis. Proteins are important for the normal functioning of the body and help veins and arteries transport nutrients to other parts of the body. However, the amount of protein depends on the individual's body weight and activity level. Therefore, high-quality protein from lean meat, poultry, fish, and eggs is recommended for dialysis patients. 

For example, A man weighing 155 pounds can quickly meet his typical protein requirements by 1.2 to 1.5 grams of protein per kilogram of body weight per day to meet the requirement of dialysis. It forms approximately 84 to 105 grams of protein per day.

Similarly, a 130-pound lady on dialysis can easily meet her usual protein demands with about 71 to 89 grams of protein per day.

However, dialysis patients are recommended to eat foods low in potassium and phosphorus. The recommended daily potassium intake for renal patients on dialysis is 2500-3000 mg. Doctors usually prescribe dialysis patients a diet with an average daily intake of approximately 900 mg of phosphorus.

3. Medical Nutrition Therapy (MNT) and Its Benefits 

Limiting protein intake is recommended for renal disease patients to slow the progression of kidney disease. Research has shown that consuming high-protein diets for a longer time harms the kidneys. People with moderate to severe kidney disease are usually recommended to eat less protein. However, even people in the early stages of kidney disease may also benefit from reducing their protein intake.

Medical Nutrition Therapy (MNT) is nutrition counseling from a dietician or nutritionist to meet daily dietary requirements for a healthier life. It plays a major role in delaying CKD complications, preventing or treating symptoms and improving quality of life. MNT helps treat other symptoms with medicines or without medicines. For example,

• Low-Sodium Diet: Reducing salt intake helps control blood pressure and prevents fluid buildup, which can stress the kidneys.
• Low-Potassium Diet: Limiting potassium-rich foods prevents high potassium levels, which can cause heart problems in people with CKD.
• Custom Meal Plans: Customized meal plans are based on the stage of kidney disease, lifestyle, and dietary choices. They make it easier to follow a kidney-friendly diet.

4. Practical Tips for Managing Fluid Intake

Kidneys are responsible for removing excess fluid from the body. When kidneys become compromised in renal disease, they are unable to maintain fluid balance and other electrolytes. However, excessive fluid intake can cause swelling, increased blood pressure, and fluid accumulation that leads to heart complications. So, healthcare providers recommend that renal patients limit fluid intake to manage kidney-related complications.

Kidney patients should consume less salty food, as it increases their thirst. These are some practical tips for managing fluid intake for people with CKD.

• Know the fluid requirement.
• Measure fluid by measuring a cup to stay within a limit.
• Keep a log to remember fluid intake.
• Use a smaller cup to control fluid intake.
• Limit salty food.

Heart-Healthy Choices for Kidney Patients 

Kidney and heart diseases are interrelated. In people with CKD, the heart works harder to pump blood to the kidneys. Heart disease is a top cause of death in the US, caused by CKD. Moreover, changes in blood pressure also cause CKD complications that can lead to heart disease.

These are some heart-healthy foods that support kidney functions.

• Fruits and vegetables.
• Whole-grain breads and cereals.
• Low-fat milk and dairy products such as yogurt and cheese.
• Lean meats or meat substitutes such as tofu.
• Fish.
• Unsaturated fats such as olive oil or corn oil.
• Low-sodium and phosphorus foods.

5. Portion Control and Meal Planning 

Portion control is important to regulate calorie intake, prevent overeating and promote healthy eating habits. It plays a significant role in weight management and managing chronic conditions like CKD and heart disease.

For example, a sample of kidney-friendly meal plan

• Breakfast: Oatmeal with blueberries (limited portion) and a slice of white toast with unsalted butter.
• Lunch: Grilled chicken breast (small portion) with white rice and a side of steamed green beans.
• Dinner: Baked salmon (small portion), mashed potatoes, and a cucumber salad.
• Snacks: Low-sodium crackers with cream cheese, a small apple, or a handful of unsalted popcorn.

Tips on label reading and identifying problematic ingredients.

For renal patients, it is important to read food labels before buying any food item. 

• Sodium: Choose foods that are labeled as low in sodium
• Potassium: Avoid food items that are labeled as potassium additives.
• Phosphorus:  Avoid packaged foods that contain phosphorus ingredients, such as phosphate or phosphoric acid.
• Protein: Choose lean protein sources and avoid processed meats, which are high in sodium and phosphorus.

6. Recipes for a Renal Diet CKD

These food items are kidney-friendly, and portion control is necessary for CKD patients. It is best to consult with a dietitian for custom meal plans based on the patient’s CKD stage (not on CKD), preferences, and condition. 

 

Breakfast Ideas	Lunch Ideas	Dinner Ideas	Snack and Dessert Ideas
Oatmeal Bran bread Peanut butter oatmeal Spiced porridge with quick-stewed apples Creamy garlic beans on toast Blueberry wholegrain muffins Omelette with spring onions and goat's cheese	Egg salad with mixed greens Grilled chicken wrap Tuna salad with apple and celery Chicken and brown rice bowl Stir-fried vegetables with tofu Vegetable soup with low-sodium crackers	Chicken Stir-Fry with Capsicum and Cabbage Baked Lemon Chicken with Quinoa and Broccoli Tofu and Vegetable Stir-Fry Grilled Kangaroo Steak with Pumpkin and Zucchini Salad Poached Chicken Salad with Cucumber and Carrot	Apples Pears Blueberries watermelon or clementine Cranberry juice Grilled chicken taco salad Spaghetti with Garlic and Olive Oil

 

Recipes for Breakfast Ideas for CKD patients (Not on Dialysis)

 

French Toast	Ingredients (2 servings)	Recipe
	2 slices white bread 2 egg whites 1 tablespoon of a renal protein drink One tablespoon of pure maple syrup.  Optional: Try adding one-fourth cup of fresh blackberries or cinnamon	Mix the egg whites and the renal protein drink (and optional cinnamon) in a medium bowl.  Dip the bread slices into the mixing bowl with the egg wash.  Heat a non-stick skillet over medium heat.  Cook the slices until golden brown on both sides. Serve with maple syrup and berries if desired.
Scrambled Eggs	2 whole eggs 1/2 cup cauliflower 1/4 cup fresh spinach (optional based on potassium restriction) 1/2 garlic clove, minced 2 tablespoons bell pepper chopped 2 tablespoons onion chopped, 1/4 tsp black pepper 1 tablespoon oil of choice Fresh parsley  Spring onion for garnish.	Beat eggs and set aside.  Heat oil over medium heat in a large skillet. Add onions, peppers, and garlic to skillet, stirring to combine. Immediately add cauliflower and spinach.  Sauté vegetables, turn heat to medium-low and cover for 5 minutes.  Add eggs and stir to combine them with vegetables.  Top with fresh parsley or spring onions.

 

Recipes for Lunch Ideas for CKD patients (Not on Dialysis)

 

Tuna salad and crackers	Ingredients	Recipe
	8 squares (32 g) low sodium, whole wheat crackers One-fourth cup (60 mL) no salt added tuna, drained 1 Tbsp (15 mL) mayonnaise 1/4 cup (60 mL) chopped celery Seasoned with one-fourth tsp (1 mL)  Dijon mustard, 1/2 tsp (2 mL) lemon juice and pepper to taste Half cup (125 mL) bell pepper, sliced Dip: 1 Tbsp (15 mL) sour cream mixed with herbs 1 medium mandarin orange	Mix the tuna, mayonnaise, chopped celery, Dijon mustard, lemon juice, and pepper in a bowl. Serve the tuna mixture on the whole wheat crackers. Arrange the sliced bell pepper on the side. Prepare the dip by mixing sour cream with herbs and serve with the crackers. Peel and serve the mandarin orange for a refreshing side.
Egg Salad Sandwich	2 slices 100% whole wheat bread 1 boiled egg 1 Tbsp (15 mL) mayonnaise One-fourth cup (50 mL) chopped celery Pepper and chopped onion to taste 1/2 cup (125 mL) each of carrots and cucumber 1/2 cup (125 mL) honeydew melon	Peel and chop the boiled egg. In a bowl, mix the chopped egg, mayonnaise, chopped celery, pepper, and chopped onion. Spread the egg mixture on one slice of whole wheat bread and top with the second slice. Serve with sliced carrots, cucumber, and honeydew melon on the side.

 

Recipes for Dinner Ideas for CKD patients (Not on Dialysis)

 

Lemon Dill Fish	Ingredients	Recipe
	2 and a half oz (75 g) Lemon Dill Fish 1 cup (250 mL) steamed white rice with 1 tsp (5 mL) soft margarine Half a cup (125 mL) of mixed vegetables (peas, carrots, corn) Half cup (125 mL) vanilla yogurt Half cup (125 mL) of frozen mixed berries, thawed	Cook the lemon dill fish using the preferred method. Steam 1 cup of white rice and stir in 1 tsp of soft margarine. Steam or heat 1/2 cup of mixed vegetables (peas, carrots, corn). Serve the fish with steamed rice and mixed vegetables on the side. Add 1/2 cup of vanilla yogurt and 1/2 cup of thawed frozen mixed berries for dessert. Rosemary and Lemon Marinade
Rosemary and Lemon Marinade	2 and a half oz (75 g) steak marinated with Rosemary and Lemon Marinade Half cup (125 mL) mashed potatoes Half cup (125 mL) of frozen peas, boiled 1 slice French bread with 2 tsp (10 mL) soft margarine Half cup (125 mL) raspberry sherbet	Marinate 2.5 oz (75 g) steak in rosemary and lemon marinade for a few hours or overnight. Cook the steak as desired (grill, pan-fry, or broil). Prepare 1/2 cup of mashed potatoes and heat 1/2 cup of boiled frozen peas. Toast a slice of French bread and spread 2 tsp of soft margarine on it. Serve with 1/2 cup of raspberry sherbet for dessert.

7. Long-term Dietary Strategies for Chronic Kidney Disease 

The long-term strategies for chronic kidney disease (CKD) include dietary modifications. These steps include

• Choose and prepare foods with less salt and sodium.
• Eat the right amount and the right types of protein.
• Choose foods that are heart-friendly and healthy for the heart.
• Prefer foods and drinks with less phosphorus.
• Choose foods with the right amount of potassium.

Moreover, patient education and monitoring are linked with improved outcomes in CKD disease. Regular monitoring of renal patients helps to achieve healthy goals and objectives through counseling and education programs. Counseling is helpful in convincing patients to change their behavior toward disease and ensure regular monitoring.

8. Resources for Additional Support 

 

Many resources are available online for CKD patients, including support networks and cookbooks for the fastest recovery. The National Kidney Foundation (NKF) provides support through NKF peers, trained peer mentors, NKF care teams, and online communities. They offer a free and anonymous place for CKD patients to share experiences and ask questions. 

Similarly, Kidney Community Kitchen also shared healthy cookbooks and food analyzers for kidney patients to improve their CKD outcomes.