You’ve been diagnosed with chronic kidney disease, and you are starting to consider ways that you can lessen the progression of your disease. One of the first steps is to find a dietitian who specializes in nutrition for kidney patients. The next step is to really work with your dietitian to establish specific nutrient levels which are appropriate for your stage of kidney disease, and any other health conditions you may have.
Your dietitian will explain the stage of your kidney disease and what it means for your diet. In the later stages of kidney disease, the recommendation for nutrients and liquids may change to help lessen the progression of the disease. In Stages 1 and 2, nutrients to consume may be less restricted. Stage 3 may call for some restrictions. Stages 4 and 5 will definitely present limitations to your diet. If on dialysis, further restrictions, including limiting fluid intake, will likely be advised.
Your dietitian will talk about phosphorus, potassium, protein, sodium, and fluids in your diet. While learning what you can eat is essential, you must also understand what you shouldn’t. So, let’s start with sodium.
Patients with high blood pressure, diabetes, or kidney disease are often told to avoid sodium. Of course, that’s easier said than done! One tactic is to use herbs and spices instead of salt in your meal. If you enjoy the food you eat, you’ll feel less restricted. Once you get the hang of mixing herbs and spices, you may want to keep shakers on the table and by the stove to supplement your cooking. The spices will enhance the flavor of the food, and you won’t miss the salt!
Examples of High-Sodium Foods to Stay Away From
- Potato chips with salt
- Canned or processed vegetables
- Frozen vegetables or prepared veggie meals with cheese, soy sauce, cream, butter, or garlic sauce
- Packaged, sliced, sandwich meats/cold cuts
- Frozen or commercially prepared marinades or dressings
Low-Sodium Foods to Use as Substitutes
- Carrot sticks with lemon and dill
- Fresh vegetables
- Plain frozen vegetables, cooked at home with spices and seasonings, and without added salt
- Homemade salad dressings, marinades, stocks
The Three Ps
There are three Ps to pay special attention to when fighting kidney disease: Phosphorus, Potassium, and Protein. Control of each can reduce your risk of kidney failure, the need for visits to the dialysis center, or for a kidney transplant. Stage 3 CKD patients must consider the three Ps at each meal.
It’s challenging to know which foods have phosphorus and which don’t. You won’t often find labels that show the phosphorus content of the food you’d like to eat. So it is up to you to educate yourself and learn which foods are likely to have phosphorus. As a rule, it’s a good idea to stay away from sodas or any dark colas and any foods containing a high amount of dairy products.
Phosphorus “hides” in packaged foods. Learn to look for phosphorus in the list of ingredients on canned, bottled, boxed, or bagged food items. It won’t be on the label where you see calories, fat, sugar, sodium, and potassium. Instead, it will be listed in the ingredients. Anything that has “phos” in it means there’s phosphorus in it. So, beware of phosphoric, phosphate, etc.
Examples of High-Phosphorus Foods to Stay Away From
- Any sodas or dark colas, all canned & bottled drinks with phosphate additives, hot chocolate
- Dairy: Milk or cheese
- Nut butter: almond, peanut, etc.
- Meats, fish, and poultry, especially if excessively processed or cured
- French fries, potato chips, baked or mashed potatoes
- Chocolate candy bar
- Flavored waters, iced tea, non-dairy creamers, commercial punches, and orange juice substitutes, as well as other bottled items, often hide phosphate additives.
Example Low-Phosphorus Foods to Use as Substitutes
- Homemade iced tea, lemon and lime sodas, apple cider, root beer (only some brands omit phosphorus)
- Rice milk (unenriched), non-dairy creamer
- White carbs like pasta, white rice, couscous, white bread
- Butter or jams and jellies
- Fresh fish or poultry; or limited amounts of fresh or frozen meats prepared with marinades instead of salt
- Soaked or boiled potatoes to reduce potassium (Note: these are not considered low-potassium but are lower in potassium than potatoes that are not leached.)
- Lollipop without chocolate center
Taking phosphate binders with meals and snacks can help lessen the detrimental effects of phosphorus in your diet. Make sure you discuss this with your doctor and dietitian.
If your doctor indicates that your potassium is too high, you can reduce it with the proper diet. Limit your intake of foods with high potassium levels including dairy products, potatoes, nuts and seeds, beans, peanut, and almond butter, dried fruits, avocados, bananas, cantaloupes, kiwi, mangos, oranges. Watch out for foods that have potassium added. Sometimes potassium hides as the ingredient potassium chloride. Stay away from fruit and vegetable juices, and from consuming large quantities of spinach, tomatoes, squash, or pumpkins.
IMPORTANT NOTE: Chewing tobacco can cause spikes in potassium.
Examples of High-Potassium Foods to Stay Away From
- Bananas, cantaloupe, honeydew, kiwi, oranges, papaya
- Tomatoes, tomato sauce, spaghetti sauce, or chili sauce
- Baked potato or french fries
- Chocolate desserts
Low-Potassium Foods to Use as Substitutes
- Apples, berries, grapes, peaches, or pineapple
- Onions, bell peppers, mushrooms (small quantities), and garlic
- Mashed potatoes, boiled potatoes, or hash browns (all must be soaked and boiled to reduce potassium). Note: these are not considered low-potassium but are lower in potassium than potatoes that are not leached.
- Vanilla or lemon-flavored desserts
It’s a good idea to replace the animal protein in your diet with more plant-based substitutes such as legumes, nuts, tofu, grains, and seitan. However, if you are going to have animal proteins, an excellent source comes from egg whites and fish like salmon, tuna, and trout.
Since we’re talking about animal protein, now is an excellent time to understand the importance of monitoring fat intake in your diet. It’s a good idea to watch the amount of animal fat in your diet and to begin replacing animal fats with healthy alternatives such as olive oils and trans-fat-free spreads.
In the later stages of kidney disease, and especially if kidneys fail, it is often advised to limit your fluid intake. This sounds counter-intuitive since you’ve probably been advised to drink more water to hydrate yourself for most of your life. It isn’t easy to limit your water intake. Limiting your water intake is more than just drinking less water. It means consuming less soup, drinks, sauces, fruits, etc. If you haven’t already begun eating less salt, now is a good time to put this into practice because it will help to stave off your thirst. Your dietitian will help you learn how to satiate yourself when you are limiting water intake.
The best foods for kidney disease patients are the foods you and your medical team have decided are best for you. Keep a journal of the foods you eat and their nutrient counts. Maintain a healthy weight. Work with your doctor to chart the results.
Chronic kidney disease, even at Stage 3, doesn’t necessarily mean you’re on your way to kidney failure and future visits to the dialysis center. But you must do everything you can to keep your chronic kidney disease CKD in check and reduce further kidney damage.
Actively managing your kidney diet is part of fighting chronic kidney disease!