Chronic Kidney Disease (CKD) is a condition characterized by damage to the kidneys, hindering their ability to filter waste and excess fluids from the blood effectively. This can lead to a buildup of toxins in the body, impacting overall health. CKD is classified into five stages, based on the Glomerular Filtration Rate (GFR), which indicates how well the kidneys are filtering waste. Stage 3 CKD is further divided into 3a and 3b, representing mild to moderate kidney damage. This article focuses on dietary management for Stage 3 CKD to slow disease progression and maintain overall well-being.
Understanding Chronic Kidney Disease
Chronic kidney disease (CKD), also known as chronic renal disease, signifies damage to your kidneys, impairing their optimal function. The kidneys act as filters, removing wastes, toxins, and excess water from the blood. They also play a crucial role in maintaining bone health and red blood cell production. When kidney function declines, waste accumulates in the bloodstream.
CKD is termed "chronic" because kidney function deteriorates gradually over time. While CKD can progress to kidney failure (end-stage kidney disease), it doesn't always do so, and treatment can slow its progression. Currently, there's no cure for CKD, but interventions like dialysis and transplantation are available for kidney failure.
What Do Your Kidneys Do?
Your two bean-shaped kidneys, located near your back on either side of your spine beneath the rib cage, are responsible for cleaning your blood, eliminating toxins, waste, and excess water as urine. They also regulate electrolyte and mineral balance, produce hormones that control blood pressure and red blood cell production, and maintain bone strength. Damaged kidneys can lead to waste buildup in the blood, causing illness.
Stages of Chronic Kidney Disease
The five stages of CKD are determined by how well your kidneys filter waste from your blood, assessed through blood and urine tests. These stages range from mild (stage 1) to kidney failure (stage 5), based on the glomerular filtration rate (GFR), which is calculated from creatinine levels in your blood.
Read also: Nutrition and stage 2 CKD
- Stage 1: GFR 90 or higher - Kidneys function well with mild damage signs.
- Stage 2: GFR 60-89 - Kidneys function well with more signs of mild damage.
- Stage 3a: GFR 45-59 - Mild to moderate kidney damage, noticeable symptoms may appear.
- Stage 3b: GFR 30-44 - Moderate kidney damage, proper treatment can prevent progression to stage 4.
- Stage 4: GFR 15-29 - Severe kidney damage, kidneys are close to failure.
- Stage 5: GFR less than 15 - Kidney failure, dialysis or transplant may be necessary.
Stage 3a CKD: An Overview
Stage 3a CKD indicates a mild to moderate loss of kidney function, with an estimated glomerular filtration rate (eGFR) between 45 and 59 for at least three months. At this stage, blood tests can confirm the diagnosis of CKD. While urine albumin-creatinine ratio (uACR) results are not required for diagnosis, they provide a comprehensive view of kidney health.
Health Risks Associated with Stage 3a CKD
Individuals with stage 3a CKD face an increased risk of CKD progression and heart disease. Higher uACR levels significantly elevate the risk of both heart disease and CKD worsening. Complications such as anemia, mineral and bone disorders, and metabolic acidosis may arise, although the risk is low. Regular screening for these complications through blood tests is recommended. People with stage 3a CKD are also susceptible to developing high blood pressure.
Common Signs and Symptoms
Symptoms may start to appear in stage 3a CKD, although many individuals remain asymptomatic. Potential symptoms include:
- Frequent or infrequent urination
- Itchy and dry skin
- Fatigue
- Nausea
- Loss of appetite
- Unexplained weight loss
The Role of Diet in Managing Stage 3 CKD
A kidney-friendly diet is crucial for managing CKD and slowing kidney damage. It involves consuming foods that are gentle on the kidneys and limiting those that can cause mineral buildup in the body. This diet helps control blood pressure, manage diabetes, and provide the necessary nutrients for energy, infection prevention, muscle building, and weight maintenance. Meeting with a dietitian is a service covered by Medicare and may also be covered by other types of insurance. You may need to call your insurance provider to see if your plan covers meeting with a dietitian.
Key Nutrients to Manage
People with CKD may need to control the amount or type of one or more nutrients:
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- Sodium
- Potassium
- Phosphorus
- Calcium
- Protein
Eating the right amount or type of one or more of these nutrients may help control the buildup of waste and fluid in your blood. This means your kidneys do not have to work as hard to remove the extra waste and fluid. If your kidney disease gets worse, you may need to limit other nutrients as well. Your dietitian or healthcare provider will tell you if you need to do this based on your blood test results.
Calorie Intake
Ensure adequate calorie intake to prevent weight loss or provide extra calories if underweight. Monitor weight regularly to adjust calorie consumption as needed. If cardiovascular disease or high blood cholesterol is present, replace unhealthy fats (saturated and trans-fats) with poly- and monounsaturated fats from vegetable oil, canola oil, and olive oil. Every person is different in terms of the calories they need each day. Calories are like fuel. If you don’t eat enough, your body will take protein from the muscles for energy. It’s important to make sure you get the right number of calories. If you don’t, you may get weak and damage your kidneys. Eating the right number of calories will:
- Help you stay at a healthy weight
- Give you the energy to do your daily tasks
- Help your body use the protein in food to build muscle and tissues
Too many calories can cause extra weight gain, which can burden the kidneys. If you are overweight, some weight loss may be helpful. If weight loss is desired or you have diabetes, you should meet with a dietitian to set up a plan based on your kidney blood tests, current food choices, and daily activities.
Fluid Intake
In stage 3 CKD, fluid restriction is typically unnecessary unless fluid retention occurs. Watch for signs of fluid retention such as sudden weight gain, shortness of breath, swelling in the extremities, and high blood pressure. Fluids include any food that is liquid at room temperature such as beverages, soups, gelatin, frozen desserts, and ice. Most people in the early stages of kidney disease do not need to limit how much fluid they drink. If you do not know your stage of kidney disease, ask your healthcare provider. If your kidney disease worsens, your dietitian or healthcare provider can let you know if you need to limit fluids and how much to drink each day. Fluids may need to be limited based on how much urine you make each day, and if fluid build-up in your body is causing swelling or stress on your heart or lungs.
Sodium Management
Limiting salt and high-sodium foods is crucial for reducing hypertension, enhancing the effectiveness of blood pressure medications, and managing fluid retention. The recommended sodium intake for stage 3 CKD ranges from 1,000 to 4,000 mg/day. Healthy kidneys control how much sodium is in your body. If your kidneys do not work well, too much sodium can cause fluid buildup, swelling, higher blood pressure, and strain on your heart. Your dietitian or healthcare provider can tell you the right amount of sodium you should have each day.
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Potassium Considerations
Potassium is usually not restricted in stage 3 CKD unless lab tests indicate elevated levels. In such cases, medication adjustments or a low-potassium diet may be prescribed. Potassium is important for muscle function, including the heart muscle. Too much or too little potassium in the blood can be very dangerous. The amount of potassium you need is based on how well your kidneys are working and your medications. Your dietitian or healthcare provider can tell you about foods with potassium and the right amount for you to eat each day.
Potassium from animal foods is absorbed at a higher rate than potassium from plants. Elevated blood sugars can also increase potassium levels. Some high-potassium foods include milk, meat, bananas, oranges and orange juice, cantaloupe, dried fruits, winter squash and salt substitutes.
Phosphorus Control
As kidney function declines, phosphorus can accumulate in the blood, leading to weakened bones. Limit high-phosphorus foods, including dairy products, organ meats, colas, deli meats, and processed foods with phosphate additives. Avoid processed foods that have additives with PHOS like disodium PHOSphate. You can find these additives in the ingredients list on food labels. As kidney function gets lower, extra phosphorus can start building up in the blood. High phosphorus levels can cause bones to get weaker. Your dietitian or healthcare provider can tell you if you need to limit goods that are high in phosphorus.
Calcium Intake
Foods that are good sources of calcium are often high in phosphorus. Your dietitian or healthcare provider will tell you if you need to limit calcium. Before taking any over-the-counter vitamin D or calcium supplements, talk to your healthcare provider.
Protein Intake
Follow the recommended daily protein intake of 0.8 g/kg body weight, consistent with the recommendation for healthy adults. Plant-based protein like beans and nuts are easier on the kidneys than animal proteins like meat and dairy products. This is because plant proteins produce less acid in the body than meat proteins. More acid in body can damage the kidneys. Your body needs protein to help build muscle, repair tissue, and fight infection.
Having very large amounts of protein, especially in the form of unnecessary supplements, can be stressful on the kidneys. But if protein intake is too low, you can lose muscle mass, become weak, and increase the body’s acid load, so it is important to eat the right amount each day. The amount of protein you need is based on:
- Your weight
- Your age - growing children and adolescents, and older people, need more protein
- The amount of protein in your urine, and depending on your type of kidney disease
Your dietitian or healthcare provider can tell you how much protein you should eat. 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.
Vitamins and Minerals
Most people get enough vitamins and minerals to stay healthy by eating a variety of foods each day. But kidney patients may need to limit some of these foods. If so, you may need to take special vitamin or mineral supplements, but only if a dietitian or healthcare provider tells you to. Some vitamins or mineral supplements may be harmful to people with kidney disease. You should check with your healthcare provider before taking any medications you can buy without a prescription. Some supplements may be harmful to people with kidney disease. Over the counter vitamin and mineral supplements may contain too much phosphorous and potassium. You should also avoid taking herbal supplements.
Practical Dietary Recommendations
Consult a Renal Dietitian: A Registered Renal Dietitian (RD) specializes in nutrition for kidney disease and can provide personalized dietary guidance. The RD does not provide medical advice. Instead, he or she will have one goal: preserve kidney function. Together, you will discuss the pros and cons of nutrients depending on your medical conditions. Make sure your RD has the proper credentials. Your doctor may have a recommendation for you. You can also find guidance at the National Institute of Diabetes and Digestive and Kidney Diseases.
Monitor Food Labels: Pay attention to phosphorus content in packaged foods by checking ingredient lists for "phos" additives. 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. 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.
Use Herbs and Spices: Enhance flavor with herbs and spices instead of salt. 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.
Limit High-Potassium Foods: If advised, limit intake of high-potassium foods like dairy products, potatoes, nuts, seeds, beans, dried fruits, avocados, bananas, cantaloupes, kiwi, mangos, and oranges. If your doctor indicates that your potassium intake 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.
Be Aware of Hidden Potassium: Watch out for foods with added potassium, often listed as potassium chloride. Watch out for foods that have potassium added. Sometimes potassium hides as the ingredient potassium chloride.
Soak and Boil Potatoes: If consuming potatoes, soak and boil them to reduce potassium content. Mashed potatoes, boiled potatoes, or hash browns (all must be soaked and boiled to reduce potassium).
Avoid Processed Foods: Minimize consumption of processed foods with phosphate additives.
Consider Phosphate Binders: Taking phosphate binders with meals and snacks can help lessen the detrimental effects of phosphorus in your diet.
Maintain a Food Journal: Keep a journal of the foods you eat and their nutrient counts.
Control Portion Sizes: Good portion control or watching how much you eat is important in a kidney-friendly eating plan, because you may need to limit how much of certain things you eat and drink. To help control your portion sizes:
- Read the nutrition label to learn the serving size and how much of each nutrient is in one serving. Many packages have more than one serving. For example, a 20-ounce bottle of soda is two-and-a-half servings.
- For foods that do not have nutrition labels, such as fruits and vegetables, ask your dietitian for a list of nutrition facts to measure the right portions.
- Eat slowly and stop eating when you are full. It takes about 20 minutes for your stomach to tell your brain that you are full. If you eat too quickly, you may eat more than you need.
- Avoid eating while doing something else, such as watching TV or driving. When you are distracted, you may not realize how much you have eaten.
Lifestyle Recommendations for Stage 3a CKD
In addition to dietary changes, adopting a healthy lifestyle is essential for managing stage 3a CKD.
- Quit Smoking: Smoking accelerates kidney disease progression. If you smoke and/or use tobacco products, stop. Smoking can speed up the kidney disease process and increase your risk of getting kidney failure. It also increases your risk for other serious health problems, including high blood pressure, heart disease, cancers, and stroke.
- Exercise Regularly: Engage in regular physical activity. Exercise regularly. Remember, it’s okay to start slowly - taking short walks is a great way to begin.
- Prioritize Sleep: Ensure adequate sleep for overall well-being. Sleeping well is important, too. Try to get enough sleep so you are well-rested.
- Maintain a Healthy Weight: If you are overweight, losing weight through a balanced diet and physical activity can help improve your health in many ways.
- Manage Stress: Find ways to reduce and manage stress in your life.
Medications and Stage 3a CKD
In stage 3a CKD, some medications may accumulate in your body due to reduced kidney function. Ask your healthcare professional or pharmacist if any of your medication doses need to be lowered because of your stage 3a CKD. Some medications may be best avoided or limited in use as well.
Your healthcare professional may prescribe medicines to slow CKD progression, such as ACE inhibitors/ARBs, SGLT2 inhibitors, and/or nsMRAs. A statin (cholesterol medicine) may also be prescribed, especially for individuals with diabetes, heart disease history, or those aged 50 and older.
Always bring an updated list of any medications, vitamins, supplements, and herbal medicines you are taking to all your medical appointments and share it with your healthcare professional. Check with your healthcare professional or pharmacist before starting any supplements, herbal medicines, or other over-the-counter products.
Other Risk-Lowering Strategies
Lowering your risk for CKD progression is very important. This includes taking steps to manage other health conditions you may also have, including high blood pressure (hypertension), diabetes, and high cholesterol. People with stage 3a CKD should also avoid certain pain medicines known as non-steroid anti-inflammatory drugs (NSAIDs). These can be harmful to your kidneys, especially at higher doses and/or with long-term use.
Avoid NSAIDs: These can harm the kidneys. Some examples include:
- ibuprofen (Motrin, Advil)
- indomethacin (Indocin)
- naproxen (Aleve, Naprosyn)
- diclofenac tablets or capsules (Cataflam, Zipsor)
- celecoxib (Celebrex)
- meloxicam (Mobic)
- aspirin (only if more than 325 mg per day)
Many of these medicines are available over the counter and may be sold under a different name or be mixed with other ingredients (like cough & cold medicines). Sometimes it may not be possible to avoid using these products depending on your other health conditions. Always ask your healthcare professional before using any products with these drug names or if the word “NSAID” is printed on the product’s label. In general, acetaminophen, also called Tylenol, is safe for your kidneys at recommended doses - but check with your healthcare professional first to determine the cause of your pain and the best way to treat it.
- Increase Fruits and Vegetables: If you have metabolic acidosis, increasing the amount of fruits and vegetables you eat everyday can help lower the level of acid in your blood. This can also help slow down your CKD progression (worsening).
Questions to Ask Your Healthcare Provider
- Risk Assessment:
- Am I at a healthy weight?
- Is my blood pressure within the recommended goal range?
- Do I have diabetes or prediabetes? If so, is my A1C within the recommended goal range?
- Do I have albuminuria?
- How high is my level of risk for developing heart disease or a stroke? What can I do to lower my risk?
- Monitoring:
- What are my eGFR and uACR numbers?
- When should I have my eGFR and uACR tested again?
- What is my bicarbonate level? If it is below the goal level, what can I do to bring it up?
- Medication Safety:
- Are the medications I am taking safe for me with stage 3a CKD?
- Should the dose of any of my medicines be lowered to prevent side effects or other problems?
- Actionable Steps:
- Are there any changes I should make to my diet?
- Should I take any medication(s) to help lower my risk for CKD getting worse?
- Can you refer me to a kidney dietitian to help me make healthier food choices?
- Have I been screened for CKD complications like anemia, metabolic acidosis, or mineral and bone disorder? If not, can you please order these tests for me?