When managing stage 2 kidney disease, a well-planned diet plays a crucial role in slowing the progression of the disease and maintaining overall health. In stage 2 chronic kidney disease (CKD), the kidneys are mildly damaged, with a glomerular filtration rate (GFR) of 60-89 ml/min. Because kidneys do a good job even when they’re not functioning at 100 percent, most people will not know they have stage 2 CKD. Regular testing for protein in the urine and serum creatinine can show whether the kidney damage is progressing. Living a healthy lifestyle can help slow progression of kidney disease. There is no cure for kidney disease, but it may be possible to stop its progress or at least slow down the damage. This article outlines the key aspects of a diet suitable for individuals with stage 2 CKD, emphasizing the importance of managing specific nutrients and adopting healthy eating habits.
Understanding Stage 2 CKD
A person with stage 2 chronic kidney disease (CKD) has kidney damage with a mild decrease in their glomerular filtration rate (GFR) of 60-89 ml/min. Having evidence of ongoing kidney damage is required to be considered stage 2 CKD. In other words, just having an eGFR between 60 and 89 is not enough to meet the criteria for having CKD. Typically, there are no symptoms associated with stage 2 CKD. If symptoms are present, they are most likely to be related to the type of kidney damage you have. For example, if you are experiencing albuminuria, you may notice foamy urine. Because there are few symptoms in stages 1 and 2 CKD, you may not feel any different. Regular testing for protein in the urine and serum creatinine can show whether the kidney damage is progressing.
General Dietary Recommendations
With stage 2 CKD, there are not many dietary restrictions, although eating healthy is important. Healthy eating generally includes consuming more vegetables, fruits, whole grains, plant-based proteins, fish, and lean meats. Processed foods, refined carbohydrates (sugars) and sweetened drinks should be limited. This kidney diet is very similar to the recommendations in the Dietary Guidelines for Americans, as well as the DASH eating plan (Dietary Approaches to Stop Hypertension). The main difference is the early stage kidney diet limits meat and dairy to help achieve a moderate protein intake.
Key Nutrients to Manage
People with CKD may need to control the amount or type of one or more nutrients:
- 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.
Read also: Managing Stage 3 Kidney Disease with Diet
Sodium
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. Decreased intake of high-sodium foods and salt helps lower blood pressure. If you read labels, choose low-sodium products and make meals from fresh foods, you can reduce daily sodium intake. If you have high blood pressure, it is important to limit your sodium (salt) intake to less than 2300 mg per day (about 1 teaspoon of salt from all the food and drinks you consume each day). Your healthcare professional may advise an even lower target depending on your other health conditions. This means a lot more than not using a saltshaker, but also limiting foods with high levels of sodium listed on their nutrition facts label. Some foods that don’t taste salty can have a surprising amount of sodium when you check their nutrition facts label.
Potassium
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
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. High phosphorus foods include 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.
Calcium
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
Your body needs protein to help build muscle, repair tissue, and fight infection. 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. 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:
Read also: Nutrition and stage 2 CKD
- 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. Eat less red meat; instead, have more lean poultry and seafood (limit to 6 ounces or less per day, based on your dietary requirements).
Importance of Fluid Management
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. Fluids include any food that is liquid at room temperature such as beverages, soups, gelatin, frozen desserts, and ice.
Calorie Intake and Weight Management
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. Adjust calorie intake to reach a healthy weight. 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.
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.
Read also: The Hoxsey Diet
Additional Nutritional Factors
Several other nutritional factors should be considered to manage stage 2 CKD effectively:
- Blood Pressure Control: High blood pressure control is impacted by diet as well as medication. Decreased intake of high-sodium foods and salt helps lower blood pressure.
- Blood Sugar Management: Hyperglycemia (high blood sugar) is a concern for people with diabetes. Uncontrolled diabetes accelerates kidney loss and contributes to artery disease and other diabetes complications. Learn about carbohydrate counting to help stay within set carbohydrate targets.
- Proteinuria: Proteinuria (protein in the urine due to losses through the kidneys) is a risk factor for kidney disease progression.
- Dyslipidemia: Dyslipidemia (high total cholesterol, LDL cholesterol and triglycerides) is often present in people with kidney disorders. CKD is a risk factor for cardiovascular disease, so in early stages of CKD, pay attention to your lab results and the fat and cholesterol in your diet. Eat more healthy fats from olive or canola oil, avocado, nuts and seeds.
- Chronic Inflammation: Chronic inflammation has been linked to kidney disease and cardiovascular disease, as well as a diet high in saturated and trans-fats, refined foods and excess sugars. To reduce your chance of chronic inflammation, limit dining out, especially on fast foods.
Lifestyle Recommendations
Now is a great time to make healthier lifestyle choices:
- 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. Remember, it’s okay to start slowly - taking short walks is a great way to begin.
- Sleeping well is important, too. Try to get enough sleep so you are well-rested.
- If you are overweight, losing weight through a balanced diet and physical activity can help improve your health in many ways.
- Find ways to reduce and manage stress in your life.
Medications for Stage 2 CKD
Your healthcare professional may prescribe one or more medications based on your medical history and the cause of your kidney damage. For example, if you have albuminuria, your healthcare professional may prescribe an ACE inhibitor/ARB, an SGLT2 inhibitor and/or an nsMRA. These medicines help lower your uACR levels and can slow down or stop your CKD from getting worse. Your healthcare professional may also prescribe a statin (cholesterol medicine). Guidelines recommend a statin for people with stage 2 CKD who also have diabetes, a history of heart disease, or are age 50 or older. Even if you do not have high cholesterol, a statin can help lower your risk of having a heart attack or stroke. 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.
The Role of Dietitians
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. A kidney-friendly eating plan helps you manage your kidney disease and slow down damage to your kidneys. It does this by preventing certain minerals from building up in your body, which is important because your kidneys do not work as well to remove waste products from your body. A kidney-friendly eating plan can also help prevent other serious health problems and controls high blood pressure and diabetes, which can prevent kidney disease from getting worse. It also ensures that you get the right balance of nutrients to help you:
- Have energy to do your daily tasks
- Prevent infection
- Build muscle
- Stay at a healthy weight