In stages 3, 4, and 5 of kidney disease, kidney damage hinders their ability to filter waste and excess fluid from the blood effectively. During these stages, a specific kidney-friendly food and fluid plan may be recommended by a doctor and dietitian. While protein is essential for muscle building, healing, and overall health, the amount you consume should be tailored to the stage of your kidney disease.
Understanding Chronic Kidney Disease (CKD)
If you've recently been diagnosed with Chronic Kidney Disease (CKD), you might feel overwhelmed. It's crucial to educate yourself about your condition, including terms like glomerular filtration rate, BUN, and creatinine levels. Denial and confusion are common initial reactions, but understanding your condition is the first step toward slowing its progression and lessening its adverse effects.
Holistic Approach to Managing CKD
Consult with your kidney specialist and dietitian to address any co-existing conditions like diabetes, high blood pressure, heart disease, fluid retention, bone disease, muscle cramps, and obesity. A holistic understanding of your health is critical for building an effective treatment plan and making necessary lifestyle changes.
Key Blood Tests for Stage 3 CKD
When you have Stage 3 kidney disease, your doctor will monitor various factors, including white and red blood cells, BUN, creatinine, and other enzymes that indicate overall kidney function.
- Blood Urea Nitrogen (BUN): Measures the amount of nitrogen from urea in the blood. High BUN levels can indicate that the kidneys are not functioning correctly.
- Creatinine: A waste product filtered out of the blood by the kidneys and passed into the urine.
- eGFR (estimated Glomerular Filtration Rate): Indicates how much kidney function you have based on how well your kidneys filter waste and extra fluid out of your blood. As CKD progresses, your eGFR number decreases.
The Role of a Registered Renal Dietitian
A Registered Renal Dietitian (RD) specializes in nutrition that reduces kidney disease progression. They will work with you to discuss the pros and cons of nutrients based on your medical conditions, with the primary goal of preserving kidney function.
Read also: Nutrition and stage 2 CKD
Dietary Considerations Based on CKD Stage
In the early stages of kidney disease (Stages 1 and 2), nutrient restrictions may be minimal. However, Stage 3 may call for some restrictions, while Stages 4 and 5 will likely require more significant limitations. Your dietitian will guide you on managing phosphorus, potassium, protein, sodium, and fluids in your diet.
Key Nutrients to Manage in Stage 3 CKD
People with CKD may need to control the amount or type of one or more nutrients. 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.
Sodium
Damaged kidneys may not effectively control sodium levels, leading to fluid buildup, swelling, higher blood pressure, and strain on the heart. Limiting salt and high-sodium foods reduces hypertension, assists blood pressure medications to work more effectively and treats fluid retention. The sodium recommendation for stage 3 CKD is 1,000 to 4,000 mg/day.
Practical Tips for Reducing Sodium Intake
- Use herbs and spices instead of salt in your meals.
- Avoid packaged, prepared, and restaurant foods, which tend to be high in sodium.
- Check the Nutrition Facts label for sodium content.
- Cook foods from scratch.
- Use spices, herbs, and sodium-free seasonings in place of salt.
- Try slowly reducing the amount of sodium in your diet over time.
Potassium
Potassium is essential for muscle function, including the heart muscle. However, too much or too little potassium in the blood can be dangerous. Usually, potassium is not restricted in stage 3 CKD unless lab tests show potassium is too high. Your doctor may make medication changes or prescribe a low-potassium diet.
Managing Potassium Intake
- 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, such as potassium chloride.
Phosphorus
As kidney function declines, phosphorus can build up in the blood, weakening bones. 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.
Read also: The Hoxsey Diet
Controlling Phosphorus Levels
- 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" in their names, such as disodium phosphate.
- Taking phosphate binders with meals and snacks can help lessen the detrimental effects of phosphorus in your diet.
Protein
Protein is crucial for building and maintaining muscle, bone, skin, and organs. However, the amount of protein you consume should be carefully managed. The recommendation for protein intake in stage 3 is 0.8 g/kg body weight, the same recommendation for a healthy 150-pound adult.
Optimizing Protein Intake
- Replace animal protein with plant-based substitutes like legumes, nuts, tofu, grains, and seitan.
- Avoid very large amounts of protein, especially in the form of unnecessary supplements.
Fluids
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. Fluid is not restricted in stage 3 CKD unless you experience fluid retention. Sudden weight gain, shortness of breath, swelling in the feet, hands and face and high blood pressure are signs of fluid retention.
Managing Fluid Intake
- Limit your intake of soup, drinks, sauces, and fruits.
- Reduce your salt intake to stave off thirst.
The DASH Diet for Kidney Disease
The DASH (Dietary Approaches to Stop Hypertension) Diet is often recommended for managing high blood pressure and kidney disease. It is rich in fruits, vegetables, low-fat dairy products, whole grains, fish, poultry, beans, seeds, and nuts, while being low in salt, sodium, added sugars, sweets, fat, and red meats.
Benefits of the DASH Diet
The DASH diet is a recognized treatment for hypertension, heart disease, and kidney disease and can slow the progression of heart and kidney disease.
Sample DASH Diet (2,000 Calorie Diet)
| Food Group | Daily Servings | Serving Size |
|---|---|---|
| Grains | 6-8 | 1 Slice bread, 1 oz dry cereal, ½ cup cooked rice, pasta, or cereal |
| Vegetables | 4-5 | 1 cup raw leafy vegetable, ½ cup cut-up raw or cooked vegetable, ½ cup vegetable juice |
| Fruits | 4-5 | 1 medium fruit, ¼ cup dried fruit, ½ cup fresh, frozen, or canned fruit, ½ cup fruit juice |
| Fat-free or low-fat milk products | 2-3 | 1 oz milk or yogurt, 1 ½ oz cheese |
| Lean meats, poultry, and fish | 6 or less | 1 oz cooked meats, poultry, or fish, 1 egg |
| Nuts, seeds, and legumes | 4-5 per week | 1/3 cup or 1 ½ oz nuts, 2 Tbsp peanut butter, 2 Tbsp or ½ oz seeds, ½ cup cooked legumes (dry beans and peas) |
| Fats and oils | 2-3 | 1 tsp soft margarine, 1 tsp vegetable oil, 1 Tbsp mayonnaise, 2 Tbsp salad dressing |
| Sweets and added sugars | 5 or less per week | 1 Tbsp sugar, 1 Tbsp jelly or jam, ½ cup sorbet, gelatin, 1 cup lemonade |
Additional Considerations for Managing Stage 3 CKD
Calories
Adequate calories can either prevent weight loss if you’re at a desirable weight or provide extra calories if you are underweight. Weigh yourself often and keep track to see if you need additional or fewer calories. Eating the right number of calories will help you stay at a healthy weight, give you the energy to do your daily tasks, and help your body use the protein in food to build muscle and tissues.
Read also: Walnut Keto Guide
Fats
If you have cardiovascular disease or your blood cholesterol is high, unhealthy fats-such as saturated fats and trans-fats-should be replaced by poly- and monounsaturated fats from vegetable oil, canola oil and olive oil. Monounsaturated fats and polyunsaturated fats-found in foods such as canola oil, safflower oil, avocados, nuts, and seeds-are healthy alternatives to saturated fats and trans fats.
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.
Medical Nutrition Therapy (MNT)
Medical nutrition therapy (MNT) is nutrition counseling from a registered dietitian to help meet your medical or health goals. If you are enrolled in Medicare and have CKD, Medicare will cover MNT services.
The Importance of Monitoring and Adjustments
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. It's essential to monitor your condition, work closely with your healthcare team, and make necessary adjustments to your diet and lifestyle. Keep a journal of the foods you eat and their nutrient counts and maintain a healthy weight.