Nutrition plays a vital role in managing kidney disease and maintaining overall health. A well-balanced diet, rich in essential nutrients and low in sodium, can significantly slow down or even halt the progression of kidney disease. This article provides comprehensive early renal diet guidelines designed to support kidney health, covering various aspects from general nutrition to specific dietary recommendations.
The Importance of Nutrition in Chronic Kidney Disease (CKD)
When you have kidney disease, it is important to watch what you eat and drink because your kidneys cannot remove waste products as well as they should. A kidney-friendly eating plan can help you stay healthier and slow down damage to your kidneys.
Basic Nutrition and CKD
A well-balanced diet of nutritious, low-sodium foods rich in vitamins and minerals can slow or stop kidney disease progression. This approach focuses on managing nutrients, reducing sodium intake, and maintaining balanced meals to support kidney health.
Nutrition for People with CKD
Adopting specific dietary patterns tailored for Chronic Kidney Disease (CKD) is essential for managing the condition effectively. These patterns emphasize controlling nutrient intake, minimizing sodium consumption, and ensuring well-balanced meals to promote kidney health.
Nutrition for People with End-Stage Kidney Disease
For individuals with end-stage kidney disease, nutritional needs become even more critical. Dietary adjustments must be carefully managed to address the advanced stage of the disease and support overall well-being.
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Key Dietary Approaches for Early CKD
General Nutrition Guidelines
A well-balanced diet is crucial for individuals with early-stage CKD. This involves consuming nutritious foods, limiting sodium, and ensuring an adequate intake of vitamins and minerals to slow or stop the progression of kidney disease.
Dietary Patterns for CKD
Explore dietary patterns for Chronic Kidney Disease (CKD) that focus on managing nutrients, reducing sodium, and maintaining balanced meals to support kidney health.
Fluid Intake
Proper hydration is essential for kidney function. Your kidneys balance hydration by retaining water, producing urine, and signaling thirst, ensuring your body stays well-hydrated for optimal function. Generous water intake helps maintain a dilute urine and decreases the risk of kidney stones, which are seen at increased frequency in PKD patients. However, as kidney function deteriorates, generous water intake can be problematic and even dangerous.
Managing Related Conditions
Kidney stones, high blood pressure, and diabetes are common conditions related to kidney disease. Managing these conditions through diet can significantly impact kidney health.
Kidney Stones
Kidney stones are hard mineral deposits that form in your kidneys, causing severe pain and requiring hydration and medical care to prevent and treat.
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High Blood Pressure
Studies in high blood pressure patients without PKD have shown that the so-called DASH diet (Dietary Approach to Stopping Hypertension), which consists of lots of fruits and vegetables combined with low-fat dairy, may lower blood pressure. A diet based on these guidelines could also seem appropriate for you.
Diabetes
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.
Foods to Include in Your Diet
Prioritize patient-friendly guides on nutritional superfoods and diverse cultural diets for better health choices.
Recipes for Kidney Health
Discover kidney-friendly recipes in our video series by expert chefs, tailored to support kidney health while enjoying delicious meals.
Macronutrient Management
Protein Intake
The major source of these waste products is the food you eat, especially protein. Therefore, when you have lost a significant amount of kidney function, a lower protein diet may be ordered by your doctor. Studies from both animals and humans with chronic kidney failure have shown that eating large amounts of protein may accelerate the progressive decline of kidney function. However, the Modification in Diet in Renal Disease (MDRD) study done by the National Institutes of Health (NIH) looked at protein intake and kidney function. The results did not show any benefit of lowering protein intake in individuals with PKD. At this time, there’s no convincing evidence to suggest protein restriction as beneficial unless you are in kidney failure. Despite all this, many consider it unwise to consume a very high protein diet. If you have moderate to advanced kidney failure, however, a modest restriction may be appropriate. For more information, you should consult your doctor and a dietitian experienced with kidney disease (and ideally knowledge of PKD), also known as a renal dietician. Recommended: 0.8 g/Kg of body weight. (56 grams/day for a 150 LBs patient). May eat more if you’re vegetarian.
Read also: Comprehensive Guide to Renal Diet Meals
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:
- 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
Carbohydrates and Fats
Choose whole grain carbohydrates. Eating too many carbs can lead to weight gain. When you have kidney disease, it is best to choose whole grains and healthy carbs such as fruits and vegetables. Unhealthy carbs include sugar, honey, hard candies, soft drinks and other sugary drinks.
If you have diabetes, you may also need to carefully track how many carbs you take in. Your dietitian can help you learn more about the carbs in your eating plan and how they affect your blood sugar.
Choosing the right types of fat is also part of a heart-healthy eating plan called DASH.
Micronutrient Management
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. Your dietitian or healthcare provider can tell you the right amount of sodium you should have each day. High blood pressure in PKD doesn’t seem to be caused by salt intake. Regardless, excessive amounts of salt should be avoided and lowering dietary salt may help in blood pressure control. This becomes important when people are on certain types of blood pressure medicine and when they have kidney failure. Choose fresh or frozen vegetables instead of canned vegetables. Avoid canned soups and frozen dinners that are high in sodium. Be careful with salt substitutes and “reduced sodium” foods.
Potassium
Potassium is essential to all living cells and is important for muscle and nerve functions in the body. It’s found in most foods including legumes, whole grains, fruits, green vegetables, potatoes, meats, milk, and yogurt. Although potassium is vital to the body, it’s unwise to take potassium supplements in pill or liquid form without consulting your doctor and/or your renal dietician, especially if your kidney function is reduced. 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
Phosphorus is a mineral found in the body. When kidney function declines, it becomes difficult for the body to balance 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 and Vitamin D
In non-PKD settings, a deficiency of calcium and magnesium has been associated with high blood pressure. Dietary calcium and magnesium are best provided by dairy products and are important in maintaining a normal mineral balance as part of a healthy diet. Because there’s an increased incidence of calcium kidney stones in individuals with PKD, women with PKD should discuss with their doctor the proper amount of calcium needed.
Vitamins and Minerals
If you’re maintaining a balanced and healthy diet, you typically won’t need extra vitamins. Unlike food, vitamins are needed only in tiny amounts. Excess amounts of vitamin A, D, and E can accumulate in your body and cause medical problems. Generally, if you feel you need extra vitamins, a one-a-day, generic brand of vitamin is sufficient. Consult your doctor before taking extra vitamins of any kind.
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.
Other Important Considerations
Cyclic AMP (cAMP) and PKD
A chemical called cyclic AMP (cAMP) has been shown to promote growth of polycystic kidneys. In your kidney, cAMP is produced in response to a hormone, vasopressin, which is produced by the brain in response to not having enough water. Avoiding dehydration is considered wise. In addition, generous water intake has the potential to suppress vasopressin production and decrease cAMP production in the kidney. Though there is no good data regarding this in humans with PKD, if kidney function is not impaired, water intake is typically safe. Therefore it seems reasonable to suggest intake of water with a goal of 2-3 quarts of urine output daily. Your urine should generally be pale in color. This will tend to suppress vasopressin production by the brain and cAMP production in the kidneys. In addition, it’s generally suggested that PKD patients limit caffeine intake, since caffeine slows degradation of cAMP.
Caffeine Intake
There is no direct evidence that caffeine will damage your polycystic kidneys. However, studies of PKD cells grown in a lab have shown that caffeine-like substances promoted cyst growth in PKD. At this time, it may be wise to limit caffeine intake to less than 200 to 250 mg.
Alcohol and Smoking
Light and/or occasional use of alcohol hasn’t been shown to damage the kidneys or the liver. Smoking increases the risk of heart disease and stroke and when paired with hypertension, the risks are even greater.
Sample Meal Plans
Here are a few sample meal plans to illustrate how to incorporate these guidelines into your daily life:
Sample Meal Plan 1
- Breakfast: One serving of egg substitute, scrambled with fresh chopped onion and red and green bell peppers.
- Lunch: Cabbage rolls-use two or three large, crisp, cabbage leaves to roll up shredded baked chicken, chopped apple, onions, a little bit of mayonnaise, and a sprinkle of honey mustard vinaigrette (made by whisking together apple cider vinegar, yellow mustard, and honey).
- Dinner: Low sodium turkey and vegetable chili, topped with a small dollop of low fat sour cream.
Sample Meal Plan 2
- Breakfast: One English muffin with one teaspoon of cream cheese and one teaspoon of sugar free fruit preserve.
- Lunch: ½ cup cauliflower and ¼ cup chopped red bell pepper, sautéed in 1 tbsp olive oil with garlic and chopped onion. Toss with ½ cup of cooked noodles.
- Dinner: Two chicken tacos, topped with a small amount of natural shredded cheese, chopped onions, and shredded cabbage.
Practical Tips for Following a Kidney-Friendly Diet
- Read Food Labels: Check for sodium, potassium, and phosphorus content.
- Cook from Scratch: Prepare meals at home to control ingredients.
- Use Herbs and Spices: Flavor your food with herbs and spices instead of salt.
- Limit Processed Foods: Avoid canned soups, frozen dinners, and processed meats.
- Control Portion Sizes: Be mindful of serving sizes to manage nutrient intake. 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.
- Measure your fluids Drink from small cups to help you keep track of how much you had to drink
- Limit sodium (salt) to help you feel less thirsty
- When you feel thirsty: Chew gum, Rinse your mouth with water and spit it out, Suck on a piece of ice, mints or sugar-free hard candy
The Role of a Dietitian
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 dietitian can help you create a kidney-friendly eating plan that is right for you and includes the foods you enjoy. Always talk to a dietitian before increasing or decreasing your daily intake of certain foods or nutrients.
Understanding Stages 1 and 2 CKD
Kidneys still work well in stage 1 and stage 2 CKD. Because there are few symptoms in stages 1 and 2 CKD, you may not feel any different. High blood pressure control is impacted by diet as well as medication. 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.
Additional Factors
Proteinuria (protein in the urine due to losses through the kidneys) is a risk factor for kidney disease progression. 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 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. Other nutritional factors to consider include adequate vitamin and mineral intake to meet your prescribed goals, and decreased or increased calories for weight management.
With fruits, vegetables, legumes, whole grains, low- and nonfat dairy, lean proteins and low-sodium foods, 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. Eat less red meat; instead, have more lean poultry and seafood (limit to 6 ounces or less per day, based on your dietary requirements). Adjust calorie intake to reach a healthy weight.
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. If you don’t have insurance or Medicare, ask a health care professional about the cost of a dietitian’s services.
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