When kidney function is compromised, the kidneys cannot effectively filter or remove waste properly, which can negatively affect a patient’s electrolyte levels. A well-balanced diet that supports kidney function while keeping sodium, phosphorus, and potassium in check is essential for managing chronic kidney disease (CKD). This comprehensive guide outlines the key aspects of a kidney dialysis diet plan, providing valuable information for individuals undergoing dialysis and their caregivers.
Introduction to Kidney-Friendly Eating
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. For people who have Stages 1 to 4 of chronic kidney disease (CKD) and are not on dialysis, a kidney-friendly eating plan is a way of eating that helps you stay healthy and can slow down damage to your kidneys. It includes foods that are easy on your kidneys and limits other foods and fluids so certain minerals in those foods, like potassium, do not build up to high levels in your body. Everyone is different and has different nutritional needs, so it's best to work with a dietitian to create a kidney-friendly eating plan that is right for you.
The Importance of a Kidney-Friendly Diet
A kidney-friendly eating plan helps you manage your kidney disease and slow down damage to your kidneys by preventing certain minerals from building up in your body. This 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, and stay at a healthy weight.
Creating a Personalized Kidney-Friendly Eating Plan
To create a kidney-friendly eating plan that is right for you, ask your doctor to refer you to a dietitian (someone with special training in food and nutrition to know which foods are right for people with kidney disease). You can talk to a dietitian about the foods you enjoy or any special requirements you have (for example, you are vegetarian or have food allergies) and they will 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. Medicare and many private insurance plans pay for a certain number of visits with a dietitian each year. Call your insurance company to ask if your plan covers medical nutrition therapy (MNT) with a dietitian. MNT is an approach to treat kidney disease through a tailored nutrition plan. As part of MNT, a dietitian will review your current eating habits, create a healthy eating plan, that includes your preferences, and help you overcome eating challenges.
Key Nutrients to Monitor
A kidney-friendly eating plan is one that is low in sodium, phosphorous, and protein. A renal diet also emphasizes the importance of consuming high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium. Your kidney-friendly eating plan may change over time but will always give you the right amount of key nutrients:
Read also: Managing Stage 3 Kidney Disease with Diet
Protein
One of the nutrients that gives you energy. Your body needs protein to grow, build muscles, heal and stay healthy. Having too little protein can cause your skin, hair and nails to be weak, but having too much protein can make your kidneys work harder and cause more damage. This happens because when your body uses protein, it makes waste products that your kidneys must filter. To stay healthy and help you feel your best, you may need to adjust how much protein you eat. The amount of protein you should eat depends on your body size, activity level and health. Your doctor and dietitian may have you limit protein or change the type of protein you eat. For example, you may need to eat more lean proteins, which are foods that are high in protein and low in fat, such as whole eggs and skinless chicken and turkey. Ask your doctor and dietitian how much protein you should eat and what the best types of protein are for you. People on hemodialysis usually need to eat more protein. Protein helps you keep healthy blood protein levels for overall good health. Protein also helps keep your muscles strong, helps wounds heal faster, and keeps your immune system strong. Eat a high protein food (lean meat, poultry, and pork, fish, eggs, or a meat alternative) at every meal, or about 8-10 ounces of high protein foods every day.
Fat
Fat is another one of the nutrients that gives you energy. Your body needs fat to carry out many jobs, such as using vitamins from your food and keep your body at the right temperature. Fat gives you energy and helps you use some of the vitamins in your food. You need some fat in your eating plan to stay healthy. Too much fat can lead to weight gain and heart disease. Limit fat in your meal plan, and choose healthier fats when you can, such as olive oil. Choosing the right types of fat is also part of a heart-healthy eating plan called DASH.
Carbohydrates
Your body's main source of energy. Your body can more easily convert carbs into energy than protein and fat. 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. The ketogenic diet or "keto diet" is a type of low-carb diet that focuses on eating very low carbs, high fats and moderate protein amounts, so your body uses stored fat for energy instead of carbs. This diet may not be a healthy option for you because it limits your options, and you may miss out on some key nutrients. If you have questions about a specific diet, ask your dietitian.
Calories
Calories are like fuel and give your body energy. Calories come from the protein, fat and carbs in your food and fluid plan. The number of calories you should have are based on individual needs and your dietitian will work with you to determine the right number for you. Age, weight, height, sex, exercise level, and other factors are considered. An important goal is to get your calories from nutrient-dense foods, which means foods that have a lot of healthy nutrients for the number of calories you take in. For example, you will get a lot of healthy nutrients from a fruit rather than a candy bar, and most likely the candy bar will add more calories that are less healthy because it has more sugar and fat.
Sodium
Sodium (salt) is a mineral found in almost all foods. It has many important roles in the way your body works. The amount of sodium found naturally in foods is enough to keep a healthy level in your body. But eating packaged foods and adding salt to foods can lead to eating too much sodium. Too much sodium can make you thirsty and make your body hold onto water, which can lead to swelling and raise your blood pressure. This can damage your kidneys more and make your heart work harder. One of the best things you can do is to limit how much sodium you eat. Here are some tips to limit sodium: Use herbs and spices for flavor while cooking. Do not add salt to your food when cooking or eating. Choose fresh or frozen vegetables instead of canned vegetables. If you use canned vegetables, drain and rinse them to remove extra salt. When eating out, ask your server to have the chef not add salt to your dish. Work with your dietitian to find foods that are low in sodium. For people on hemodialysis, sodium intake should be the same as it is for most everyone else. Sodium intake should be less than 2300 milligrams per day. This is equal to one teaspoon of salt. 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. Avoid high sodium foods like deli meats and chips. Less sodium in the diet helps prevent fluid from building up between dialysis treatments and helps reduce thirst. Less sodium also helps keep your blood pressure within your goal range. Sodium is a mineral found in most natural foods. Most people think of salt and sodium as interchangeable. Salt, however, is actually a compound of sodium and chloride. Foods we eat may contain salt or they may contain sodium in other forms. Sodium is one of the body’s three major electrolytes (potassium and chloride are the other two). Electrolytes control the fluids going in and out of the body’s tissues and cells. Too much sodium can be harmful for people with kidney disease because their kidneys cannot adequately eliminate excess sodium and fluid from the body. Always read food labels.
Read also: A Review of the Mediterranean Diet in Kidney Disease
Potassium
A mineral found in foods that your body needs to make your muscles work. When your kidneys are not working well, your potassium level may be too high or too low. Having too much or too little potassium can cause muscle cramps, problems with the way your heart beats and muscle weakness. If you have kidney disease, your doctor or dietitian may tell you to lower the amount of potassium in your eating plan. Limits on potassium in the diet are based on your specific blood levels. People who do frequent hemodialysis at home usually do not need to limit potassium. If you do need to limit potassium, discuss options with your dietitian. The potassium from meat and dairy products is absorbed more easily than from fruits, vegetables, legumes, nuts, and seeds. So a plant-based diet is possible when you’re on hemodialysis. However, you may need to limit portion sizes of certain plant-based foods when your potassium levels are very high. Avoid foods with additives like acesulfame potassium and potassium sorbate, as they are easily absorbed. Do not use salt substitutes that contain potassium. When potassium in the blood is too high or too low this can cause heart problems and even death. Therefore, it’s very important to keep track of your potassium levels. Potassium binders are medications that can lower your potassium levels, and they may make it possible to add more foods to your diet. Your healthcare team can also adjust the dialysate (the cleansing fluid used during dialysis) to help lower your potassium. Potassium is a mineral found in many of the foods we eat and is also found naturally in the body. Potassium plays a role in keeping the heartbeat regular and the muscles working correctly. Potassium is also necessary for maintaining fluid and electrolyte balance in the bloodstream. When the kidneys fail, they can no longer remove excess potassium, so potassium levels build up in the body.
Foods low in potassium: Apples, cranberries, grapes, pineapples and strawberries, Cauliflower, onions, peppers, radishes, summer squash and lettuce, Pita, tortillas and white breads, Beef and chicken, White riceFoods high in potassium: Avocados, bananas, melons, oranges, prunes and raisins, Artichokes, winter squash, plantains, spinach, potatoes and tomatoes, Bran products and granola, Beans (baked, black, pinto, etc.), Brown or wild rice
Phosphorus
A mineral found in foods that works with calcium and vitamin D to keep your bones healthy. Healthy kidneys keep the right amount of phosphorus in your body. When your kidneys are not working well, phosphorus can build up in your blood. Too much phosphorus in your blood can lead to weak bones that break easily. Ask your doctor and dietitian if you need to limit phosphorus. They may also prescribe a medicine called a phosphate binder, which prevents your body from absorbing phosphorus from foods you eat. Phosphorus levels in the blood can become too high in kidney failure. Hemodialysis does not effectively remove phosphorus. This leads to weak bones and phosphorus binding with calcium to settle into blood vessels and the heart. Therefore, you may need to limit phosphorus in your diet, depending on your lab results. The best way to improve your diet overall and to decrease your phosphorus load is to avoid processed foods. Check labels for additives with PHOS, such as disodium phosphate. Phosphate additives are inorganic and are much more easily absorbed. Plant-based foods with organic phosphates like nuts and seeds are absorbed less. Animal-based foods like meat and dairy products have inorganic phosphates that are more easily absorbed. Therefore, eating more plant-based healthy foods instead of processed foods will decrease the phosphorus load. Phosphorus binders and phosphorus blockers are medications that also lower your phosphorus levels, and they may make it possible to add more foods to your diet. Phosphorus is a mineral that is critical in bone maintenance and development. Phosphorus also assists in the development of connective tissue and organs and aids in muscle movement. Normal working kidneys can remove extra phosphorus in your blood. When kidney function is compromised, the kidneys no longer remove excess phosphorus. High phosphorus levels can pull calcium out of your bones, making them weak. Phosphorus can be found in many foods. Avoid packaged foods that contain added phosphorus.
Eat these low phosphorus foods: Italian, French or sourdough bread, Corn or rice cereals and cream of wheat, Unsalted popcorn, Some light-colored sodas and lemonadeAvoid these high phosphorus foods: Whole-grain bread, Bran cereals and oatmeal, Nuts and sunflower seeds, Dark-colored colas
Fluids
When you have kidney disease, you may need to limit water and fluids. This is because damaged kidneys do not get rid of extra fluid as well as they should. Too much fluid in your body can cause high blood pressure, swelling and heart failure. To limit fluids, you will need to cut back on how much you drink and limit eating some foods that contain a lot of water, such as soups, ice cream, gelatin and many fruits and vegetables. People on in-center hemodialysis usually need a fluid restriction, but the amount depends on how much urine they still make. So, the restriction can range from one to two liters or more per day. Most people on home hemodialysis do not need a fluid restriction. Your healthcare professional or dietitian will help you determine the right amount of fluid to drink each day. A sudden increase in weight, along with swelling, shortness of breath, or a rise in your blood pressure may be signs that you are drinking too many fluids. Tell your dialysis care team if you are having any of these problems. Check your weight at the beginning of each treatment. Ask your dietitian for creative ways to cut down on the amount of fluid you are drinking. Fluid is any food or beverage that is liquid at room temperature. Some examples are: ice, beverages like coffee, tea, sodas, juices, and water, frozen desserts such as ice cream, sherbet, or popsicles, gelatin, gravy and soups. A patient’s fluid allowance is calculated on an individual basis, depending on urine output and dialysis settings.
Read also: Nutrition and stage 2 CKD
If you need to limit fluids, here are some tips: 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
Vitamins and Minerals
Vitamin and mineral needs are also specific to each person. Eating a wide variety of foods gives your body the vitamins and minerals it needs each day. In addition to a good diet, your healthcare professional may order special vitamin and mineral supplements. Kidney disease and dialysis change the amounts of vitamins and minerals your body needs. Also, your special diet may limit some food groups that would normally provide important vitamins and minerals. Take only those supplements ordered by your kidney healthcare professional, since certain vitamins and minerals can be harmful if you are on dialysis. Your doctor and dietitian can help you find vitamins that are right for you. To help you get the right amounts of vitamins and minerals, your dietitian may suggest you take: A special supplement made for people with kidney disease. A special kind of vitamin D, folic acid or iron pill, to help prevent some common side effects of kidney disease, such as bone disease and anemia. Regular multi-vitamins may not be healthy for you if you have kidney disease. Tell your doctor and dietitian about any vitamins, supplements or over-the-counter medicines you are taking.
Portion Control
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.
Dietary Adjustments Based on CKD Stage
Yes, how strict your eating plan should be depends on your stage of kidney disease. When you are in the early stages of CKD (Stages 1 and 2), you will have less limits on what you can eat. As your kidney disease gets worse (Stages 3, 4 and 5), your doctor may recommend that you limit potassium, phosphorus, and fluids.
Managing Diabetes with a Kidney-Friendly Diet
If you have diabetes, you need to control your blood sugar to prevent more damage to your kidneys. Your doctor and dietitian can help you create an eating plan that helps you control your blood sugar, while also limiting sodium, phosphorus, potassium and fluids. You can also ask your doctor to refer you to a diabetes educator who can work with you to better manage your diabetes.
Sample Meal Plans
The sample meal plans given provide about 40-50 grams of protein, 1500 mg sodium, 1500 mg potassium and less than 500 cc or 16 ounces of fluid for each of the three days. You may adjust selections to fit your individual taste. These meal plans are stricter than your normal kidney diet to keep waste products from building up in your blood during the emergency situation. Fluid is limited to less than 500 cc (2 cups or 16 ounces) each day to prevent you from swelling or having shortness of breath. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only.
The Hemodialysis Diet
The hemodialysis diet is an eating plan tailored to patients who are on hemodialysis. In addition to enjoying a variety of nutritious foods, the hemodialysis diet will introduce a higher amount of high-quality protein into your eating plan. Your dietitian will determine the amount. Foods containing high amounts of sodium, phosphorus and potassium are restricted. Your dietitian will provide you with food lists that indicate which foods are allowed and which ones you should avoid or limit. Potassium is easily removed by dialysis, but when it builds up in the blood between treatments, it can cause muscle weakness and make your heart stop beating. Phosphorus is difficult for hemodialysis to filter from the blood so it’s important to limit foods that contain the mineral. Phosphorus can build to high levels in the bloodstream and cause weak bones, heart problems, joint pain or skin ulcers. Sodium causes your body to hold onto more fluid and raises your blood pressure. Too much fluid gain between hemodialysis sessions can cause discomfort, including swelling, shortness of breath or high blood pressure. Fluid intake is not limited to what you can drink; it’s also hidden in some foods you eat, including gelatin, ice, sherbet, watermelon, sauces and gravies. You will follow the hemodialysis diet as long as you need hemodialysis. There are various ways of knowing if the hemodialysis diet is working. By following the hemodialysis diet, sticking to your fluid allowance and taking your prescribed medicines, the buildup of waste and fluid will be minimal and you won’t feel ill. Your dialysis treatments won’t have to pull too much fluid from your body and you can avoid feeling weak or dizzy afterwards. Another way to tell that the hemodialysis diet is working is by your target, or "dry", weight. Your target weight is the weight your doctor thinks you would be when all the extra fluid is removed from your body. You will be weighed before and after your treatment to see how close you are to your target weight. Following your recommended fluid intake will keep you from going too high above your target weight. Test results are the best way to see how well you’re doing on your diet and hemodialysis. Monthly laboratory tests are done to help your healthcare team evaluate you for anemia, mineral balance, protein nutrition and adequacy of dialysis. Your dietitian will also perform a nutrition assessment when you begin hemodialysis and at least yearly. Signs of nutrition problems, changes in weight and energy levels and any other problems will be checked.
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