Nutrition and Chronic Kidney Disease

In chronic kidney disease, the kidneys are unable to filter excess water and waste out of your blood as they should. Early detection of kidney disease combined with dietary and lifestyle changes can help you prevent or delay the progression to kidney failure.

This article provides a basic guide of dietary habits and foods that support kidney health to help people with kidney disease.

Diet and Kidney Disease

In addition to filtering water and waste, your kidneys also work to keep the right balance of minerals and nutrients in your blood.

There is no "best" diet that fits everyone with kidney disease. However, it's important to eat a low-sodium diet that includes:

• Fruits
• Vegetables
• Whole grains
• Legumes (including beans, peas, and lentils)
• Lean protein

For stages 1 and 2 kidney disease, you may have very few or no restrictions on what you eat or drink. The DASH (Dietary Approaches to Stop Hypertension) diet is commonly recommended to people with early stages of kidney disease.

The DASH diet is low in sodium, added sugar, saturated fat, and red meat, which most people with stage 1 or 2 kidney disease should avoid. Some people may be instructed to limit protein intake as well.

In addition to limiting protein, as kidney function declines, you may need to reduce your intake of foods high in potassium and phosphorus. You may also need to watch your fluid intake.

A healthcare provider and dietitian will closely monitor your blood test results and guide you on which nutrients to limit. A dietitian will also keep track of your weight to help you stay within a healthy weight range and avoid loss of muscle mass.

Nutrients to Monitor

Sodium

Normally, kidneys work to control the amount of sodium in the body. If the kidneys are not functioning properly, the extra sodium can lead to fluid buildup, high blood pressure, and swelling.

Eating a low-sodium diet can help lower your blood pressure and slow down the progression of kidney disease.

Potassium

During the early stages of kidney disease, you may not need to limit potassium. However, as kidney function declines, your healthcare provider may tell you to limit the amount of potassium you eat daily.

Many foods we eat contain potassium, which the body uses to maintain essential functions. Potassium helps your muscles work, including the muscles that control your heartbeat. It also helps move nutrients into cells and waste products out of cells.

The kidneys excrete extra potassium. When the kidneys are not functioning correctly, potassium builds up, leaving too much potassium in the blood. High levels of potassium in the blood, or hyperkalemia, can lead to an irregular heartbeat or heart attack.

Phosphorus

Phosphorus is another mineral that can build up in the blood when your kidneys aren’t working well.

When phosphorus builds up in the blood, it pulls calcium from the bones, weakening them. Over time, this can lead to bone disease and an increased risk for a fracture or bone break. High phosphorus levels in the blood can also lead to itchy skin, bone pain, and joint pain.

Protein and Fluid Intake

Protein is an essential macronutrient that helps build muscle, repair tissue, and fight off infection.

When a person with healthy kidneys eats protein-rich foods like meat and dairy, it breaks down into waste within the body and is filtered out by the kidneys. When the kidneys aren't functioning properly, they have difficulty removing the extra waste from extra protein.

The amount of protein a person with kidney disease needs varies based on:

• Body size
• Progression of kidney disease
• Amount of protein found in the urine

Most people with stage 1 or 2 kidney disease should limit their protein intake to 0.8 grams per kilogram of their ideal body weight.

To slow the progression of stages 3–5 kidney disease, the National Kidney Foundation KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines recommend:

• An adult without diabetes who is metabolically stable to restrict protein to 0.55–0.60 grams per kilogram of body weight per day under close medical supervision.
• An adult with diabetes who is metabolically stable to restrict protein to 0.06–0.08 grams per kilogram of body weight to promote glycemic control and maintain stable nutritional status.
  

Most people will not need to restrict fluid intake during early kidney disease (stages 1 and 2). However, as the disease progresses, you may need to limit the liquid you consume because your kidneys cannot remove excess fluid. This can lead to fluid buildup in the body, causing a strain on the heart and swelling throughout the body.

Foods to Limit With Kidney Disease

Depending on the amount of kidney function you have left, you may need to limit or avoid certain foods. Everyone with kidney disease should avoid high-sodium foods. Depending on your blood test, a healthcare provider may also instruct you to limit foods high in potassium and phosphorus.

Foods high in sodium:

• Packaged foods
• Canned foods
• Ham, bacon, sausage, or lunch meat
• Pickled foods
• Pizza
• Potato chips
• Seasoned rice or pasta
• Soy sauce, ketchup, and other condiments

Foods high in potassium:

• Grapefruit juice
• Bananas
• Potatoes
• Milk
• Yogurt
• Salt substitutes
• Dried beans
• Cooked greens
• Prune juice
• Melon

Foods high in phosphorus:

• Deli meat
• Processed cheese
• Dark colas
• Pancakes
• Cornbread
• Pastries
• Milk
• Frozen yogurt

Renal Diet Grocery List

Fortunately, there are still many foods that a person with kidney disease can eat. This list combines all of the foods that are safe to eat for most people following a renal diet.

Vegetables

• Asparagus
• Bell peppers
• Cabbage
• Celery
• Kale
• Lettuce
• Broccoli
• Green peas
• Green beans
• Corn
• Mushrooms
• Iceberg lettuce
• Carrots
• Zucchini
• Okra
• Cucumber
• Eggplant
• Garlic
• Onions
• Cauliflower
  

Fruits

• Apples
• Cranberries
• Blueberries
• Raspberries
• Strawberries
• Cherries
• Mandarin oranges
• Red grapes
• Peaches
• Pears
• Lemon/Lime
• Pineapple
• Plums
  

Protein

• Lean chicken and turkey without the skin
• Eggs or egg substitutes
• Seafood
• Nuts
• Tofu
• Lean beef
• Pork (avoid sausage, bacon, and hotdogs)
• Beans
• Low-fat dairy
  

Starches

• White rice
• Flour tortillas
• White or sourdough bread
• Dinner roll
• Unsalted popcorn
• Bagels
• Rice cakes
• Waffles
• English muffin
• Grits
• Unsalted crackers
• Pasta
  

Beverages

• Coffee
• Unsweetened tea
• Apple juice
• Grape juice
• Clear sodas
• Lemonade
• Water or sparkling water
• Green tea

Sample Day of Eating

Here's a look at a sample day of eating on a renal diet.

Breakfast:

• 1 boiled egg
• 1/2 cup 1% milk
• 1 cup of Chex cereal
• 1/2 cup of blueberries
• 1/2 cup of coffee

Snack:

• 3 cups unsalted popcorn
• Handful of nuts or seeds
• Lemonade

Lunch:

• 2 slices of white bread
• 2 ounces roasted white turkey
• 2 teaspoons light mayo
• 1/2 cup coleslaw
• 1/2 cup peaches
• Water

Snack:

• 1 pouch or can of low-sodium tuna
• 1 individual packet of low-fat mayonnaise

Dinner:

• 3 ounces baked chicken
• 1 cup white rice
• 2 tablespoons unsalted gravy
• 1 cup mixed vegetables
• 1 slice angel food cake
• Water, apple juice, or other kidney-friendly beverage
  

Summary

Early detection and lifestyle modifications, such as diet changes, can delay or prevent the progression of kidney disease. For early kidney disease, most people will only have to watch their sodium and protein intake while eating a well-balanced diet. Those with advanced kidney disease may need to avoid other nutrients such as phosphorus, potassium, and excess fluid.

Be sure to closely work with a healthcare team and registered dietitian to develop a meal plan tailored to your individual nutritional needs and preferences.

A Word From Verywell

Making dietary changes can be difficult and frustrating at times. Fortunately, most of the time, you can still enjoy the foods that you love and fit them into your kidney diet. A dietitian can guide and support you throughout your journey by working with you to improve your health and decrease the workload on your kidneys.