Kidney Disease Diet: How To Eat Right With CKD

Today, I'm going to give you five kidney disease diet tips. Have you or a loved one been diagnosed with kidney disease? Do you want to do your best to keep that kidney disease from worsening, or progressing to dialysis? Are you a dialysis patient who is struggling with what you should and should not eat? How to eat properly when you have kidney disease, and how to prevent it.

I'm Dr. Frita. I'm a triple board-certified medical doctor, and I practice nephrology at Emory University Hospital, Midtown. I'm also the medical director of a dialysis unit with DCI, here in Atlanta, Georgia. As a nephrologist, I counsel my patients day in and day out on how to eat properly.

Question, if you are on the kidney diet, what do you find is the hardest part about following that kidney diet?  Please give us some tips, and comment down below.

5 Kidney Disease Diet Tips

The best diet for kidney function varies depending on your percent of kidney function, or your eGFR estimated glomerular filtration rate. Be sure to consult your physician, and ask what your eGFR is. If your eGFR is less than 60 milliliters per minute, then you will benefit from a kidney diet. Remember, today I'm going to give you some guidelines, but you need to consult your physician, and your nutritionist, to find out the specifics and what is best for you.

1. Protein Intake

We need protein to build our muscles, to help us to fight infections, and to help us to heal, so protein is important. But, if you have an eGFR of less than 60 milliliters per minute, and you are not nephrotic, and you are not on dialysis already, then a modest protein restriction can actually help you. Restricting your protein, or decreasing the protein in your diet when you have kidney disease, can actually delay the progression of kidney disease, it can keep the kidneys from getting worse, and it can delay your time for having to go on dialysis for years. So what should be your protein restriction?

Protein Recommendations

We recommend that the protein restriction be between 0.6 grams per kilogram and 0.8 grams per kilogram of protein per day. So somewhere around between 60 to 80 grams of protein in your diet per day. And again, that's if your eGFR is less than 60 milliliters, but you're not yet on dialysis. So this will give you a CKD, or chronic kidney disease stage, of three, four, or five, as long as you're not on dialysis yet.

In addition to helping to delay the progression of kidney disease, a modest protein restriction can also decrease toxins in your body. It can decrease the BUN, or that blood urea nitrogen, it can decrease those uremic toxins or those kidney poisons that the kidneys are supposed to be filtering out. A modest protein restriction in your diet can also help to decrease your acid load. It can help make your blood a little more alkaline, which is helpful.

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Sources Of Protein

Good sources of protein in the diet include lean meats like grilled fish or grilled chicken. You can also have plant-based sources of proteins. So even if you are a vegetarian or vegan, you can still get your good protein sources. Just be sure to consult your physician, and to consult your dietician. Modest protein restriction is also good for patients who have diabetic kidney disease. Diabetes is the number one cause of kidney failure. Please watch my YouTube video on diabetes here.

So, patients who have diabetic kidney disease who are not yet on dialysis, this modest protein restriction is excellent for you as well. Now, if you are a patient who is already on dialysis, if you have ESRD, or end-stage renal disease, or ESKD, end-stage kidney disease, then we actually do not want you to have this protein restriction. In fact, we want you to have protein, because studies show that if you are a dialysis patient, and you have a good and proper protein intake, then this can help to make you a healthier patient, and it can even prolong your life. Dialysis patients: you know, we check these labs every month, and we look for that protein in your blood, or that albumin, which you want to be greater than 4.0. So dialysis patients, please do not restrict your protein, but consult your dieticians, and your nephrologist on your proper protein intake.

2. Practice Low Salt Intake

Patients who have kidney disease should have low salt or low sodium intake. It should generally be less than two grams of sodium per day, but no less than 1.5 grams of sodium per day. When you have a decreased sodium intake, this helps to decrease hypertension, or high blood pressure, which, incidentally, high blood pressure is the second leading cause of kidney failure.

Having a low-salt diet can also slow the progression of kidney disease, and it can help to improve cardiovascular outcomes.

Ways to Avoid Having a High Salt Intake?

Be a label-watcher. When you pick up food, take a look at the nutrition facts on the label. It will tell you how much sodium in milligrams or grams. And so try to stay under 2 grams of sodium in 24 hours. Also, try not to be a salt shaker. I know a lot of people, as soon as they get a meal, they'll grab that salt even before they taste their food, and start putting salt on the food. Taste your food first, and try to get accustomed to lower salt. Also, try to avoid a lot of fried foods, salty chips, salty popcorn, and a lot of processed food.

3. Proper Potassium Intake

Potassium is a mineral found in many of the foods that we eat, like bananas and tomatoes. And potassium is important in our bodies because it helps to regulate our heartbeats, and it also helps to give us good muscle function. When your kidneys function properly, they are responsible for filtering out potassium in your body, and they help to maintain a good and proper potassium balance. If you have kidney disease however, your potassium may not be filtered out by your kidneys properly, and you may develop elevated potassium in the blood, or hyperkalemia. Hyperkalemia can cause many problems. If your potassium in your blood is too high, it can cause abnormal heart rhythms or cardiac arrhythmias, and it can even cause the heart to stop. So if you are a person with kidney disease, and you have high potassium in the blood, it is very important that for your kidney diet that you have a low potassium diet.

eGFR and Potassium Intake

Now, the eGFR, that estimate glomerular filtration rate, is important, again, in dealing with potassium. Usually, kidney patients don't require potassium restriction until that eGFR is less than 30, or when they are CKD stage four. But for some patients with kidney disease, they may require potassium restriction even at higher eGFRs, especially if they're taking medicines that have a side effect of giving you high potassium. Some medicines that can cause high potassium as a side effect include ACE inhibitors like lisinopril, or angiotensin receptor blockers, like losartan, or medications like spironolactone.

So what your potassium should be in your diet will vary depending on your eGFR, or on medications you're taking. So again, it's very important that you consult your physician, find out what your potassium level is, so you know what potassium restriction, or what potassium level is best for your diet.

Now, for patients who do not have kidney disease at all, you should have potassium, anywhere from two to five grams of potassium a day, because potassium is a mineral that is good for you. But it has to be in balance, not too high, and not too low.

Dialysis Patients and Potassium Intake

Dialysis patients, for you, your potassium is largely being cleared through your dialysis, whether it's hemodialysis or home dialysis, peritoneal dialysis, like P.D.  So for you, it's important that you follow your nephrologist's recommendations, and the recommendations of your dietician to find out what your potassium restriction should be. Here are some foods that tend to have high potassium, that you want to avoid having a whole lot of if you are a person with hyperkalemia or high potassium. Bananas have high potassium, tomatoes, avocados, spinach, and broccoli. I'm not saying that you have to avoid these foods altogether, but make sure you're aware of the foods that have high potassium so that if you need to restrict the potassium in your diet, you're able to make wise choices.

4. Phosphorous Intake

Phosphorous is another mineral in the body. It, along with calcium, helps to give you healthy, strong bones. Typically, when the kidneys work well, they will filter out the excess phosphorous in the body, but if you are a patient with kidney disease, then you may have high levels of phosphorous in your blood or hyperphosphatemia. Hyperphosphatemia can lead to problems. It can cause an increase in your PTH, or parathyroid hormone, which can lead to weak bones, or increase your chances for bone fractures, or broken bones.

High phosphorous can also lead to deposits in the blood vessels, in the lungs. It can lead to cardiovascular issues. So you definitely want to maintain a normal level of phosphorous in the blood. If you are a person with kidney disease, usually this phosphorous level is not affected until that eGFR is less than 60, or you have CKD stage three, or worse, CKD four, or CKD five. In that case, you should be limiting the amount of phosphorous intake. It should be limited to around 800 milligrams, and certainly no more than one gram per 24 hours. In particular, you want to avoid inorganic phosphorous.

Foods That Contain Phosphorous

So, what kinds of foods do you need to avoid? You need to avoid heavily processed foods. You need to avoid dark sodas, cheese, and milk. You want to avoid chocolate, and ice cream, some of these things I know sound a little bit miserable. And again, I'm not being absolute, I'm not saying you can never, ever have ice cream again, or never have chocolate, what I'm saying is that these are things that tend to have high levels of inorganic phosphorous, and so you need to be aware of the foods that you want to have in moderation, or in very, very limited levels. Because again, hyperphosphatemia is problematic when you have kidney disease.

For patients who are on dialysis or even patients who have eGFRs of less than 30, if you have CKD four, or CKD five, then you may also need to take a medication to help you to have a low phosphorous level, a phosphorous binder. You take these medications with your meals, and they help to bind to the phosphorous so that your body never has a chance to absorb it. Patients who are on a special diet for kidney disease, who have elevated phosphorous need to have phosphorous restriction in the diet.

If you are a patient who does not have kidney disease, and you have normal phosphorous levels, then you do not need to limit your phosphorous intake, just make sure you follow up with your primary care physician regularly so you know what your phosphorous levels are.

5.  Water Intake

If you are a patient with kidney disease who is not on dialysis, then you want to be sure that you have an adequate water intake in order to prevent the progression of kidney disease and to delay your need for dialysis. A lot of patients who come into the hospital end up on dialysis, or having kidney failure have it because of dehydration, or not enough water, prerenal azotemia. And this is actually a little-known fact, so yes, having enough water can help to prevent the progression of kidney disease.  Now the amount of water you need will vary.

For most people, it's anywhere between two and three liters of water a day, depending on your activity, depending on how much you sweat, or how much you do. But if you generally have about four of those 16-ounce bottles of water anywhere from four, to six, or even more, then that should be an adequate amount of water intake. Consult your physician to find out what water intake level is appropriate for you.

Now if you are a person who has contraindications to having too much water, then that water intake will vary. For example, if you have CHF or congestive heart failure, then you will need to have a fluid restriction. Again, consult your physician and find out the proper water intake for you. Now for patients who are on dialysis, you should be restricting the water intake, especially if you're no longer making urine.

If you are a dialysis patient and you make no urine, if you drink excessive amounts of fluid, excessive amounts of water, then you will have volume overload. You will have swelling in your legs, your ankles, you'll have edema. You can also get fluid to build up in your lungs, and that can cause you to have shortness of breath or respiratory distress.

Also, dialysis patients, if you drink too much fluid, if you gain too much water weight in between treatments, this can stress your heart, and it can even cause you to have abnormal heart rhythms. That is why we are constantly asking you, please do not gain too much weight between dialysis treatments. It can be detrimental to your health.

Question, I know a lot of people reading this will have varying degrees of activities. You might be a person who exercises a lot and you sweat a lot, and you drink a lot of water, or you may be a patient I described who has congestive heart failure. Let me know what your physician has recommended for you, as far as water intake. Please comment down below.

 

Conclusion

These are some general guidelines on a proper kidney disease diet, how to eat properly with kidney disease. And I threw in some tips on how to try to prolong your good kidney function if you have no kidney problems. I just want you to live your healthiest, happiest life. Another way to help to live your healthy, happy life is to download my free PDF, "Ten Healthy Habits for a Better You, and a Better Life." This is a healthy habits checklist that I live by myself. It helps me, and I'm sure that it will help you too. So please go ahead and download that free PDF.