Dietary changes are extremely important not only in the management of chronic kidney disease but also in maintenance and broader health of CKD patients. Lifestyle changes make a significant difference for many people who follow a few simple guidelines. So what are some dietary tips for CKD patients ?
Log Your Progress
The only way to know you’re making progress is to log your stats over time. Frequent measurements of nutritional status helps gauge this progression. Several parameters can track your progress, including:
- Thorough history and examination
- Anthropometric measurements
- Keeping a dietary diary
- Blood albumin level
This last parameter (blood albumin) not only reflects protein intake, but it is a strong predictor of future mortality in new patients starting dialysis. With that said, we must take that number with a grain of salt because it is susceptible to changes with inflammation or ongoing infection.
Monitoring salt and fluid intake becomes particularly critical for patients with CKD stages 4 and 5. In these stages, the kidneys work less efficiently so the body starts to retain fluid. Restricting fluid helps prevent this type of volume overload.
When we have too much fluid in the body, we can easily become short of breath and experience difficulty breathing. It can also lead to swollen legs as excess fluid collects.
Patients on dialysis should keep an eye out for a decline in urine output. It is vital to restrict fluid intake to minimize weight gain between dialysis treatments. Ideally, we aim for 1-1.5 kg of weight gain per day for patients that don’t make urine. Restricting to one liter of fluid a day helps to achieve this.
Cutting back on dietary salt is critical for CKD patients. It helps lower fluid retention for more successful dialysis treatments. A low salt diet in the United States is about 2400 MG of sodium per day. Salt restriction is particularly helpful in patients who have excess fluid and high blood pressure.
Sodium rich foods often include:
- Frozen foods
- Canned foods
- Any processed food
- Meats such as bacon, ham, and lunch meat
- Many breads and cereals
- Salted nuts
For more advice on a low-sodium diet, check out the DHS article on the topic.
A low-protein diet has been shown to slow the progression of kidney failure and patients with CKD. But over-restricting protein can lead to malnutrition during dialysis. This is why most advocate moderate protein restriction.
Our daily protein targets are:
- 0.8 to 1.0 g of protein per kilogram of weight daily for CKD stage is 4-5
- 2 grams of protein/kilogram of weight daily when a patient is on dialysis
Protein sources include nuts, milk, eggs, fish, meat, and beans.
The target carbohydrate intake is 30-35 kcal per kg daily. Complex carbohydrates offer an advantage because they pack in more nutrients, contain more fiber, and digest slower for longer satiety.
Find more information: Simple Carbohydrates vs. Complex Carbohydrates
Did you know that the kidney is one of the main route for the elimination of phosphate? Most of our phosphate comes from our diet. Foods rich in phosphate are:
- Dairy products including milk, cheese, yogurt, custard, and ice cream
- Foods with certain preservatives
- Some processed food
- Sodas and other sweet beverages
We ask patients to restrict phosphate from their diet. We also may prescribe phosphate binders which are capsules or tablets to be taken three times a day with meals.
Please talk to your health care provider for how you should handle phosphate restriction.
As you may already know, the kidneys are responsible for eliminating most of the potassium in the body through urine. As kidney failure progresses during CKD, the elimination of potassium goes down. Potassium then accumulates in the blood and becomes dangerous. High potassium levels can cause cardiac arrhythmias which can potentially make your heart stop.
It is very important to avoid or restrict potassium-rich foods when your GFR is less than 30 ml/ min. Some foods which contain potassium are:
- Certain fruits such as pineapple, grapes, bananas
- Fresh fruit juices
- Sweet corn
More Dietary Tips for CKD
Your food choices can significantly alter the progression of CKD and your clinical condition. Restriction of foods high in sodium, potassium and phosphorus can change the course of your treatment for the better. Please refer to other sources that can help you along with your families understand and adjust to these dietary restrictions: www.kidney.org