Kidney Diet Tips

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Late Stage Kidney Disease Eating Tips

There is no question that managing your diet during late stage chronic kidney disease (CKD) can be overwhelming. Depending on the stage of your kidney disease nutrition requirements will vary. During late stage (stage 4) kidney disease the primary goal is to prevent overworking the kidneys. Taking additional stress off of your kidneys by limiting the accumulation of fluids and waste products can help protect the kidneys. Your nephrologist and dietitian can help develop a personalized diet plan to help prevent the progression of your kidney disease. The CKD diet is important in preserving your remaining kidney function for as long as possible. When you approach late stage 4 or stage 5 it’s important to consider options for dialysis or transplant.

 

Nutrient Recommendations

Protein

Protein is an important part of everyone’s diet, particularly for those with kidney disease. Depending on your kidney function the amount of protein you need will vary. The correct amount as recommended by a healthcare provider can help to prevent malnutrition or over nutrition. For late stage kidney disease a low protein diet is most often recommended.   Although we all need protein in our diets, too much protein creates additional waste products in the blood which can build up when the kidneys do not work properly. Not only can these waste products accumulate to cause fatigue and loss of appetite, they can lead to an increased workload on your kidneys. By limiting protein and the need to remove this waste product your kidneys will have less strain.

Speak to a dietitian or healthcare provider about the right amount of protein for you. The amount will vary based on your stage of kidney disease, lab work and body size. If a low protein diet is recommended, you may need to include additional foods such as healthy carbohydrates and healthy fats to ensure your daily calorie needs are met. Consuming enough calories is critical in preventing weight loss and maintaining nutritional status.

Adequate Calories

Poor appetite and decline in overall intake can be a common side effect for those with late stage kidney disease. This can quickly turn into a downward spiral of malnutrition if not followed closely. With progression of kidney disease the increased buildup of toxins can cause altered taste and decrease in appetite leading to weight loss. It is important to include adequate calories daily to maintain your energy levels and weight. Talk to your dietitian or health care provider about changes in your appetite or intake. Calorie restriction should only be followed under medical advice if overweight or obese.

Restricting nutrients such as protein can also lead to lower daily caloric intake. Adequate intake can be achieved by including healthy fats, nutritious carbohydrates and other high calorie foods. Include extra healthy fats such as olive and canola oils, nuts and nut butters and avocados. Nuts and avocado are limited if you are on a low potassium diet. You can add healthy carbohydrates such as fruits and whole grain breads, pastas and cereals.

To ensure adequate intake you may need to change your normal meal routine from three larger meals to 5-6 smaller meals throughout the day. Including high calorie foods and nutrition supplementation may be necessary. By limiting foods with little caloric and nutritionally value such as water, coffee and diet soda you can allow for more nutritious, higher calorie foods. Gradually increasing your intake can help your appetite to jumpstart and hopefully start eating more as a part of your daily routine. Make sure you talk to a dietitian about the best way to add extra calories.

Salt

Limiting salt is important for the general population, especially those with kidney disease.  The consumption of too much salt can lead to retention of sodium and fluids in your body which cause additional work on your kidneys. Increased levels of sodium and fluids also lead to a rise in blood pressure. This dangerous cycle of high blood pressure causes additional breakdown of kidney function.  High salt intake can also lead to swelling (edema), heart failure and shortness of breath. If you have kidney disease it is critical to limit your intake of sodium.

Consult with your dietitian or healthcare provider about restricting sodium in your diet. There are numerous resources available for following a low salt diet. One of the most popular and well researched low-sodium diets is the DASH diet (Dietary Approaches to Stop Hypertension).  The National Kidney Foundation among others promotes this diet to help lower blood pressure and protect against heart disease. This diet focuses primarily on fruits, vegetables, low-fat dairy products, whole grains, fish, poultry, beans, seeds and nuts. The DASH diet is also low in salt, added sugars and sweets, fat and red meats.

Potassium, Phosphorus and Calcium

Your nephrologist or health care provider will monitor your blood work and evaluate your lab values to make sure your potassium, phosphorus and calcium levels are in recommended ranges. Your kidney plays an important role in regulating these minerals in your body. With kidney disease you may need to limit or add additional foods to keep these labs in the recommended ranges.

Other Dietary Considerations

 

Vegetarian Diet

A vegetarian diet may be helpful in slowing the progression of your kidney disease and associated complications of CKD as shown in research studies. The consumption of a plant-based diet has shown to lower protein in the urine, improve blood pressure and lessen the amount of tissue damage in the kidneys. A plan- based diet has been avoided in the past due to the potential for increase in potassium and phosphorus levels in CKD patients. However, following a vegetarian diet is possible when you have CKD if executed correctly while monitoring these nutrient levels.

Acid-Base Balance

Research has also evaluated the importance of regulating metabolic acidosis in the body to prolong kidney function. Acidosis causes a low pH in the blood and tissues. Metabolic acidosis is a combination of low pH and low bicarbonate levels in the blood. Low levels of bicarbonate have demonstrated negative outcomes for kidney patients, including the progression of kidney disease and higher bone breakdown. To reduce the dietary acid load, it is recommended to include more fruits and vegetables while obtaining protein from milk, yogurt and soy protein products. Since fruits, vegetables and dairy products can affect your potassium levels and dairy your phosphorus levels, it is important to work with your dietitian or other health care provider to ensure your potassium and phosphorus levels stay in a safe range.

Delaying Progression

To sustain kidney function it is important to consider the cause(s) of your kidney disease.  If you have diabetes or high blood pressure it is important to manage these conditions. Diabetes is the leading cause of kidney disease, followed by hypertension. If uncontrolled, both of these conditions can cause further breakdown of remaining kidney function.

Diabetes

If you have diabetes, it is important to manage your blood sugars. Talk to your doctor about the best range for you. High levels of sugars (glucose) in your blood can cause damage your kidneys. Improving diabetes control can help slow the progression of kidney disease. Your doctor can help you manage your diabetes with an oral medication or insulin and a diabetes diet. A dietitian can help you to follow a meal plan to manage diabetes while incorporating recommendations for kidney disease as well.

Hypertension

Like high blood sugars, high blood pressure or hypertension is damaging to your kidneys. The increased pressure to your blood vessels creates an additional workload to your kidney. Talk to your doctor about managing your hypertension. A combination of medications and a low-sodium diet can be extremely helpful in managing your blood pressure. By choosing lower sodium foods and taking your high blood pressure medication as prescribed you can improve management of high blood pressure.

Taking Control

Although the CKD diet can help slow the progression of kidney disease, it will not cure kidney disease.  Other lifestyle choices such as taking prescribed medications, following a physician approved exercise regimen, and not smoking can help keep you healthier longer. By following up with your nephrologist, dietitian and other healthcare providers you can develop a plan. Stick with it to keep your kidneys and your body as healthy as possible for as long as possible.

References

  1. https://www.jrnjournal.org/article/S1051-2276(17)30257-1/fulltext
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409713/
  3. https://www.jrnjournal.org/article/S1051-2276(13)00159-3/fulltext
  4. https://www.jrnjournal.org/article/S1051-2276(07)00267-1/fulltext
  5. https://www.kidney.org/atoz/content/Dash_Diet

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

Jessica Triggs, MPH, RDN

Jessica Triggs, MPH, RDN

Jessica has been a registered dietitian for over 10 years with nearly all of that time working with the renal population. She is passionate about the power of food in improving the health of our communities. She grew up on a farm in Kansas and enjoys gardening and incorporating farm fresh foods in to a healthy diet for her family. Jessica and her husband have two young daughters with whom they enjoy traveling.