If you’re like most people with chronic kidney disease (CKD), understanding and managing your diet can seem very challenging. Patients are often given overly general diet handouts and vague information at their doctors’ offices. Others may search online for information, only to find it leading to contradictions and confusion.   

As a renal dietitian, I’ve worked with early- to late-stage CKD patients including dialysis and post-transplant patients. When working with new patients, my main goal is to simplify the renal diet and help set realistic ways to incorporate the diet into their lifestyle. Learn more about kidney-friendly nutrition as I answer common questions I receive as a renal dietitian. 

What should I eat?

While this is a question that requires more information to give a specific answer, I do generally give a few good starting points to patients. These include:

• Incorporate the MyPlate method for as many meals as possible. This simple approach helps to ensure you are eating the recommended five servings of fruits and vegetables per day. Cutting down on animal-based meats and processed foods with this method can also be beneficial to your kidneys. 
• Know your sources of sodium. It is recommended for most CKD patients to consume 2000 mg or less of sodium daily. Patients come to me quite often not adding any salt to their food and think this means they are following a low sodium diet. However, the majority of the packaged foods we buy contains sodium. If you eat three meals a day, I’d recommend trying to stay at less than 600 mg per meal. Start getting in the habit of checking the nutrition label for sodium and try to buy snacks, salad dressings, and entrée side items like vegetables and starches with less than 200 mg per serving. 
• Be a smart shopper. Beware of products identified as “Unsalted,” “No Salt Added,” “Reduced Sodium,” or “Lower Sodium.” These items may still be high in sodium. You should always check the nutrition label.
• Eat heart-healthy fats. This starts with your cooking oils. Replace butter, stick margarine, and palm oil with oils that contain more unsaturated fat (olive, peanut, soy, sunflower, and canola). 

Do these starting points sound like anything you’ve heard from a doctor regarding high blood pressure or heart disease? They are. Good kidney health starts with good heart health. For many patients in stages 1-3 CKD, a heart-healthy diet may be all you need to follow. 

As CKD progresses, you may need to limit certain foods high in potassium and phosphorus. Your doctor keeps an eye on your bloodwork, and will tell you when you need to limit these nutrients. 

Do I need to limit protein?

If you have CKD and are not on dialysis, you may need to watch how much protein you eat. Too much protein can cause wastes to build up in your blood. However, you do not want to completely eliminate protein from your diet, as it does help to maintain muscle and fight infections. 

Once you reach stage 3 or higher CKD, it is highly recommended to talk to a renal dietitian to give you specific protein guidance. Reach out to your insurance if you are at this stage, as most insurance carriers will cover visits to a renal dietitian. 

To give you some understanding of what goes into estimating your protein needs, a renal dietitian needs certain information to do their calculation. This includes:

• Bodyweight and any weight changes
• Age
• Gender
• Stage of CKD
• Amount of protein in your urine
• Other health conditions, such as diabetes, cancer, and liver cirrhosis 

Is a plant-based diet good for your kidneys?

When done wisely and with guidance, a plant-based diet has been shown to help prevent CKD from getting worse. Unlike a vegetarian diet, a plant-based diet reduces but does not eliminate animal foods such as dairy, eggs, fish, meat, and poultry. This new approach to eating healthier allows for individuals to still occasionally enjoy their steak or hamburger. 

To make a plant-based diet as kidney-friendly as possible, it is also recommended that you limit refined grains (white bread and pasta, highly processed or high sugar cereals, white rice, snack foods (potato chips and cookies), and sugar-sweetened beverages. Eating less of these foods helps to leave more room for foods that are rich in fiber, vitamins, and minerals. 

Some popular and well-known plant-based diets include:

• The Mediterranean diet. This is a diet typical of many Mediterranean countries such as Italy and Spain. It consists mainly of cereals, grains, vegetables, beans, fruits, and nuts, along with moderate amounts of fish, cheese, olive oil, yogurt, and a little red meat
  
• The DASH diet. This diet is often recommended for people with high blood pressure. It involves eating fruits, vegetables, low-fat dairy foods, whole grains, fish, poultry, and nuts. It also limits sodium (salt), sweets, sugary drinks, red meats, and foods that are high in saturated fat, cholesterol, and trans fats
  
• The MIND diet. This diet combines the Mediterranean diet and the DASH diet to create a diet that focuses on brain health. Green leafy vegetables, berries, nuts, olive oil, whole grains, fish, beans, and poultry are the main focus.

Before making any changes to your diet, please discuss them with your doctor to ensure their safety for you.

Where can I find recipes and more trusted diet information?

While there are many recipe websites available, here are some of my recommendations based on your stage of CKD:

• National Kidney Foundation offers many recipes and includes a great filtering system, where you can select your stage of CKD and diet preferences. 
• For patients with diabetes, it is important to learn to control your diabetes to help prevent CKD progression. You can learn more at the Recipes and Nutrition section of the American Diabetes Association website.
• The American Kidney Fund is also a great resource for many areas of CKD and offers in-depth patient webinars. 

If you find yourself struggling with your kidney diet, it is understandable as it is a complex diet. It is also a diet that does not need to be perfect to see progress and improvement in your health. Speaking with a renal dietitian can be invaluable and help you to balance a healthy diet and the lifestyle you enjoy. 

What is a Plant-Based Diet, and Is It Good For Your Kidneys? (2022, January 14). National Kidney Foundation. https://www.kidney.org/atoz/content/what-plant-based-diet-and-it-good-kidney-disease