Sodium is an element that is abundantly found in the American diet—either naturally or added into processed foods. For those with chronic kidney disease (CKD), the body is unable to filter out excess sodium, which can have harmful effects on the body. The National Kidney Foundation (NKF) and DaVita Kidney Care explain how CKD patients can manage their sodium intake.

Sodium 101 

Many people use the terms “salt” and “sodium” interchangeably. “Salt” is a term used for sodium chloride and refers to table salt. Sodium is also found in other forms, including monosodium glutamate (MSG), sodium bicarbonate (baking soda), and sodium nitrate (a preservative).

Sodium is the body’s main source of electrolytes. One important function of an electrolyte is controlling the amount of fluid going in and out of the body’s tissues. Therefore, sodium plays a key part in managing the body’s fluids, which is needed to regulate blood pressure. 

What excess sodium does to the body? 

If you have chronic kidney disease (CKD), since your body can’t filter out excess sodium, sodium builds up. As sodium builds up, fluid builds up in the tissues and leads to high blood pressure. Over time, high blood pressure worsens CKD. If this happens, other sodium-related complications may arise, such as fluid retention (in the legs, arms, and face), heart failure, and shortness of breath.

What are some tips to reduce sodium intake? 

Using natural ingredients while cooking, such as herbs and spices, is a great way to add flavor or a kick to your food without increasing your sodium intake.

Here are some herbs and spices to try out and what foods to put them in: 

• Curry: Beef, chicken, pork, fish, green beans, carrots, and in marinades
• Dill: Beef, chicken, green beans, cabbage, carrots, peas, and in dips
• Ginger: Beef, chicken, pork, green beans, cauliflower, and eggplant
• Rosemary: Chicken, pork, cauliflower, peas, and in marinades
• Thyme: Beef, chicken, pork, fish, green beans, beets, and carrots
• Sage: Chicken, pork, eggplant, and in dressing 

Substitutes for high-sodium foods

Finding acceptable substitutes for high-sodium foods is important in preventing the progress of kidney disease. The NKF breaks down what foods to limit because of their high sodium content and why—and what to sub in instead.

What to limit

• Sea salt and salt seasonings (table salt, seasoning salt, garlic salt, and onion salt)
• Salty sauces (barbecue sauce, steak sauce, soy sauce, and teriyaki sauce)
• Salty foods (crackers, potato chips, corn chips, and pretzels)
• Cured foods (ham, salt pork, bacon, and sauerkraut)
• Lunch meats (hot dogs, cold cuts, deli meat, and pastrami)
• Processed dairy products (buttermilk and cheese)
• Processed canned foods (soups, tomato products, vegetable juices, and canned vegetables)
• Processed convenience foods (canned ravioli, chili, macaroni and cheese, commercial mixes, frozen prepared foods, and fast foods)

What to use instead

• Fresh garlic, fresh onion, garlic powder, onion powder, black pepper, lemon juice, low-sodium/salt-free seasoning blends, and vinegar
• Homemade or low-sodium sauces and salad dressings, vinegar, and dry mustard
• Unsalted popcorn, pretzels, and tortilla or corn chips
• Fresh beef, veal, pork, poultry, fish, and eggs
• Low-salt deli meats (If you need to limit phosphorus, too, be aware that these are likely high in phosphorus.)
• Natural cheese (1-2 oz per week)
• Homemade or low-sodium soups and canned food without added salt
• Homemade casseroles without added salt, made with fresh or raw vegetables, fresh meat, rice, pasta, and unsalted canned vegetables  

What to look for on the nutrition label?

Creating a habit of reading the nutrition label and reviewing the sodium content will help to start healthier eating habits. A standard low-sodium diet is 2300 mg (2.3 grams) of sodium daily. For a person who eats three meals and two to three snacks daily, a good goal is to stay at less than 600 mg per meal and less than 150 mg per snack. 

Many companies use labels to promote health in their product. This is sometimes helpful for the consumer, but other times may be misleading. 

Here are definitions of each sodium-related term seen on current nutrition labels:

• Sodium-Free: Only a trivial amount of sodium per serving
• Very Low Sodium: 35 mg or less per serving
• Low Sodium: 140 mg or less per serving
• Reduced Sodium: Foods in which the level of sodium is reduced by 25%
• Light or Lite in Sodium: Foods in which the sodium is reduced by at least 50%

What about salt substitutes? 

Salt substitutes seem to be an easy choice when told to lower salt intake. Unfortunately, many salt substitutes are replaced with potassium—another thing to keep an eye on with CKD. Before using a salt substitute, discuss with a doctor or dietitian first who can make recommendations on salt substitutes for each individual.

For more information on sodium and kidney disease, check out “Sodium and Chronic Kidney Disease” and “Sodium, the Heart and Kidney Disease” by DaVita Kidney Care.

*Sodium and Your CKD Diet: How to Spice Up Your Cooking. (2020, June 26). National Kidney Foundation.