If you have stage 4 chronic kidney disease (CKD), your remaining kidney function is between 15 and 29%. has declined significantly. Accumulated toxins, wastes, and minerals in your body may be causing fatigue, insomnia, nerve issues, fluid retention, nausea and vomiting, loss of appetite, and weight loss. In addition to negatively impacting your quality of life, these symptoms can also lead to malnutrition, which is why stage 4 CKD diet goals focus on minimizing symptoms and optimizing nutrient intake.*

Protein in stage 4 

Our bodies generally only need about 46 (women) to 56 (men) grams of protein per day. When your kidneys aren’t functioning properly, however, having to process all that protein can place a strain on them. This is why kidney diets, also called renal diets, often limit protein intake unless you’re on dialysis.

According to the Kidney Disease Outcome Quality Initiatives (K/DOQI) Nutrition Guidelines, once your kidney function goes below 25%, reducing your protein consumption to 0.6 grams per kilogram of body weight can help relieve kidney stress.

Consistently eating lower-than-normal amounts of protein, however, can lead to muscle-wasting and malnutrition. For this reason, the K/DOQI recommends that half your protein sources should provide all essential amino acids, which can be found in such foods as:

• Eggs, 
• Milk,  
• Poultry,   
• Red meat,
• Seafood, and
• Soy. 

Protein requirements vary from person to person, so speak with your renal dietitian about safe amounts and sources of protein for you at this stage.

Phosphorus in stage 4

Inadequate kidney function can also cause the mineral phosphorus to accumulate in your blood. Phosphorus works with calcium to keep your bones strong. When too much phosphorus causes an imbalance, your body leaches calcium from your bones in an attempt to recreate a balance.

This can cause weak, brittle bones, calcification of the heart and blood vessels, and other complications. To avoid this, your doctor may recommend restricting phosphorus in your diet to between 800 and 1,000 milligram a day.  

Foods to limit can include:

• Chocolate
• Nuts, seeds, and legumes (peanuts, lentils, peas, beans)
• Milk, cheese, yogurt, ice cream, and other dairy products

Potassium in stage 4 

Like phosphorus, potassium can also accumulate in the blood when the kidneys are no longer able to fiIter out the excess. In order to minimize the buildup, you may need to eat no more than 2,000 to 3,000 milligrams of potassium daily. 

Foods high in potassium include:

• Fruits such as avocados, bananas, melons, oranges, and any dried fruits
• Pumpkin and squash
• Nuts, seeds, and legumes
• Milk and yogurt
• Potatoes and potato prpoducts
• Tomatoes and tomato products

Sodium in stage 4

Sodium is a major cause of water retention. Even people without kidney disease can have swelling after eating a lot of salt. With healthy kidneys, however, the extra fluid is flushed out of the body, eliminating the swelling. Kidneys functioning at low capacity can’t do this, and the swelling remains, placing stress on various major organs. Kidney experts often recommend a maximum of 1,500 to 2,000 milligrams of sodium per day.  People with advanced kidney diseaseMost kidney diets start with a goal of 1,000 to 2,000 mg per day, depending on your fluid intake.  

Remember, you don’t need to cut out these foods and nutrients completely in order to eat healthily with stage 4 CKD. Being mindful about portion control and food combinations can   support your kidneys and satisfy your personal tastes and preferences. Speak with your nephrologist and renal dietitian about the optimal amounts of nutrients, calories, and fluids for your individual health needs.

*DaVita Kidney Care. (n.d.) Stage 4 Kidney Disease Diet: Focusing on Nutrition. https://www.davita.com/diet-nutrition/articles/advice/stage-4-kidney-disease-diet-focusing-on-nutrition#:~ 

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