As kidney disease progresses into the later stages of CKD, nutritional needs change. If you have reduced kidney function, your doctor may recommend that you change your eating plan to protect your kidneys. Learning about your food choices will help you understand what changes you need to make.

You can prevent or delay health problems from CKD by eating the right foods. Eating too much protein can burden the kidneys and speed the progression of CKD. Protein foods like meat and dairy products break down into urea nitrogen and creatinine which are waste products that unhealthy kidneys cannot properly remove from the blood. Foods high in phosphorus, potassium, and sodium should be avoided.

Calories

Calories are units of energy provided by food. Work with your dietitian to determine how many calories you need each day to maintain a healthy weight.

As CKD progresses, you may find that foods do not taste the same, and you may lose your appetite. Your dietitian can help you find healthy ways to add calories to your diet if needed.

Protein

Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs, and blood. They help fight disease and heal wounds. Protein also breaks down into waste products that must be cleaned from the blood by the kidneys. Eating more protein than your body needs may put an extra burden on the kidneys and cause kidney function to decline faster.

Doctors have long recommended that patients with CKD eat moderate or reduced amounts of protein. There are two sources: 1) animal products like fish, poultry and meat and 2) non-animal sources like vegetables, breads, cereal, pasta, and dry beans. You need protein from both sources but should not exceed four to six ounces of animal-based protein each day.

Talk with your dietitian about the amount of protein and the sources of protein in your diet. Animal sources such as egg whites, cheese, chicken, fish, and red meats contain more of the essential amino acids your body needs. A well-balanced vegetarian meal plan can also provide these nutrients. Your dietitian can suggest ways to make small adjustments in your eating habits that can result in significant protein reduction. For example, you can make sandwiches using thinner slices of meat and filling out the sandwich with lettuce, onions, bell peppers, mushrooms, cucumber slices, and apple slices.

Fat

Fat provides energy, helps produce hormone-like substances that regulate blood pressure and other heart functions, and carries fat-soluble vitamins. You need fat in your diet, but some fats are healthier than others. Saturated fats and trans-fatty acids can raise your blood cholesterol levels and cause clogging of blood vessels.

Talk with your dietitian about healthy and unhealthy sources of fat. Saturated fats are found in animal products like red meat, poultry, whole milk, and butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercial baked goods like cookies and cakes and in fried foods like doughnuts and french fries.

Your dietitian can suggest healthy ways to get fat into your diet, especially if you need more calories. Vegetable oils like olive or canola oil are healthier than animal fats like butter or lard. Avoid hydrogenated vegetable oils because they are high in trans-fatty acids.

Bad Fats	Healthier Fats
Saturated Fats and Trans-fat Acids	Polyunsaturated Fats
Red Meat	Corn Oil
Poultry	Safflower Oil
Whole Milk
Butter
Lard	Healthiest Fats
Commercial baked goods	Monounsaturated Fats
French fries	Olive Oil
Doughnuts	Peanut Oil
Hydrogenated vegetable oils	Canola Oil

Sodium

Too much sodium in your diet can be harmful because it causes your blood to hold fluid. The extra fluid raises your blood pressure and puts a strain on your heart and kidneys. Sodium is found in ordinary table salt and many seasonings like onion/garlic salt, soy sauce, teriyaki sauce, ketchup and barbecue sauce to name a few. Canned foods, some frozen foods, most processed meats, chips, crackers and other snack foods have large amounts of sodium. Talk with your dietitian about reducing sodium in your diet. Look for the sodium content on the nutrition labels of the foods you buy. Choose "sodium-free" or "low-sodium" food products. Aim to keep your daily sodium intake less than 2,000 milligrams (about 2/3 of a teaspoon of salt).

Try alternative seasonings like lemon juice, vinegar, salt-free seasoning mixes, or hot pepper sauce. Avoid salt substitutes that use potassium.

High Sodium Foods	Lower Sodium Alternatives
Salt	Salt-free herb seasonings
Canned vegetables	Frozen vegetables
Hot dogs	Unsalted popcorn
Packaged rice with sauce	Plain rice
Packaged noodles with sauce	Plain noodles
Frozen vegetables with sauce	Unsalted pretzels
Canned soup
Tomato sauce
Snack foods

Potassium

Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. Too much potassium can be very dangerous to your heart. Potassium is found in many fruits and vegetables such as bananas, oranges, tomatoes, potatoes, avocados, and melons. Check your blood tests to make sure that your potassium level stays in the normal range. If it begins to climb, talk with your dietitian about ways to limit the amount of potassium you eat. You may need to avoid some fruits and vegetables.

High Potassium Foods	Lower Potassium Alternatives
Oranges and orange juice	Apples and apple juice
Melons	Cranberry juice
Apricots	Canned fruit
Banana	Strawberries, blueberries, raspberries
Kiwi	Plums
Potatoes	Pineapple
Tomatoes	Cabbage
Sweet potatoes	Cauliflower
Cooked spinach	Mustard greens
Beans (baked, kidney, lima, pinto)	Broccoli

Phosphorus

Phosphorus is a mineral found in many foods. Too much phosphorus in your blood takes calcium from your bones. Losing calcium will make your bones weak and likely to break. Too much phosphorus may also make your skin itch. Foods like milk, cheese, dried beans, peas, colas, canned iced teas and lemonade, nuts, and peanut butter are high in phosphorus. Talk with your dietitian about how much phosphorus you should have in your diet.

As your kidney disease progresses, you may need to take a phosphate binder which acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is passed out of the body in the stool.

High Phosphorus Foods	Lower Phosphorus Alternatives
Dairy foods (milk, cheese, yogurt)	Liquid non-dairy creamer
Beans (baked, kidney, lima, pinto)	Sherbet
Nuts and peanut butter	Pasta and rice
Processed meats (hotdogs, canned meats)	Rice and corn cereals
Cola	Green beans
Canned iced tea and lemonade	Lemon-lime soda
Bran cereals	Root beer
Egg yolks	Powdered iced tea and lemonade

Keep Track of Test Results

If you have CKD, your doctor will order regular blood tests. Many patients find that keeping track of their test results helps them see how their treatment is working. Ask your doctor for copies of your lab reports and have them explained to you. Note any results that are out of the normal range. When you learn how to read your reports, you will see how the foods you eat affect your kidneys. Talk with your doctor or your dietitian about making healthier food choices. Remember that you are the most important member of your health care team.