Nutrition for advanced kidney disease

Knowing what to eat when you have kidney disease can be confusing.  You may read recommendations for a “renal diet” but there is no one renal diet appropriate for everyone with kidney disease. Kidney disease progresses at different rates for different people and the need for dietary restrictions may arise at different times during this disease process. 

To find out the appropriate renal diet for you, speak with your nephrologist and then see a renal dietitian for advice on how to alter your eating habits to fit these restrictions.

Your kidneys have many important jobs in the body:

• Regulate the amount of water in the body
• Remove waste products
• Produce hormones for a variety of purposes, including making red blood cells and regulating blood pressure
• Maintain the body’s balance of different minerals and chemicals
• Make Vitamin D active to keep your bones strong

When kidney function is reduced, many important activities of the body are affected and imbalances can occur. Thus, when you have advanced kidney disease, you may have to watch your consumption of various nutrients. The restrictions you need to follow depend on the imbalances which you have.

Possible restrictions include:

If your kidneys can no longer filter out excess potassium and/or if the medications you take contribute to retention of potassium, you will need to limit potassium intake from foods.

If your kidneys are no longer able to maintain a good balance of phosphorus and calcium in the blood, you may need to limit phosphorus intake from foods.

If your kidneys no longer filter out all waste products from protein metabolism, then you need to limit protein to prevent the build-up of protein wastes. However, restricting protein too much can cause breakdown of muscle mass. A renal dietitian can calculate your protein needs.

High protein diets are not recommended for patients with chronic kidney disease.

Limiting sodium helps to control blood pressure and fluid balance in the body.

Fluids may be restricted if your body is not able to produce as much urine as needed to get rid of excess fluids in the body. This usually occurs in very late stages of kidney disease.

If your blood lipids are high, you may need to control saturated fat consumption. There is an association between chronic kidney disease and cardiovascular disease.

If you have diabetes, you need to match your carbohydrate consumption with an appropriate amount of medication or insulin so that your blood glucose levels are in range most of the time

Not everyone needs these limitations at the same stages of kidney disease. Your nephrologist will monitor your labs and let you know which of these dietary restrictions will help keep you healthy.