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It is important to maintain adequate nutrition while maintaining electrolyte and fluid balance with chronic kidney disease
Modification of diet in chronic kidney disease (CKD) depends on the stage of chronic kidney disease
Chronic kidney disease I-II: Mild early signs of kidney problem such as protein in urine or slight elevation in creatinine.
Continue healthy balanced diet based on your medical conditions, such as diabetic diet if you have diabetes and low sodium diet if you have high blood pressure.
Goal of care at this stage of chronic kidney disease is prevent further progression
Chronic Kidney Disease III: Moderate kidney disease and now classified as 3A and 3B based on severity
Elevated creatinine with estimated kidney function 30-59 ml per minute
Continue healthy balanced diet based on your medical conditions, such as diabetic diet if you have diabetes and low sodium diet if you have high blood pressure. Goal of care at this stage of chronic kidney disease is prevent further progression
Dietary restrictions on dialysis may seem daunting in the beginning. However, with right guidance you can continue to enjoy some of the foods that you like with guidance from your dialysis unit dietician.
Every dialysis unit has a team consisting of a dietician highly trained in nutrition and diet on dialysis.
Take the time to write down your questions and discuss your food intake with your dietician. I recommend for patients who have difficulty regulating high potassium, phosphorus or fluid balance to maintain a food diary.
If you have high potassium or hyperkalemia, avoid high potassium containing foods such as bananas, oranges, tomatoes and potatoes
If you have high phosphorus, avoid high phosphorus containing foods such as dairy products and cheese
If you have difficult to control fluid status, follow low sodium diet and restrict your fluid intake
While water is most essential for survival and maintenance of good health, too much water can be harmful in certain conditions.
What are those conditions?
Most common conditions where you may be asked to limit your water intake are
Hyponatremia (low sodium levels) or SIADH (Syndrome of Inappropriate ADH secretion)
Congestive Heart Failure (CHF)
In SIADH, you body inappropriately holds onto water and dilutes your sodium causing a drop in sodium levels
In Congestive Heart Failure or CHF, too much water and salt intake can cause worsening swelling and can cause fluid in the lungs
In cirrhosis liver, excess water intake can cause increased swelling and worsening hyponatremia
In Dialysis, similar to CHF, most patients don't urine or produce less urine so excess fluid and salt intake can cause fluid retention worsening swelling and fluid in the lungs
How much water intake?
For hyponatremia, depending on your sodium level, fluid restriction especially free water (plain water) restriction of 1000 ml to 1200 ml (34 oz to 40 oz) per day is recommended
Fluid restriction also depends on your weight, and activity levels as well as other medications, and medical conditions you may have.
In CHF/dialysis patients, usual fluid restriction is up to 1500 ml per day, again depending on medications, and fluid status of individual patients
Discuss with your nephrologist or your provider about your individual fluid restriction and condition. The information on this website is for information purpose only and is not to be used as medical advice
Why low potassium diet?
Kidneys are organs that regulate potassium balance in the body. Too high of potassium can cause heart to go out of rhythm and in some cases even stop the heart.
When kidney function is low, especially low enough to need dialysis, it is important to follow low potassium diet.
What is a low potassium diet?
Potassium is found in many types of foods, predominantly fruits and some vegetables.
Most common fruits with high potassium are avocados, bananas, oranges, nectarines, cantaloupe.
Juices like carrot juice and prune juice
Dried fruits like raisins, dates and prunes
Vegetables: potatoes, tomatos, spinach, swiss chard, beets, beet greens
Beans: white beans and adzuki beans have the highest amount of potassium among beans. Other beans with high potassium are pinto beans and lima beans
Seafood: such as salmon, halibut, clams
Dairy: yogurt is also a rich source of potassium
The most popular and recommended Mediterranean diet /DASH diet and a well balanced diet is also rich in potassium.
While diet rich is fruits and vegetables is recommended for most healthy adults to maintain and improve healthy eating choices, diet for kidney patients needs to be carefully regulated.
Every dialysis unit has an assigned dietician to discuss diet with every dialysis patient and will explore reasons for uncontrolled potassium. Most often, diet is the main reason for high potassium.
Discuss your diet and questions regarding your diet and nutrition with you dietician
Potassium level is measured with routine lab work ordered by your physician called Basic Metabolic Panel (BMP) or Comprehensive Metabolic Panel (CMP)
Normal potassium level is 3.5 to 5 mmol (or meq)/L
Potassium levels 5.1 to 5.5: Low potassium diet and repeat potassium and follow up is recommended. Your doctor may discontinue medications that can increase potassium
Potassium level 5.5 to 5.9 meq/dL: Requires more aggressive medical management, including discontinuing medications that increase potassium, give medications called Kayexalate that get rid of potassium through stool
Potassium levels >6 meq/L: can cause dangerous heart arrythmias and require hospitalization to reverse hyperkalemia
Always discuss lab results in detail with your provider. This information on this website is for educational purpose only and is not to be used in place of medical advice.
Why low phosphorus diet?
Low phosphorus diet is important to regulate bone health in kidney patients.
Phosphorus level is ideally 3.5 to 5 mg/dL
Phosphorus levels up to 5.5 mg/dL may be managed with diet, with decreasing amount of phosphorus in the diet.
However, most of the time, a medication called phosphorus binder is needed to control phosphorus.
What type of foods contain high phosphorus?
Colas especially dark colored colas
Eggs (especially with yolk)
Meats and poultry
High phosphorus stimulates a hormone called parathyroid hormone that is made by parathyroid glands.
Parathyroid hormone is elevated in dialysis patients, and in chronic kidney disease patients.
The goal PTH level in dialysis patients is 150-300 picograms/mL.
This hormone is measured with labs that are routinely done in dialysis patients.
The information on this website is for educational and informational purpose only and not to be used as medical advice or distributed without permission.
Copyright © 2022 Ratnaja Katneni MD, Newport Beach Kidney doctor - All Rights Reserved.