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Chronic Kidney Disease (Part 2)

Ackerman Cancer Center

June 1, 2019

Nutritional status plays an important role in the long-term survival of patients with kidney (renal) complications. Malnutrition is very common in patients with CKD, especially those who are on dialysis and its prevalence ranges from approximately 20 percent to 70 percent among adult dialysis patients.

Nutritional care correlates with the level of kidney dysfunction, stage of the disease and its medical treatment. In patients with chronic kidney disease (CKD) without dialysis (stages 1-4) nutrition must be focused on improving the control of other diseases in order to delay the progression of kidney damage; such interventions include improving blood pressure, blood glucose control, cholesterol levels, etc.

A diet low in protein can be beneficial due to the dietary protein being broken down into amino acids and absorbed from the intestine into the blood. Excess amino acids are broken down into carbohydrates and nitrogen-containing waste that is eliminated by the kidneys. More intake of dietary protein means more work for our kidneys to eliminate waste products. This process may further damage the kidneys and speed up the progression of chronic renal failure (CRF or stage 5 CKD).

Learn more about nutrition and CKD, educational materials and recipes

  • Click here to learn more about nutrition and kidney complications

Patients with stage 3-4 CKD are encouraged to restrict protein, phosphorus, sodium and potassium (potassium is restricted if serum level are high).

Learn more about nutrition in CKD stages 1-4 

The main goals for patients with stage 5 CKD are to meet nutritional requirements, minimize uremia (urea levels in blood) and associated CKD complications; such as cardiovascular disease, anemia, etc.) as well as maintianing blood pressure and fluid status. The diet for individuals that are in hemodialysis is high in protein and controls intakes of potassium, phosphorus, fluids, and sodium. Patients receiving peritoneal dialysis have a more liberalized diet than hemodialysis patients.

  • Click here for an introduction to nutrition in stages 1-4
  • Click here for basics on nutrition in stage 1 – 4 (protein, sodium, phosphorus and potassium restriction, etc.)
  • Click here for a booklet on nutrition for stage 5 CKD
  • Click here for a DAHS diet to improve blood pressure

Learn more about nutrition in stage 5 CKD

  • Click here for more information about nutrition and kidney failure (dialysis)
  • Click here for more information about nutrition and peritoneal dialysis
  • Click here for more information about nutrition while hemodialysis
  • Click here for more information about nutrition after a kidney transplant

Extra tips for dietary changes

  • Click here for tips for dining out
  • Click here to learn how to get more protein while on dialysis
  • Click here to see how much is the right amount of protein
  • Click here for more information on Sodium
  • Click here for more information on Potassium
  • Click here for more information on Phosphorus

The Nutrition Care Manual from the Academy of Nutrition and Dietetic has client educational materials for patients on dialysis. Continue reading to obtain some tips and recommendations for ESRD or stage 5 CKD:

Meal planning tips

  • Stick to the food portions shown in your meal plan.
  • Plan menus based on what you usually eat. Add snacks as desired.
  • Take your phosphorus binder as directed, usually with every meal and snack.
  • Develop simple, quick menus for days that you can’t cook.
  • Plan ahead for special occasion meals and for when you eat at restaurants so you can choose the foods that are best for you.

Cooking tips

  • Use very little or no salt and other salt seasonings when cooking.
  • Add lemon juice, herbs, and spices that do not contain salt to add flavor.
  • Measure portions of food and ingredients using standard measuring cups and spoons.
  • Weigh portions of high-protein foods using a kitchen scale.
  • For soaking vegetables to lower potassium, peel and cut into pieces that are approximately 1/8 inch thick. Rinse and soak them in warm water for at least 2 hours. Use approximately 10 times more water than vegetables. Drain and rinse them under warm water, and then boil them for 5 minutes.
  • Soaked potatoes can be made into several dishes. For instance, they can be french fried, mashed, boiled, home fried with onions, or scalloped.

Shopping tips

  • Read labels
  • Avoid processed foods to reduce your intake of sodium and phosphorus.
  • Avoid any food that is calcium-enriched or calcium-fortified if your doctor or dietitian has recommended you watch your intake of calcium.

Nutrition label tips

  • If salt or sodium is listed as one of the first five ingredients, the food is high in sodium and should not be bought.
  • Food labels show milligrams (mg) of sodium. The sodium level of 300 milligrams or more in each serving is too high for you to eat.

I hope you find this information helpful. Although there is a lot of information to learn ease into it by focusing on one topic at a time. This may help you better manage and understand your health condition.


Karen Alexander, MS, RDN, LD/N

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