Diet: What Foods Can I Eat With Chronic Kidney Disease?

When you suffer from chronic kidney disease, nutritional management is an essential part of your treatment plan. Depending on the severity of your disease, your recommended diet may change over time. Especially, in a more advanced stage of your disease when your glomerular filtration rate (GFR) continues to decrease, the amount of protein together with calories and other nutrients (e.g. minerals and vitamins) in your diet have to be adjusted to meet your changing needs.1

Please note that the following nutrients should be carefully monitored if you suffer from chronic kidney disease:1

  • Protein
  • Phosphate
  • Calcium
  • Potassium
  • Sodium
  • Fluid

Additionally it is important, that your nutrition contains enough calories (energy), because many patients develop malnutrition, particularly in later stages of the disease.1

Basically, nutrition in chronic kidney disease should contain:1

  • Low amounts of table salt (i.e. sodium)
  • Low amounts of phosphate
  • Sufficient calories
  • Low amounts of protein in predialysis stages
  • High amounts of protein in dialysis stage

Please ask your doctor to refer you to a skilled dietician who will support you in understanding the changing needs within the different stages of your disease and who will help you with the composition of your diet.

Main changes during disease progression

There are major differences in the nutritional recommendations during the predialysis phase and the dialysis phase of chronic kidney disease.

Nutritional requirements change within the different stages of CKD.

1. Predialysis

In predialysis stages of chronic kidney disease it is advisable to reduce your daily protein intake substantially compared to your familiar diet. High amounts of protein would damage the nephrons in your kidneys. Every protein ingested above the daily requirement will increase the appearance of uraemic symptoms and enhance the progression of kidney disease. For these reasons at least, protein should be limited to the recommended intake of 0.7-0.8 g/kg ideal body weight/day.1

However, even more efficient is a marked restricted protein intake (0.3/0.4-0.6 g/kg body weight/day) supplemented with essential keto acids/amino acids. This is indicated with a decline of GFR below the value of 60 to 50 ml/min. Both kinds of dietary protein restriction ensure that you will stay in a good nutritional status. In this respect, please note that you have to receive sufficient amounts of energy as well as adequate amounts of other essential nutrients (e.g. minerals and vitamins).1

 

2. Dialysis

When dialysis treatment becomes necessary, your dietary support has to change completely. Due to the enhanced protein losses through the dialysis procedure and excess catabolism secondary to the haemodialysis session, your daily protein intake has to be increased to 1.2 g protein/kg body weight/day or more.2

Your daily energy intake should remain constant at 30-35 kcal/kg body weight/day or preferably higher according to your physical activity or if you are below 60 years of age. Of even more importance becomes the monitoring of the intake of fluids and of specific compounds such as phosphate and potassium. With respect to phosphate, this is a tricky topic: increasing dietary protein intake always parallels with an increased intake of phosphate! Please ask for the support of a trained dietician to clarify these difficulties and to receive help in planning your diets.2

SOURCES

  1. D'Alessandro C, Piccoli GB et al. "Dietaly": practical issues for the nutritional management of CKD patients in Italy. BMC Nephrol 2016; 17(1): 10
  2. Cano NJ, Fiaccadori E et al. ESPEN Guidelines on Enteral Nutrition: Adult Renal Failure. Clin Nutr 2006; 25(2): 295–310
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