Nutrition and pre-dialysis

High protein is stress for the kidneys and thus accelerate the progression of chronic kidney disease. Therefore, protein intake should be reduced at least to the recommended daily allowance of 0.8 g/kg body weight/day. If the GFR decreases below the value of 60 to 50 ml/min (stages 3 to 5), a more intense protein reduction might be recommended. To prevent protein malnutrition, essential keto-analogues/amino acids are often taken as supplementation to protein-reduced diets. 

Please note: If proteins are reduced it is important to take in sufficient amounts of energy and other essential nutrients (e.g. minerals and vitamins).

Low protein

>   Tomatoes 

>   Carrots 

>   Mushrooms

>   Fruits

>   selected cereals

You should reduce your intake of table salt, because it contains sodium. By holding water in the body, sodium elevates blood pressure, which is accompanied by a higher protein excretion too. Both can damage your kidneys. Be careful with processed food as this often contains high amounts of sodium.

You should also reduce your intake of phosphate, because high blood phosphate levels may cause itching and may result in losing calcium from your bones. But be careful with processed food as this often contains not only high amounts of sodium, but also phosphate.

It is useful to reduce the intake of potassium too, as high potassium levels in your blood may cause nausea and irregular heartbeat. Additionally to the diminished potassium elimination by your kidneys there are several other factors that may contribute to an increase in potassium blood levels.

Particularly in early stages of chronic kidney disease, calcium blood levels in many patients are too low. Together with the high blood levels of phosphate this may contribute to the development of bone disease (renal osteodystrophy). That means bones may become fragile or painful.

In early stages of chronic kidney disease (stage 1-4), you do not need to limit your fluid intake much as long as your urine output is normal.¹