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Nutrition and Chronic Kidney Disease (Not on Dialysis)

Your food choices can be one of the most effective ways to manage your kidney disease. By determining your stage of kidney disease you can learn what diet is best for you and what foods to select.

Below are the five stages of chronic kidney disease. Your doctor will determine your stage based on your Glomerular Filtration Rate (GFR), a measure of your kidney function.

When kidney function is impaired, excess protein, sodium, potassium and phosphorus can build up in the blood stream. This table is a guideline to your diet needs.

Stages of Chronic Kidney Disease

Stage

GFR cc/min

Description

Diet needs

1

90

Kidney damage,
protein in the urine,
normal filtration

Low sodium

2

60-89

Kidney damage
with mild decrease
in kidney filtration

Low sodium

3

30-59

Moderate decrease
in filtration

Low sodium,
low phosphorus
and low protein

4

15-29

Severe decline
in filtration

Low sodium,
low phosphorus,
low protein
and low potassium

5

< 15

End stage kidney disease;
dialysis or transplant
will be needed soon

Low sodium,
low phosphorus,
low potassium,
high protein,
fluid restriction

Protein

Your doctor or dietitian will determine your protein needs. Two-thirds should come from a variety of high quality sources. Below are the best sources of protein, including fish, poultry, eggs, meat and soy. Research shows soy protein to be most beneficial with chronic kidney disease. Try to include at least one soy choice in your daily diet. For more information, view our brochure: Protein in Your Diet.

High Quality Protein Sources

Serving Size
1 serving = 7 grams of protein
8 oz = 1 cup

Dried, cooked beans
1 serving daily

½ cup

Meat, fish or poultry
Or meat substitutes
1 serving daily

1 oz
1 garden burger, 1 tofu hotdog or 3 oz tofu

Dairy products and milk substitutes
1 portion daily

2 Tablespoons nut butter
1 cup soy milk
½ protein bar or nutritional drink
1 egg or ¼ cup egg substitute
4 oz 2% cottage cheese

Sodium

All foods contain sodium, however, processed and canned foods have higher concentrations of this mineral. Review the list of foods you should avoid below. If you eat these foods in significant portions, you may be consuming too much sodium. For more information, view our brochure: Sodium in Your Diet.

Convenience foods: frozen meals, bacon, ham, bologna, hot dogs, canned or dried soups, canned beans, vegetables, miso, processed cheese

Meat Analogues: Limit to 1 serving/day (1 tofu hot dog, 1 garden burger, or one frozen meal entrée)
o Limit processed vegetarian meals or meat analogues to one/day with less than 600 mg of sodium. Limit side dishes, such as canned vegetables or beans, to less than 150 mg sodium per serving.

Condiments: Soy or teriyaki sauces, salt, rock/sea salt, garlic or onion salt
Add herbs and spices instead of salt; use garlic or onion powder instead of garlic or onion salt.

Phosphorus

When kidney function falls below a GFR of 50, phosphorus should be restricted, even if blood phosphorus levels are normal. The most concentrated sources of phosphorus are dark colored carbonated beverages and commercial iced tea, followed by dairy products and some dried cooked beans. However, the phosphorus in dried cooked beans is absorbed less and seldom requires restriction when eaten as one protein serving per day. To restrict phosphorus appropriately, follow these guidelines:

Phosphorus Restriction Sources

Serving Size
8 oz = 1 cup

Dairy products and milk substitutes
1 portion daily

2 oz (1/4 cup) cheese
3 oz (.375 cup) soy cheese
1½ cups ice cream
8 oz (1 cup) milk
8 oz (1 cup) yogurt

Dried cooked beans
1 portion daily

½ cup cooked

Note: Avoid dark carbonated sodas like colas, Pepsi, Dr. Pepper and bottled or canned iced tea.

Potassium

Potassium restriction varies based on GFR and medications. If your dietary potassium requires restriction, follow the guidelines below. For more information, view our brochure: Potassium in Your Diet

Potassium Restriction Sources

Serving Size
8 oz = 1 cup

Fruit
2 portions daily

1 small fruit or ½ large
½ cup canned fruit
½ cup fruit juice

Vegetables and starches
3 portions daily

1 cup fresh
½ cup cooked
½ cup dried cooked beans (once per day)
½ potato

Note: Avoid salt substitutes, wasabi or herbal supplements which can be high in potassium. Review these with your doctor or dietitian.

Fluid

Fluid usually does not need to be restricted unless you are in end-stage kidney disease. When not receiving dialysis treatment, a typical fluid restriction is your 24-hour urine output plus 250 cc (8 oz). With dialysis, a typical fluid restriction is 750 cc (24 oz) plus your 24-hour urine output. Fluid is defined as anything liquid at room temperature, such as water, ice tea, coffee, soda, gelatin, ice cream or sherbet.

Calories

If you need high calorie foods to keep from losing weight, see the list of food below that will help you balance variety in your diet.

High Calorie Sources

Serving Size

Bread, grains and starches
6 to 8 portions daily

1 slice bread, ½ bagel,
½ English muffin,
½ cup rice, pasta, barley, ½ cup cooked cereal or grains,
1 cup dry cereal,
6 low sodium crackers,
2 rice cakes,
3 cups unsalted popcorn

Fats
3 or more portions daily

1 tablespoon margarine,
butter,
sour cream,
mayonnaise,
oils

In addition, other high sugar foods include: agave, honey, table sugar, cream mints, gum drops, jelly beans, non-dairy whipped cream, syrup, homemade cookies, pies and cakes.*

*These foods are suggested for Non-diabetics only. They are sources of high calories and concentrated sugars and are recommended to help prevent weight loss.

If you have diabetes

While following the guidelines above, keep these recommendations in mind:

  • eat meals regularly to meet your insulin needs
  • monitor your blood sugar regularly, it is not uncommon to have changes in insulin needs with progressive kidney decline
  • use clear carbonated beverages or Lifesavers® for low blood sugar reactions
  • avoid orange juice for low blood sugar reactions, this concentrated source of potassium may cause your potassium level to rise

Vitamins and minerals

Discuss vitamin and mineral supplements with your doctor or dietitian. A vitamin, and possibly mineral supplement, may be beneficial while following a diet modified in potassium, phosphorus and protein.

Some over-the-counter multivitamins are adequate for kidney disease stages one through four. For stage five, take vitamin and mineral supplements according to your doctor’s or dietitian’s guidance.

During dialysis, your needs will be especially high for Vitamin B and C. However, supplements with mega doses of Vitamin C and trace minerals should be avoided. Without careful monitoring, these can be dangerous to those with kidney disease.

Nutrition FAQ:

How long do I have to follow this diet?
You will most likely need to follow some type of diet after dialysis is completed. It is not uncommon for your diet needs to change. Work with your doctor or dietitian to determine what changes may need to be made.

How do I know the diet is helping me?
The best way to determine how your diet is working is by obtaining routine blood tests. You will then know such things as changes in your GFR, potassium and phosphorus level. You will also want to monitor your blood pressure. High blood pressure can affect your kidneys as well.

Will a diet cure my kidney disease?
If you have been diagnosed with chronic kidney disease, most likely you cannot be cured. However, diet can help slow down the decline of kidney disease or prevent further decline.