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Recommended Fact Sheets: Nutrition and kidney failure and Calcium & phosphate
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Helping kidneys to control body chemistry by eating a sensible diet is an important part of managing chronic kidney disease (CKD)
Managing what you eat when you have kidney disease can be a challenge but can have a positive influence on how you feel and the other treatments you might need. It is important to recognise that as kidney disease progresses your dietary needs will more than likely change. Every person with kidney disease is different with individual food preferences and dietary needs.
Advice is given on a personal basis, taking into account what you like to eat, how you are feeling, your age, lifestyle, weight, muscle size, health status and blood test results. You may find that initially the suggested changes might be small, but as kidney disease progresses more significant changes may be required.
Being careful about what is eaten can reduce the amount of fluid and waste build-up, helping to minimise symptoms and side effects of CKD. Dietary assessment includes review of intake of energy and important nutrients such as protein, sodium/salt, potassium, phosphate, fluid, fat and carbohydrate.
Explanations of nutrients below. Your dietary needs change with the different stages of your kidney failure. Other than reducing salt and fat intake, there is no standard kidney disease diet.
Nutrition and CKD - important points to remember
- get the right amount of energy from food as well as staying at a healthy body weight.
- your nutritional care plan needs to be personalised and based on your kidney function.
- ask questions until you fully understand your diet.
- you may need to measure foods and fluids; for greater accuracy, measure with a cup or scale.
- take your medication as prescribed.
- organise reviews and follow-up with your renal dietitian.
- be aware of and note your trends in body weight, blood pressure and blood values.
- inform your doctor or dietician if you are losing weight or have any concerns about your diet.
- following your suggested nutritional care plan may not treat or cure your kidney problem, but it could help you reduce some of the symptoms, and improve your general feeling of wellbeing.
An Accredited Practicing Dietitian experienced in the area of diet and kidney disease can explain how it all works and help plan your meals. This Dietitian will take into account how you are feeling, your age, lifestyle, weight, muscle size, health and blood test results. Ask your GP or kidney specialist for referral. Dietitians Association of Australia for name and contact details of a local renal dietitian or call 1800 812 942. If you have seen a dietitian the information below should not take the place of the diet prescribed for your personal health profile.
CONTROLLING IMPORTANT NUTRIENTS IN YOUR RENAL DIET
These key nutrients to consider and control in your renal diet are summarised below.
Kidney disease, high blood pressure and sodium are all linked. Most people should limit the amount of sodium in your diet. Even if you don’t use salt in cooking or at the table, your diet can still be high in sodium. This is because sodium is found in many processed foods. Generally, foods that have a lot of sodium include:
- salty seasonings like soy sauce, Teriyaki sauce, garlic or onion salt
- most canned foods and some frozen foods
- processed meats like ham, bacon, sausage and cold cuts
- salted snack foods like chips and crackers
- most restaurant and take-away foods
- canned or dehydrated soups like packaged noodle soup
Salt substitutes are often high in potassium and should NOT be used without consulting your doctor or an Accredited Practicing Dietitian.
Australian World Action on Salt & Health - Drop the Salt Campaign for helpful tips. Extensive list of low sodium foods are listed at www.lowsodiumfoods.com.au
Potassium is an important mineral in the blood helping your muscles and heart to work properly. Healthy kidneys usually excrete any extra potassium from your body. Too much or too little potassium in the blood can can cause an irregular heartbeat. As your kidney disease progresses you may need to limit the amount of high-potassium foods you consume. Blood tests can monitor potassium levels. Potassium is found in large amounts of fruits and vegetables:
- potato, sweet potato, pumpkin
- tomato, avocado, beans (i.e baked beans, soy beans) and lentils
- banana, custard apple, stone fruits such as nectarines
- dried fruit, vegetable juice, kiwi fruit and olives
- tinned and homemade soups
- liqueurs, red wine, cider, stout, nuts and seeds
- spinach, mushrooms
- dried peas, beans, baked beans
- chocolates, cocoa, liquorice
- high fibre breakfast cereals, unprocessed bran
Tip for reducing potassium intake: Cut vegetables into small pieces, soak them in a large volume of water for 1-2 hours before cooking, drain and cook normally. Alternatively, boil them and drain off the water. Not all fruits and vegetables have the same amount of potassium.Talk to your renal dietitian about what diet is appropriate for your individual needs.
Phosphate & Calcium
Phosphate and calcium are minerals found in your blood and bones. With kidney failure your kidneys may not remove enough phosphate from your blood. A high blood phosphate level may cause you to itch and lose calcium from your bones which may then become weak and break easily. Avoiding large amounts of foods high in phosphate will help lower your blood phosphate level. Additionally special medications known as phosphate binders can be taken with meals to absorb the phosphate. Phosphate is found in large amounts in:
- dairy products such as milk, cheese, yoghurt and ice cream
- dried beans and peas such as kidney beans, split peas and lentils
- nuts and peanut butter
- drinks such as cocoa, beer and cola drinks
Getting the right amount of protein is important to overall health and affects how well a person feels. The body needs protein for building muscles, repairing tissue and fighting infections. You may need to follow a diet with controlled amounts of protein. This can help regulate the amount of waste in your blood and increase the life of your kidneys. Protein comes from animal or plant based products:
- animal based products include: eggs, fish, meat, chicken, cheese, milk and other dairy foods.
- plant-based products include: nuts, peanut butter, lentils, baked beans, bean soup mix, beans salad mix, chickpeas and hommus dip.
Protein builds, repairs and maintains body tissue. It also helps to fight infections and heal wounds. Urea is a waste product, which is formed when the body breaks down protein. Your eating plan should be designed to provide enough protein for your body without causing urea to overload the kidneys.
Tips for restricting fluids: Sip small amounts throughout the day, use smaller cups and glasses, remember that foods containing fluids need to be included in your fluid allowance.
When diagnosed with CKD, some people need to drink large amounts of fluid while others may need to limit fluid intake. Your suggested fluid intake will depend on your urine output, fluid build-up and blood pressure. Fluids are any foods that are liquid at room temperature including ice cream, yoghurt and ice cubes. Fluid is also contained in food like cooked pasta and rice, salad ingredients, soup and watermelon.
There are times when managing a renal diet can be difficult. If you would like to ask further questions or order resources, contact our Kidney Health Information Service, or email firstname.lastname@example.org
Alternatively your kidney specialist or GP may refer you to a renal dietitian for individual advice and support. A renal dietitian can design a specific diet for your needs. Contact Dietitians Association of Australia or call 1800 812 942.
Links to KHA resources and valuable reviewed external information
iKidneyDiet - iTunes app Highly recommended app for iTunes and Android phones
Refer to this at any time - gives instant levels for the 3 Ps - Potassium, Phosphorous, Protein - useful when watching your food intake for a renal diet. Some USA products are noted.
Kidney Friendly - for a variety of recipe delights for those living with kidney failure
Updated 12 September 2014 Disclaimer: This information is intended as an introduction to this topic and is not meant to substitute for your doctor's or health professional's advice. All care is taken to ensure the information is relevant and applicable to each Australian state. It should be noted Kidney Health Australia recognises each person's experience is individual and variations do occur in treatment and management due to personal circumstances. Should you require further info always consult your doctor or health professional.