Living with Stage 4 Chronic Kidney Disease

Nutrition and a dietitian

Making healthy food choices is important to us all, but it is even more important if you have kidney disease. Good nutrition can help to:

• Provide energy to do your daily tasks

• Prevent infection

• Avoid loss of muscle

• Help maintain a healthy weight

• Slow down the progression of kidney disease

A well-balanced diet gives you the right amounts of protein, calories, vitamins, and minerals each day. Eating a healthy diet, staying physically active and taking all your medicines as prescribed are all important parts to keeping you healthy and feeling well.

Healthy changes

Your kidneys help to keep the right balance of nutrients and minerals in your body. But if you have kidney disease, your kidneys may not be able to do this job very well. You may need to make some changes to your diet.

Ask your clinician about meeting with a Registered Dietitian with special training in kidney disease. A dietitian can teach you to make the best food choices based on your lab tests and personal lifestyle. Making changes in your diet to better control diabetes and high blood pressure can also help to keep kidney disease from getting worse.

There is not one eating plan that is right for everyone with kidney disease. What you can or cannot eat may change over time, depending on how much kidney function you have and other factors. Also, if you are following a special diet for diabetes or heart conditions, you will need to continue to follow it as well.

People with kidney disease may need to control the amount of sodium, potassium, phosphorus, fluid, and calcium in their diet. If your kidney disease gets worse, you may need to limit other nutrients as well. Your clinician or dietitian will tell you if you need to do this based on your blood test results.

Avoid herbal supplements and discuss any dietary supplements you’re taking to see if they’re safe. Ask your clinician if lowering your dietary acid load can be helpful for you. If yes, then you should limit animal-based foods such as meat and use more plant-based foods instead. You should discuss this type of diet with your healthcare team. They may also recommend bicarbonate therapy to also help lower your acid load.

For more information, you can view the following video on nutrition and CKD:

The right number and types of calories

Every person is different. Calories are like fuel. If you don’t eat enough calories, your body will use protein for energy. This protein comes from your muscles. This can make you weak and may also cause damage to the kidneys. It is important to make sure you are getting the right amount of calories. The right amounts of calories are important to:

• Help you stay at a healthy weight

• Give you energy to do your daily tasks

• Help your body use the protein in food to build muscle and tissues

Too many calories can cause extra weight gain which can be a burden on the kidney. If you are overweight, some weight loss may be beneficial. If weight loss is desired or you have diabetes, you should meet with a dietitian to set up a plan based on your kidney blood tests and other lab numbers, current food choices and daily activities.

Learning more about fluids

Most people in the early stages of kidney disease do not need to limit the amount of fluids they drink. However, as kidney disease gets worse and reaches stage 4, your dietitian or clinician can let you know if you need to limit fluids and how much to drink each day.

Having too much water in your body is called fluid overload (or hypervolemia). One of the main functions of the kidneys is to balance fluid in the body. If too much fluid builds up in your body, it can have harmful effects on your health, such as difficulty breathing and swelling. Therefore, at some point, you may need to track your fluids to prevent fluid overload, especially if you receive dialysis.

People on dialysis might a special diet. For example and fluids might need to be controlled. Sodium, potassium, phosphorus might also need to be managed. This video has more information on diet for people receiving dialysis:

Learning more about protein

Your body needs protein to help build muscle, repair tissue, and fight infection. If you have kidney disease, you may need to watch how much protein you eat. Having too much protein can cause waste to build up in your blood. Your kidneys may not be able to remove all the extra waste. It is important to eat the right amount of protein each day. The amount of protein you need is based on your body size, your kidney problem, and the amount of protein that may be in your urine. Protein intake should not be too low, or it may cause other problems.

Protein needs might change as kidney disease progresses. For example, people with CKD might be asked to limit their protein intake. However, people might need to increase their protein intake if they end up receiving dialysis. This is why you should talk to a dietitian or clinician about how much protein you should eat based on your specific medical situation.

Understanding sodium

Healthy kidneys control how much sodium is in your body. If your kidneys do not work well, too much sodium can cause fluid buildup, swelling, higher blood pressure, and strain on your heart. Your dietitian or clinician can tell you the right amount of sodium you should have each day.

Sodium, in the form of salt, causes your body to hold on to water. Too much salt in your diet will increase your chances of fluid overload and make it more difficult to remove fluid during dialysis. Therefore, you might also need to limit salt to help avoid fluid overload if your receive dialysis.

If you need to limit salt, ways to cook without salt include:

• Cooking with herbs and spices instead of salt

• Read food labels and choose those foods low in sodium

• When eating out, ask for meat or fish without salt. Ask for gravy or sauce on the side; these may contain large amounts of salt and should be used in small amounts

• Limit use of canned, processed and frozen foods

Understanding potassium

Potassium is an important nutrient. It helps your nerves and muscles (including your heart) work the right way. Too much or too little potassium in the blood can be very dangerous. The amount of potassium you need is based on how well your kidneys are working and medications you are taking. Your dietitian or clinician can tell you about foods that have potassium and the right amount for you to eat each day. If you need to limit potassium for any reason, avoid salt substitutes and specialty low-sodium foods made with salt substitutes because they can be high in potassium.

Understanding phosphorus

Phosphorus is a mineral found in your bones. Phosphorus is needed to build strong healthy bones, as well as, keeping other parts of your body healthy. Normal working kidneys can remove extra phosphorus in your blood. When you have chronic kidney disease (CKD), your kidneys cannot remove phosphorus very well. As kidney function gets lower, extra phosphorus can start building up in the blood. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. Your dietitian or clinician can tell you if you need to limit foods that are high in phosphorus.

Understanding calcium

Calcium is another mineral that is very important in building strong and healthy bones. In advanced CKD, extra phosphorus can cause body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Phosphorus and calcium control can be very important for your overall health. Foods that are good sources of calcium are often high in phosphorus. Your dietitian or clinician provider will tell you if you need to limit calcium based on your overall health. Also, talk to your healthcare provider before taking any over the counter vitamin D or calcium supplements.

Diet and kidney disease: What can I do?

A healthy diet with the right amount of calories and nutrients is important for everyone, especially people with kidney disease. It’s important to keep the following in mind.

• Ask a clinician for help with a dietitian. They can help to come up with a diet plan that’s right for you.

• If you are seeing a dietitian for the first time, ask if you need to manage the following, based on your kidney disease:

  • Salt and sodium
  • Carbohydrates, if you have diabetes
  • Fluids
  • Potassium
  • Phosphorus
  • Calcium
  • Calories
  • Fats

• Learn to read food labels so you know what you are eating. For example, reading labels can help you shop for foods with lower sodium and to check for "added" nutrients that might need to limit.

• Try fresh or dried herbs and spices instead of table salt to bring out the flavor of foods. When you limit salt, you may have to use more herbs and spices to get more flavor. Also, try adding a dash of hot pepper sauce or a squeeze of lemon/lime juice for flavor.

• Do not use salt substitutes unless approved by your clinician.

Finally, it’s okay to ask for help. You can speak to a clinician for help with diet and nutrition. You cans also ask for help from a friend or loved one to get the information you need or to help with motivation and support to stay with a diet.

For more information on diet and CKD, visit the NKF nutrition page.