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Your Guide to Create a Balanced Kidney-Friendly Meal

Published:January 29, 2019DOI:https://doi.org/10.1053/j.jrn.2018.12.003

      Introduction

      Meal planning can be an overwhelming task for patients with chronic kidney disease (CKD) who are not on dialysis. With various nutrition restrictions, patients may have difficulty determining where to start when creating a meal or identifying a recipe that is kidney friendly. This handout provides diet recommendations and modifications for food groups that will help patients with CKD get adequate nutrition while limiting kidney disease progression.

      Protein

      Protein is an essential building block for skin, hair, and nails. It also plays a significant role in helping to build and maintain muscle, as well as fight off infections. The average person needs 40-65 g of protein per day; however, patients with CKD differ in protein needs due to compromised kidney function. When protein is consumed, waste byproducts are formed and excreted through the urine. Kidney disease prohibits protein from excreting properly and increases blood urea nitrogen and creatinine levels. The recommended average protein intake for patients with CKD who are not on hemodialysis is 0.6-0.8 g/kg of body weight per day.
      • Kalantar-Zadeh K.
      • Moore L.W.
      • Tortorici A.R.
      • et al.
      North american experience with low protein diet for non-dialysis-dependent chronic kidney disease.
      • Moore L.W.
      • Byham-Gray L.D.
      • Parrott J.S.
      • et al.
      The mean dietary protein intake at different stage of chronic kidney disease is higher than current guidelines.
      There are about 7 g of protein in a one ounce portion of meat. A standard serving of protein is 3 ounces, which is roughly the size of a deck cards. For patients with CKD, it is recommended that at least 50% of protein consumed is high biological value.
      • Kopple J.D.
      • Fouque D.
      Pro: the rationale for dietary therapy for patients with advanced chronic kidney disease.
      Limiting dietary protein can help reduce the advancement of CKD.

      Grains

      Patients should restrict phosphorus-containing foods to maintain a safe phosphorus range between 2.7 and 4.6 g/dL.
      National Kidney Disease Education Program
      Chronic kidney disease (CKD) and diet: Assessment, Management, and Treatment.
      Grains, specifically whole grains, contain phosphorus, are good sources of fiber, and should be part of the CKD diet. Working with a dietitian can help patients consume the appropriate amount of these foods. Label reading is another method to control phosphorus levels. Patients should be encouraged to avoid foods with phosphorus additives or “phos” listed as part of the ingredient list.
      National Kidney Disease Education Program
      Chronic kidney disease (CKD) and diet: Assessment, Management, and Treatment.
      In addition to a phosphorus-restricted diet, patients with CKD may be prescribed a phosphate-binding agent that is taken with meals to limit phosphorus absorption.

      Fruits and Vegetables

      One important role of the kidneys is to keep a balance of minerals in the body. With CKD, potassium may build up to toxic levels in the blood stream. Hyperkalemia and hypokalemia have detrimental effects on the body including heart irregularities; therefore, it is important to keep potassium levels between 3.5 and 5.0 mmol/L.
      National Kidney Disease Education Program
      Chronic kidney disease (CKD) and diet: Assessment, Management, and Treatment.
      Fruits and vegetables vary in their potassium content. Patients with CKD should consume low-potassium fruits and vegetables and limit high-potassium fruits and vegetables. Low-potassium fruits contain less than 200 mg per small fruit or ½ a cup of fresh or canned fruit. Low-potassium vegetables contain less than 200 mg per cup of leafy greens or ½ a cup of vegetables.

      Dairy and Milk Alternatives

      Dairy and milk alternatives provide essential nutrients but also contain varying levels of phosphorus, sodium, and potassium. Healthy kidneys regulate these minerals in our body, but in patients with CKD, this function can be compromised. Hyperphosphatemia pulls calcium from bones, causing bones to weaken. Another side effect of hyperphosphatemia is itchy skin. Patients can balance phosphorus levels by reducing their intake of milk, cheese, and yogurt. If the patient has trouble controlling phosphorus levels, the dietitian should be consulted for milk alternative recommendations. In addition, patients with CKD should be evaluated for need of calcium and vitamin D supplementation.

      Other Considerations

      Sodium restrictions help control blood pressure, lower the risk of cardiovascular disease, and slow the progression of kidney disease. Patients with CKD should reduce their sodium intake to 2000 mg or less per day and discuss with a dietitian about label reading to choose appropriate low-sodium foods. The ability of the kidneys to filter and excrete fluid decreases with CKD, which increases blood pressure and strains the heart and kidneys. If fluid retention becomes an issue, a patient's physician is likely to recommend a specific amount of daily liquids to help minimize these symptoms. Therefore, as CKD progresses, the patient may need to monitor the amount of fluid they are drinking and reduce beverage serving size with meals.
      The attached handout will assist patients with meal planning. The teaching tool places emphasis on identifying different foods groups, understanding portion sizes, and also incorporating foods beneficial to the kidneys' health. Guiding patients with planning their meal can improve their overall quality of life and help manage CKD.

      References

        • Kalantar-Zadeh K.
        • Moore L.W.
        • Tortorici A.R.
        • et al.
        North american experience with low protein diet for non-dialysis-dependent chronic kidney disease.
        BMC Nephrol. 2016; 17: 90
        • Moore L.W.
        • Byham-Gray L.D.
        • Parrott J.S.
        • et al.
        The mean dietary protein intake at different stage of chronic kidney disease is higher than current guidelines.
        Kidney Int. 2013; 83: 724-732
        • Kopple J.D.
        • Fouque D.
        Pro: the rationale for dietary therapy for patients with advanced chronic kidney disease.
        Nephrol Dial Transpl. 2018; 33: 373-378
        • National Kidney Disease Education Program
        Chronic kidney disease (CKD) and diet: Assessment, Management, and Treatment.
        2015 (Accessed March 4, 2018)
        • National Institutes of Health
        Nutrition for Advanced Chronic Kidney Disease in Adults.
        2014 (Accessed March 4, 2018)