Kidney 101
Health Tips for People with Chronic Kidney Disease (CKD)
Renalus Center for Kidney Care believes in delivering accessible, educational content to our audience. Below you will find information for people with early and advanced Chronic Kidney Disease (CKD) in conjunction with general information for how potassium, sodium, protein, and phosphorus affect kidney health. We also have information about how to read Nutrition Fact Labels.
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Nutrition tips for Early Chronic Kidney Disease in Adults
Why is nutrition important for someone with early chronic kidney disease (CKD)?
Controlling blood glucose, also called blood sugar, and blood pressure through healthy food choices is an important step toward slowing or stopping the progression of CKD. Diabetes and high blood pressure are the two leading causes of CKD in the United States. A person’s eating habits can increase or decrease diabetes and blood pressure risks.
What do the kidneys do?
The kidneys remove wastes and extra water from the blood and make urine. To keep the body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium, and potassium—that circulate in the blood. The kidneys also release hormones that help make red blood cells, regulate blood pressure and keep bones strong.
What are the effects of CKD?
CKD usually takes a long time to develop and does not go away. In CKD, the kidneys continue to work—just not as well as they should. Wastes may build up gradually so that the body becomes accustomed to having those wastes in the blood. Salts containing phosphorus and potassium may rise to unsafe levels, causing heart and bone problems. Anemia—low red blood cell count—can result from CKD because the kidneys stop making enough erythropoietin, a hormone that causes bone marrow to make red blood cells. After months or years, CKD may progress to permanent kidney failure, which requires a person to have a kidney transplant or regular blood filtering called dialysis.
Who is at risk for CKD?
Millions of Americans are at risk for developing CKD because they have diabetes, high blood pressure, or both. High blood glucose levels put people with diabetes at risk for heart disease, stroke, amputation and eye and kidney problems. People with high blood pressure are at risk for damaged blood vessels, including tiny vessels in the kidneys.
What does a person with CKD and diabetes need to know about food and controlling blood glucose?
People with either type 1 or type 2 diabetes must choose foods carefully to control their blood glucose, the body’s main source of energy. Following a meal plan to keep blood glucose at a healthy level may prevent CKD from developing.
People with diabetes should talk with their health care provider about setting goals for maintaining healthy blood glucose levels and how often to check their blood glucose level. The results from these blood glucose checks indicate whether a person’s meal plan is helping to keep diabetes under control. People with diabetes should also ask their doctor for an A1C test at least twice a year. The A1C number reflects a person’s average blood glucose level over the past 2 to 3 months.
Following regular, daily habits can help maintain healthy blood glucose levels:
- Eating about the same amount of food each day.
- Eating meals and snacks at about the same times each day.
- Not skipping meals or snacks.
- Taking medicines at the same times each day.
- Participating in physical activity each day.
What does a person with CKD and high blood pressure need to know about food and controlling blood pressure?
As blood pressure rises, the risk of damage to the arteries, heart, brain and kidneys increases. Controlling blood pressure through healthy food choices and regular physical activity can delay or prevent the development of CKD.
Blood pressure is expressed as two numbers. The top number represents the force of the blood pushing against the artery walls when the heart beats. The lower number represents the pressure between beats. Normal blood pressure is 120/80 millimeters of mercury (mmHg). People with CKD should try to keep their blood pressure below 130/80 mmHG.
Following a meal plan can help control blood pressure and protect the kidneys. The National Heart, Lung and Blood Institute supported research that compared a typical American diet with the Dietary Approaches to Stop Hypertension (DASH) eating plan, which is lower in saturated fat, cholesterol and total fat and emphasizes eating fruits, vegetables and low-fat dairy foods. People who followed the DASH eating plan were able to reduce their blood pressure much more than those who ate a typical diet. The DASH eating plan also includes whole grain products, fish, poultry and nuts. Limiting sodium, or salt, is another important feature of the plan. A dietitian can help find low-salt or salt-free alternatives to foods that are high in salt.
What is medical nutrition therapy (MNT)?
MNT is the use of nutrition counseling by a registered dietitian to help promote a medical or health goal. A doctor may refer a patient to a registered dietitian to help with the patient’s food plan. Many insurance policies cover MNT when recommended by a doctor. Anyone who qualifies for Medicare can receive a benefit for MNT from a registered dietitian or nutrition professional when a doctor provides a referral indicating the person has diabetes or kidney disease.
One way to locate a qualified dietitian is to contact the American Dietetic Association at www.eatright.org and click on “Find a Registered Dietitian.” Users can enter their address or ZIP code for a list of dietitians in their area. A person looking for dietary advice to prevent kidney damage should click on “Renal (Kidney) Nutrition” in the specialty field. Dietitians who specialize in helping people with CKD are called renal dietitians.
How can understanding and keeping track of lab reports help someone with early CKD make healthy food choices?
Learning how to read and understand lab reports lets a person see how different foods can affect the kidneys. A doctor should order regular blood tests for people with CKD. Patients can ask their doctor for copies of their lab reports and ask to have them explained, noting any results out of the normal range. Keeping track of these lab results can help people see whether they are making progress or getting worse. People with CKD should talk with their doctor or dietitian about how they can make healthier food choices. For example, a person who has a high A1C score should follow a diabetes meal plan to lower blood glucose levels.
Considerations
- Controlling blood glucose and blood pressure through healthy food choices is an important step toward slowing or stopping the progression of chronic kidney disease (CKD).
- The kidneys remove wastes and extra water from the blood and make urine.
- Millions of Americans are at risk for developing CKD because they have diabetes, high blood pressure, or both.
- People with either type 1 or type 2 diabetes must choose foods carefully to control their blood glucose. Following a meal plan to keep blood glucose at a healthy level may prevent CKD from developing.
- Controlling blood pressure through healthy food choices and regular physical activity can delay or prevent the development of CKD. People with CKD should try to keep their blood pressure below 130/80 mmHg.
- Medical nutrition therapy (MNT) is the use of counseling by a registered dietitian to help promote a medical or health goal.
- Dietitians who specialize in helping people with CKD are called renal dietitians.
- Learning how to read and understand lab reports lets a person see how different foods can affect the kidneys. Patients can ask their doctor for copies of their lab reports and ask to have them explained, noting any results out of the normal range.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) has many research programs aimed at slowing the progression of CKD. For example, the NIDDK is sponsoring the Chronic Renal Insufficiency Cohort study to determine the risk factors for rapid decline in kidney function and development of cardiovascular disease. This study of about 3,000 patients with chronic renal insufficiency, another way of describing CKD, will reflect the racial, ethnic and gender composition of the people in the United States who have permanent kidney failure. The data collected and specimens obtained will serve as a national resource for investigating CKD, as well as cardiovascular disease. Establishing this group of patients and following them into the future also provides an opportunity to examine genetic, environmental, behavioral, nutritional, quality-of-life and health resource use factors in this population. The main part of the study will consist of monitoring participants and following up at regular clinic visits with kidney function measurements, cardiovascular studies and lab tests. In addition, participants will answer questionnaires to assess various demographic, nutritional and quality-of-life factors.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available and help others by contributing to medical research. For information about current studies, visit www.clinicaltrials.gov.
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Nutrition tips for Advanced Chronic Kidney Disease
Why is nutrition important for someone with advanced chronic kidney disease (CKD)?
A person may prevent or delay some health problems from CKD by eating the right foods and avoiding foods high in sodium, potassium and phosphorus. Learning about calories, fats, proteins and fluids is important for a person with advanced CKD. Protein foods such as meat and dairy products break down into waste products that healthy kidneys remove from the blood.
As CKD progresses, nutritional needs change. A health care provider may recommend that a patient with reduced kidney function choose foods carefully.
What do the kidneys do?
The kidneys remove wastes and extra water from the blood and make urine. To keep the body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium and potassium—that circulate in the blood. The kidneys also release hormones that help make red blood cells, regulate blood pressure and keep bones strong.
What are the effects of CKD?
CKD usually takes a long time to develop and does not go away. In CKD, the kidneys continue to work—just not as well as they should. Wastes may build up gradually so that the body becomes accustomed to having those wastes in the blood. Salts containing phosphorus and potassium may rise to unsafe levels, causing heart and bone problems. Anemia—low red blood cell count—can result from CKD because the kidneys stop making enough erythropoietin, a hormone that causes bone marrow to make red blood cells. After months or years, CKD may progress to permanent kidney failure, which requires a person to have a kidney transplant or regular blood filtering called dialysis.
What is medical nutrition therapy (MNT)?
MNT is the use of nutrition counseling by a registered dietitian to help promote a medical or health goal. A doctor may refer a patient to a registered dietitian to help with the patient’s food plan. Many insurance policies cover MNT when recommended by a doctor. Anyone who qualifies for Medicare can receive a benefit for MNT from a registered dietitian or nutrition professional when a doctor provides a referral indicating the person has diabetes or kidney disease.
One way to locate a qualified dietitian is to contact the American Dietetic Association at www.eatright.org and click on “Find a Registered Dietitian.” Users can enter their address or ZIP code for a list of dietitians in their area. A person looking for dietary advice to prevent kidney damage should click on “Renal (Kidney) Nutrition” in the specialty field. Dietitians who specialize in helping people with CKD are called renal dietitians.
Why is knowing about calories important for someone with advanced CKD?
As CKD progresses, people often lose their appetites because they find that foods do not taste the same. As a result, they consume fewer calories—important units of energy in food—and may lose too much weight. Renal dietitians can help people with advanced CKD find healthy ways to add calories to their diet if they are losing too much weight.
Why is knowing about protein important for someone with advanced CKD?
Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs and blood. They help fight disease and heal wounds. But proteins also break down into waste products that must be removed from the blood by the kidneys. Eating more protein than the body needs may put an extra burden on the kidneys and cause kidney function to decline faster.
Health care providers recommend that people with CKD eat moderate or reduced amounts of protein. However, restricting protein could lead to malnutrition, so people with CKD need to be careful. The typical American diet contains more than enough protein. Learning about portion sizes can help people limit protein intake without endangering their health.
What is the right meat portion size?
Most people—with or without CKD—can get the daily protein they need by eating two 3-ounce servings of meat or meat substitute. A 3-ounce serving of meat is about the size of a deck of cards or the palm of a person’s hand.
A renal dietitian can help people learn about the amount and sources of protein in their diet. Animal protein in egg whites, cheese, chicken, fish and red meats contain more of the essential nutrients a body needs. With careful meal planning, a well-balanced vegetarian diet can also provide these nutrients. A renal dietitian can help people with advanced CKD make small adjustments in their eating habits that can result in significant protein reduction. For example, people can lower their protein intake by making sandwiches using thinner slices of meat and adding lettuce, cucumber slices, apple slices and other garnishes. When kidney function declines to the point where dialysis becomes necessary, patients should include more protein in their diet because dialysis removes large amounts of protein from the blood.
Why is knowing about fat important for someone with advanced CKD?
Everyone should know about fat sources because eating the wrong kinds of fat and too much fat increases the risk of clogged blood vessels and heart problems. Fat provides energy, helps produce hormone-like substances that regulate blood pressure and other heart functions and carries fat-soluble vitamins throughout the body. Everyone needs dietary fat, but some fats are healthier than others. People with CKD are at higher risk of having a heart attack or stroke. Therefore, people with CKD should be especially careful about how dietary fat affects their heart health.
People with advanced CKD should talk with a dietitian about healthy and unhealthy sources of fat. Saturated fats and trans-fatty acids can raise blood cholesterol levels and clog blood vessels. Saturated fats are found in animal products such as red meat, poultry, whole milk and butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercially baked goods such as cookies and cakes and in fried foods like doughnuts and French fries. A dietician can suggest healthy ways to include fat in the diet, especially if more calories are needed. Hydrogenated vegetable oils should be avoided because they are high in trans-fatty acids. Monounsaturated fat—olive oil—is a healthy alternative to animal fats.
Why is knowing about sodium important for someone with advanced CKD?
Too much sodium in a person’s diet can be harmful because it causes blood to hold fluid. People with CKD need to be careful not to let too much fluid build up in their bodies. The extra fluid raises blood pressure and puts a strain on the heart and kidneys. A dietitian can help people find ways to reduce the amount of sodium in their diet. Nutrition labels provide information about the sodium content in food. The U.S. Food and Drug Administration advises that healthy people should limit their daily sodium intake to no more than 2,300 milligrams (mg), the amount found in 1 teaspoon of salt. People who are at risk for a heart attack or stroke because of a condition such as high blood pressure or kidney disease should limit their daily sodium intake to no more than 1,500 mg. Choosing sodium-free or low-sodium food products will help them reach that goal.
Sodium is found in ordinary table salt and many salty seasonings such as soy sauce and teriyaki sauce. Canned foods, some frozen foods and most processed meats have large amounts of salt. Snack foods such as chips and crackers are also high in salt.
Alternative seasonings such as lemon juice, salt-free seasoning mixes and hot pepper sauce can help people reduce their salt intake. People with advanced CKD should avoid salt substitutes that use potassium, such as AlsoSalt or Nu-Salt, because CKD limits the body’s ability to eliminate potassium from the blood.
Why is knowing about potassium important for someone with advanced CKD?
Keeping the proper level of potassium in the blood is essential. Potassium keeps the heart beating regularly and muscles working right. Problems can occur when blood potassium levels are either too low or too high. Damaged kidneys allow potassium to build up in the blood, causing serious heart problems. Potassium is found in many fruits and vegetables, such as bananas, potatoes, avocados and melons. People with advanced CKD may need to avoid some fruits and vegetables. Blood tests can indicate when potassium levels have climbed above normal range. A renal dietitian can help people with advanced CKD find ways to limit the amount of potassium in the diet when levels have climbed above the normal range. The potassium content of potatoes and other vegetables can be reduced by boiling them in water.
Why is knowing about phosphorus important for someone with advanced CKD?
Damaged kidneys allow phosphorus, a mineral found in many foods, to build up in the blood. Too much phosphorus in the blood pulls calcium from the bones, making the bones weak and likely to break. Too much phosphorus may also make skin itch. Foods such as milk and cheese, dried beans, peas, colas, canned iced teas and lemonade, nut, and peanut butter are high phosphorus. A renal dietitian can help people with advanced CKD learn how to limit phosphorus in their diet.
As CKD progresses, a person may need to take a phosphate binder such as sevelamer hydrochloride (Renagel), lanthanum carbonate (PhosLo), or calcium carbonate (Tums) to control phosphorus in the blood. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into the blood. Instead, it is removed from the body in the stool.
Why is regulating fluid intake important for someone with advanced CKD?
People with advanced CKD may need to limit how much they drink because damaged kidneys can’t remove extra fluid. The fluid builds up in the body and strains the heart. Patients should tell their health care provider about any swelling around the eyes or in the legs, arms or abdomen.
How can understanding and keeping track of lab reports help someone with advanced CKD make healthy food choices?
Learning how to read and understand lab reports lets a person see how different foods can affect the kidneys. A doctor should order regular blood tests for people with CKD. Patients can ask their doctor for copies of their lab reports and ask to have them explained, noting any results out of the normal range. Keeping track of these lab results can help people see whether they are making progress or getting worse. People with CKD should talk with their doctor or dietitian about how they can make healthier food choices. For example, if a test shows that a person with advanced CKD has a high potassium level, that person should concentrate on reducing potassium in the diet by limiting high-potassium foods.
Considerations
- A person may prevent or delay some health problems from chronic kidney disease (CKD) by eating the right foods and avoiding foods high in sodium, potassium and phosphorus.
- The kidneys remove wastes and extra water from the blood and make urine.
- Medical nutrition therapy (MNT) is the use of counseling by a registered dietician to help promote a medical or health goal.
- Dieticians who specialize in helping people with CKD are called renal dietitians.
- People with advanced CKD often lose their appetites and consume fewer calories—important units of energy in food—and may lose too much weight.
- Eating more protein than the body needs may put an extra burden on the kidneys and cause kidney function to decline faster. Most people—with or without CKD—can get the daily protein they need by eating two 3-ounce servings of meat or meat substitute.
- People with CKD are at a higher risk of having a heart attack or stroke.
- Everyone needs dietary fat, but some fats are healthier than others. Too much sodium in a person’s diet can be harmful because it causes blood to hold fluid. People with CKD need to be careful not to let too much fluid build up in their bodies.
- People with advanced CKD should avoid salt substitutes that use potassium because CKD limits the body’s ability to eliminate potassium from the blood.
- Damaged kidneys allow potassium to build up in the blood, causing serious heart problems. Potassium is found in many fruits and vegetables, such as bananas, potatoes, avocados and melons.
- Too much phosphorus in the blood pulls calcium from the bones, making the bones weak and likely to break.
- People with advanced CKD may need to limit how much they drink because damaged kidneys can’t remove extra fluid.
- Many patients find that keeping track of their test results helps them see how their treatment is working. Patients can ask their health care provider for copies of their lab reports and ask to have them explained, noting any results out of the normal range.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) has many research programs aimed at slowing the progression of CKD. For example, the NIDDK is sponsoring the Chronic Renal Insufficiency Cohort study to determine the risk factors for rapid decline in kidney function and development of cardiovascular disease. This study of about 3,000 patients with chronic renal insufficiency, another way of describing CKD, will reflect the racial, ethnic and gender composition of the people in the United States who have permanent kidney failure. The data collected and specimens obtained will serve as a national resource for investigating CKD, as well as cardiovascular disease. Establishing this group of patients and following them into the future also provides an opportunity to examine genetic, environmental, behavioral, nutritional, quality-of-life and health resource use factors in this population. The main part of the study will consist of monitoring participants and following up at regular clinic visits with kidney function measurements, cardiovascular studies and lab tests. In addition, participants will answer questionnaires to assess various demographic, nutritional and quality-of-life factors.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available and help others by contributing to medical research. For information about current studies, visit www.clinicaltrials.gov.
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Eating right for Kidney Health
What you eat and drink can help slow down chronic kidney disease. Some foods are better for your kidneys than others. Cooking and preparing your food from scratch can help you eat healthier. These tips will help you eat right as you manage your CKD. The First Steps to Eating Right are important for all people with CKD. The Next Steps to Eating Right may become important as your kidneys slow down. Work with your dietitian to choose the right foods for you.
The First Steps to Eating Right
Step 1 Choose and prepare foods with less salt and sodium.
Why? To help control your blood pressure. Your diet should contain less than 1,500 milligrams of sodium each day.
- Buy fresh food more often. Sodium (a part of salt) is added to many packaged foods.
- Use spices, herbs and sodium-free seasonings in place of salt.
- Check the Nutrition Facts label on food packages for sodium. A Daily Value of 20% or more means the food is high in sodium.
- Try lower-sodium versions of frozen dinners and other convenience foods.
- Rinse canned vegetables, beans, meats and fish with water before eating.
Step 2 Eat the right amount and the right types of protein.
Why? To help protect your kidneys.
- Eat small portions of protein foods.
- Protein is found in foods from plants and animals. Talk to your dietitian about how to choose the right combination for you.
Step 3 Choose foods that are healthy for your heart.
Why? To help keep fat from building up in your blood vessels, heart and kidneys.
- Grill, broil, bake, roast or stir-fry foods, instead of deep frying.
- Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
- Trim fat from meat and remove skin from poultry before eating.
The Next Steps to Eating Right
As your kidneys slow down, you may need to eat foods that are lower in phosphorus and potassium. Your health care provider will use lab tests to watch your levels.
Step 4 Choose foods with less phosphorus.
Why? To help protect your bones and blood vessels.
- Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS”—on ingredient labels.
- Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.
Step 5 Choose foods that have the right amount of potassium.
Why? To help your nerves and muscles work the right way.
- Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt substitutes.
- Drain canned fruits and vegetables before eating.
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Protein
What is protein?
Protein is in many foods that you eat. Protein can be found in foods from animals and from plants. Most diets include both animal-based and plant-based proteins. Protein provides the building blocks that maintain and repair muscles, organs and other parts of the body.
Animal-based protein foods
- Meat, such as pork, beef, chicken, turkey, duck
- Eggs
- Dairy products, such as milk, yogurt, cheese
- Fish
Plant-based protein foods
High protein
- Beans, peas, lentils
- Soy foods, such as soy milk and tofu
- Nuts and nut spreads, such as almond butter, peanut butter, soy nut butter
- Sunflower seeds
Low Protein
- Bread, tortillas
- Oatmeal, grits, cereals
- Pasta, noodles, rice
- Rice milk (not enriched)
Why is protein important for people with CKD?
When your body uses protein, it produces waste. This waste is removed by the kidneys. Too much protein can make the kidneys work harder, so people with CKD may need to eat less protein. Animal protein includes all of the building blocks that your body needs. Plant proteins need to be combined to get all of the building blocks that your body needs.
How do I eat the right amount of protein?
Your dietitian will tell you what amount and types of protein are right for you. Eat smaller portions of meat and dairy. This will also help you lower the amount of phosphorus in your diet, because phosphorus is found in meat and dairy foods. A serving of each is:
- Meat, poultry and fish: A cooked portion should be about 2 to 3 ounces or about the size of a deck of cards.
- Dairy foods: A portion is ½ cup of milk or yogurt, or one slice of cheese.
Plant proteins should make up the rest of the protein that you eat. A serving is:
- ½ cup of cooked beans
- ¼ cup of nuts
- a slice of bread
- ½ cup of cooked rice or noodles
What if I am a Vegetarian?
There are many good sources of protein for people who do not eat meat or dairy foods. Talk to your dietitian about how to combine plant proteins to be sure you are getting all of the building blocks your body needs.
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Sodium
What is sodium?
Sodium is a part of salt. It is found in many canned, packaged and “fast” foods. It is also found in many condiments, seasonings and meats.
Why is sodium important for people with CKD?
Eating less sodium helps lower blood pressure and may slow down CKD. Talk with your provider about the right blood pressure goal for you. One of the kidneys’ important jobs is to filter sodium out of the body and into the urine. Damaged kidneys cannot filter as well as healthy kidneys can. This can cause sodium to stay in your body and make your blood pressure go up.
How much sodium should I eat every day?
Most people need to eat less sodium than they are eating. Aim for less than 1,500 milligrams of sodium each day. Much of the sodium you eat does not come from a saltshaker. Sodium is added to the prepared foods you buy at the supermarket or at restaurants. Examples of foods lower and higher in sodium are:
Foods lower in sodium
- Fresh or frozen fruits and vegetables
- Rice
- Cooked cereal without added salt
- Fresh meat, poultry, seafood
- Low-fat, low-sodium cheese
- Unsalted nuts
- Low- and reduced-sodium frozen dinners, peanut butter, salad dressings
- Air-popped popcorn
Foods higher in sodium
- Bacon, corned beef, ham, hot dogs, luncheon meat, sausage
- Bouillon, canned and instant soups
- Boxed mixes, like hamburger meals and pancake mix
- Canned beans, chicken, fish and meat
- Canned tomato products, including juice
- Canned and pickled vegetables, vegetable juice
- Cottage cheese
- Frozen meals
- Frozen vegetables with sauce
- Olives, pickles, relish
- Pretzels, chips, crackers, salted nuts
- Salt and salt seasonings, like garlic salt
- Seasoning mix and sauce packets
- Soy sauce
- Salad dressings, bottled sauces, marinades
- Some ready-to-eat cereals, baked goods, breads
- Ready-to-eat boxed meals and side dishes
How do I lower the sodium in my diet?
Buy fresh foods more often. Cook foods from scratch, instead of eating prepared foods, “fast” foods, frozen dinners and canned foods that are higher in sodium.
Use spices, herbs and sodium-free seasonings in place of salt. Check with your healthcare provider about using salt substitutes. Rinse canned vegetables, beans, meats and fish with water to remove extra sodium.
Always read the Nutrition Facts label to compare foods. Choose foods with the lowest Percent Daily Value (%DV) for sodium. The %DV lets you see if a food is high or low in sodium. 5% or less is low and 20% or more is high.
Check the label on fresh meats and poultry. Sodium additives can be used to make meat last longer.
Look for foods labeled: sodium free, salt free, very low sodium, low sodium, reduced or less sodium, light in sodium, no salt added, unsalted and lightly salted. Check the ingredient label for added sodium such as:
- Salt (sodium chloride)
- Monosodium Glutamate or MSG
- Baking Soda (sodium bicarbonate)
- Baking Powder
- Sodium Nitrate
- Sodium Sulfite
- Sodium Phosphate
- Sodium Alginate
- Sodium Benzoate
- Sodium Hydroxide
- Sodium Propionate
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Potassium
What is potassium?
Potassium is a mineral that helps your nerves and muscles work the right way.
Why is potassium important for people with CKD?
In some people with CKD, the kidneys may not remove extra potassium from the blood. Some medicines also can raise your potassium level. Your food choices can help you lower your potassium level.
How do I know if my potassium is high?
People often do not feel any different when their potassium is high. Your health care provider will check the level of potassium in your blood and the medicines you take. The level of potassium in your blood should be between 3.5 to 5.0 (normal ranges may vary).
How do I lower potassium in my diet?
Eat smaller portions of foods high in protein at meals and for snacks: meat, poultry, fish, beans, dairy and nuts. Use spices and herbs in cooking and at the table. Salt substitutes often contain potassium and should not be used. Potassium chloride can be used in place of salt in some packaged foods, like canned soups and tomato products. Limit foods with potassium chloride on the ingredient list. Drain canned fruits and vegetables before eating.
If you have diabetes, choose apple, grape or cranberry juice when your blood sugar goes down.
Choose fruits and vegetables that are lower in potassium. Have very small portions of foods that are higher in potassium, like one slice of tomato on a sandwich, a few slices of banana on cereal or half of an orange.
Fruits lower in Potassium (200 mg or less in one serving*)
- Apples/apple juice/applesauce
- Apricots (canned)/apricot nectar
- Berries
- Cranberry juice
- Fruit cocktail
- Grapes/grape juice
- Grapefruit/grapefruit juice
- Honeydew melon
- Lemons and limes
- Mangoes
- Papayas
- Pears
- Peaches
- Plums
- Pineapple
- Rhubarb
- Tangerines
- Watermelon
Fruits higher in Potassium (More than 200 mg in one serving *)
- Apricots (fresh)
- Bananas
- Cantaloupe
- Dates
- Nectarines
- Kiwi
- Prunes/Prune juice
- Oranges/orange juice
- Raisins
* One serving of fruit is one small piece; ½ cup fresh, canned or cooked fruit; ¼ cup dried fruit; or ½ cup juice.
Vegetables lower in Potassium (200 mg or less in one serving*)
- Alfalfa sprouts
- Bell peppers
- Bamboo shoots (canned)
- Broccoli (fresh)
- Cabbage
- Carrots
- Cauliflower
- Celery and onions (raw)
- Corn
- Cucumber
- Eggplant
- Green beans
- Kale
- Lettuce
- Mushrooms (fresh)
- Okra
- Summer squash (cooked)
Vegetables higher in Potassium (More than 200 mg one serving*)
- Acorn and butternut squash
- Avocado
- Baked beans
- Beet and other greens
- Broccoli (cooked)
- Brussels sprouts (cooked)
- Chard
- Chile peppers
- Mushrooms (cooked)
- Potatoes
- Pumpkin
- Spinach (cooked)
- Split peas, lentils, beans
- Sweet potatoes, yams
- Vegetable juice
- Tomatoes/tomato juice/tomato sauce
*One serving of vegetables is ½ cup of fresh or cooked vegetables, 1 cup raw leafy vegetables, or ½ cup juice.
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Phosphorus
What is phosphorus?
Phosphorus is a mineral that helps keep your bones healthy. It also helps keep blood vessels and muscles working. Phosphorus is found naturally in foods rich in protein, such as meat, poultry, fish, nuts, beans and dairy products. Phosphorus is also added to many processed foods.
Why is phosphorus important for people with CKD?
When you have CKD, phosphorus can build up in your blood, making your bones thin, weak, and more likely to break. It can cause itchy skin and bone and joint pain. Most people with CKD need to eat foods with less phosphorus than they are accustomed to eating.
Your healthcare provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood.
Foods lower in phosphorus
- Fresh fruits and vegetables
- Rice milk (not enriched)
- Breads, pasta, rice
- Corn and rice cereals
- Light-colored sodas/pop
- Home-brewed iced tea
Foods higher in phosphorus
- Meat, poultry, fish
- Dairy foods
- Beans, lentils, nuts
- Bran cereals and oatmeal
- Colas
- Some bottled ice tea
How do I lower phosphorus in my diet?
- Know what foods are lower in phosphorus (see above).
- Eat smaller portions of foods high in protein at meals and for snacks.
- Meat, poultry and fish: A cooked portion should be about 2 to 3 ounces or about the size of a deck of cards.
- Dairy foods: Keep your portions to ½ cup of milk or yogurt or one slice of cheese.
- Beans and lentils: Portions should be about ½ cup of cooked beans or lentils.
- Nuts: Keep your portions to about ¼ cup of nuts.
- Eat fresh fruits and vegetables—if you have not been told to watch your potassium.
- Many packaged foods have added phosphorus. Look for phosphorus, or for words with PHOS, on ingredient labels. Choose a different food when the ingredient list has PHOS on the label.
Examples of foods that may have added phosphorus
- Fresh and frozen uncooked meats and poultry (ask the butcher to show you which fresh meats do not have added phosphorus)
- Chicken nuggets
- Baking mixes
- Frozen baked goods
- Cereals, cereal bars
- Instant puddings and sauces
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How to read a Food Label
If you have CKD, you may need to limit some nutrients in your diet such as sodium, phosphorus or potassium. You should limit some saturated and trans fats too. Read the food labels to help make healthy food choices for your kidneys.
- Check the Nutrition Facts label for sodium.
- Check the ingredient list for added phosphorus and potassium.
- Look for claims on the label, like “low saturated fat” or “sodium free.”
What should I look for on the Nutrition Facts Label?
Look for sodium on the Nutrition Facts label. Some Nutrition facts labels will list phosphorus and potassium too, but they do not have to.
What should I look for on the Ingredient List?
- Look for phosphorus or PHOS, on the ingredient list. Many packaged foods have phosphorus. Choose a different food when the ingredient list has PHOS on the label.
- Look for potassium on the ingredient list. For example, potassium chloride can be used in place of salt in some packaged foods, like canned soups and tomato products. Limit foods with potassium on the ingredient list.
Did you know? Ingredients are listed in order of the amount in the food. The food has the most of the first ingredient on the list, and the least of the last ingredient on the list. Look for claims on food packages to help you find foods lower in sodium and saturated fat. Sodium chloride (salt) is replaced in some foods with potassium chloride. If you need to watch your potassium, check the ingredient list. Example claims include:
- Saturated fat free
- Low saturated fat
- Less saturated fat
- Trans fat free
- Sodium free
- Very low sodium
- Low sodium
- Reduced salt
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