Living with chronic kidney disease (CKD) requires being more mindful of what you eat and drink. Watching your diet will help you keep your kidneys functioning as long as possible and help you stay healthier for the long term.

Perhaps you’ve just been diagnosed with CKD or are caring for a loved one who has it and needs help with easing into a kidney-friendly lifestyle. Here are frequently asked questions about kidney disease dieting along with their respective answers.

(Note: This information only serves as a guide. To get more specific answers tailored to your unique CKD condition, please talk to a renal dietitian.)

Basics of Kidney-Friendly Dieting for People with Non-Dialysis CKD

Why is it important to have a diet plan?

Uncontrolled blood pressure and blood sugar are huge contributing factors to chronic kidney disease. Over time, too much blood pressure can weaken, harden, and narrow the arteries around the kidneys. 

How is a CKD diet different from the average diet?

Impaired kidneys don’t function as well as they should. As a result, waste and fluids accumulate in your body. Gradual buildup of waste and fluid can have a negative impact on the heart and bones. This could possibly develop into other health conditions.

This is where a kidney-friendly diet is crucial. A meal plan specially designed for preserving kidney function aims to control your intake of certain nutrients, macronutrients, and minerals from food and beverages, specifically sodium, potassium, protein, and phosphorus. This is necessary to reduce the amount of waste materials in your blood that the kidneys need to filter out.

A renal diet also plays an important role in maintaining kidney function. It helps keep your condition from progressing to end-stage renal disease (ESRD) or kidney failure.

What substances should I control when on a CKD diet?

• Sodium - Lowering of sodium intake helps reduce blood pressure and prevent the swelling of the hands, legs, and ankles (edema). To control your sodium, avoid adding salt to your food both when cooking and eating.

• Protein - Our bodies need protein to maintain a number of body functions. However, damaged kidneys can’t metabolize protein in the blood, leading to waste buildup. Eat the right amount of protein based on your CKD stage.

• Phosphorus - Impaired kidneys are not able to get rid of excess phosphorus. Too much of this mineral can weaken the bones and damage the eyes, heart, and blood vessels. Avoid packaged foods that have phosphorus additives.

• Fat - Your doctor may recommend that you eat more unsaturated fat (or “good” fat) if you need to gain weight. If you need to shed off some extra pounds, you’ll need to limit unsaturated fat in your diet. Olive oil and sunflower oil are some examples of unsaturated fat.

• Fluids - It’s important to keep your body hydrated throughout the day. But when you have CKD, you may need to watch your daily fluid intake. Compromised kidneys don’t remove excess fluid from the body. Fluid buildup can cause a surge in blood pressure, edema, and heart failure.
  
  Talk to your doctor about your daily fluid allowance. Besides limiting your water intake, you may also need to cut back on soups, ice, ice cream, and fruits and vegetables that have high water content. Talk to your dietitian about your recommended daily fluid intake.

• Calories - Your body needs calories for energy. You can source your calories from the protein, carbohydrates, and fat that you consume. Your doctor or dietitian will help you determine your calorie requirement based on your age, gender, height, and physical activity.

What can I use to flavor my foods if I swear off salt?

• Use non-sodium or saltless seasonings.
• To release their flavor, roast vegetables before adding them to soups and sauces.
• Use home-made roasted vegetable stock to enhance the flavor of any dish.
• Avoid processed seasonings. Replace onion salt, garlic salt, and celery salt with onion powder, garlic powder, and celery seeds. 
• Limit or avoid high-sodium condiments like ketchup, soy sauce, and BBQ sauce.

What are some diet considerations if I have CKD and diabetes?

Work closely with your doctor and renal dietitian in developing a meal plan that keeps your sugar within a healthy range as well as your sodium, protein, potassium, phosphorus, and fluids.

Here are some foods a person with diabetes and CKD can eat, according to the Center for Disease Control and Prevention (CDC):

• Vegetables - Cauliflower, eggplant, onions, and turnips
• Fruits - Apples, berries, cherries, grapes, and plums
• Carbohydrates - Bagels, pasta, unsalted crackers, and white bread
• Proteins - Oats, soya, quinoa, and tofu
• Fluids - Ginger ale, lemonade, water, and unsweetened tea,

CKD and diabetes can change over the years, and so will your nutritional requirements. Always consult your dietitian before making any adjustments in your diet.

How can I control my food portions?

• Read the Nutrition Facts label each time you buy groceries. Look at a product’s serving size and the amount of nutrients contained in one serving.
• Consult with your dietitian about how to measure the portions of fresh foods like fruits and vegetables.
• Eat your food slowly. Stop eating once you feel you’re full. 
• Do not eat while you’re watching TV, reading, or driving. When your attention is elsewhere you may not be able to control how much you’re eating.
• Avoid eating directly from the package. Rather, take out one serving.

All You Need to Know About a Plant-Based CKD Diet

Is it safe for people with CKD to follow a plant-based diet?

Generally, plant-based diets are a potent source of fiber and various vitamins and minerals. These help reduce the risk of chronic diseases, including diabetes, heart disease, and CKD. 

Many health experts believe that a whole-food plant-based diet can reduce inflammation, slow down eGFR decline, help people maintain a healthy weight, and lower blood pressure and cholesterol levels.

Make sure to check in with your doctor and dietitian first to determine if going plant-based is healthy for you.

What is the difference between a vegan diet and a plant-based diet?

A vegan diet eliminates all kinds of animal products, including meat, poultry, and dairy.  A plant-based diet focuses on eating MORE whole foods (fruits, vegetables, legumes, nuts, and whole grains) and less processed meat, fast food, packaged food, and sweetened beverages.

There are many types of plant-based diets, each focusing on certain plant food groups. Every person with CKD has specific nutrient requirements based on their kidney disease stage, existing medical conditions, and dietary preferences.

How can I meet my protein requirements if I eliminate meat from my diet?

Cutting off meat doesn’t mean eliminating essential protein from your diet, nor does it result in protein deficiency. Plant-based protein sources could also provide the protein your body needs. A plant-based diet is even more beneficial for people with kidney disease who are not undergoing dialysis! 

Eating low-protein plant foods makes it easier for you to keep your protein levels at a minimum, preventing protein buildup in your body. The lower the protein level in your urine, the less work it is for your kidneys. 

Compared to animal protein, lean plant protein sources are lower in cholesterol and saturated fat. This is important to people with CKD who have cardiovascular diseases.

What are examples of plant protein sources?

Here are low-protein plant foods that are safe for people with kidney disease:

• Soy Products - Tofu, soy milk, soy cheese, and tempeh (a type of soy paste)
• Beans and Legumes - Red beans, kidney beans, black beans, chickpeas, and lentils. 
• Whole grains - Cereals, rice, bread, pastas and flour made from whole grains (Avoid whole grain products that have added sugar).
• Nuts and Seeds - Choose from almonds, cashews, walnuts, sesame seeds, flax seeds, chia seeds.
• Healthy Oils - Common types are sunflower oil, safflower oil, and olive oil (they also have antioxidant properties that help reduce inflammation)
  
  
• Natural Herbs and Spices - Cumin, thyme, paprika, cinnamon, and ground chilies.

Note: KDIGO, a non-profit organization advocating for evidence-based clinical practice in managing kidney disease, suggests limiting protein intake to 0.8g/kg a day for people with diabetes and non-dialysis CKD and not greater than 1.3g/kg a day for non-diabetic individuals with CKD. Still, every CKD patient has different protein requirements depending on their age, gender, weight, medical condition and kidney disease stage.

What steps can I take to switch to a plant-based kidney disease diet?

You don’t have to completely quit on animal foods on your first attempt at going plant-based. Replacing animal sources of protein with plant proteins at one or two meals each day is a good start! 

• Swap animal protein sources (e.g. beef, fish, and dairy) with plant proteins (e.g. whole grains, nuts, soy, and tofu) either in your meals or snacks.
• Swap processed grains with whole grain foods.
• Keep a food journal where you list down your daily calorie and protein intake. Doing this helps you stay on top of your diet and to track your progress.
• Develop the habit of reading the nutrition information on labels when buying groceries. Take note of the serving sizes, specifically the amount of protein, calories, sodium, potassium, and phosphorus for every food item.