The RenalTracker Team
March 23, 2022

A healthy kidney-friendly diet is especially important if you have chronic kidney disease (CKD). Through proper nutrition, you have the energy to do your daily activities, prevent infection and inflammation, build muscles, and slow down the progression of kidney disease. Your dietary needs vary depending on different factors such as your CKD stage and the presence of co-morbid conditions including diabetes, hypertension, and heart disease. 

chronic kidney disease

A kidney-friendly diet should help slow the progression of kidney failure, reduce proteinuria, and lower the risk of CKD-related complications such as hypertension, cardiovascular disease, and bone disease. Proteinuria has increased levels of protein in the urine, indicating kidney damage, which, if left untreated, could further lead to CKD.

Stages of Chronic Kidney Disease

Your CKD stage is determined based on the presence of your glomerular filtration rate GFR, a test to measure how well the kidneys are functioning. Accurate estimates of GFR are necessary to determine kidney disease, as it often doesn’t show symptoms until just before the kidneys fail. A simple blood test measuring your creatinine levels is the standard way to estimate GFR. Creatinine is a waste product that the kidneys normally eliminate from the body. It is from the digestion of dietary protein and the normal breakdown of muscle tissue. Besides CKD, other factors affect your creatinine levels such as age, gender, and hydration levels.

Stages of Chronic Kidney Disease

Stage 3 Chronic Kidney Disease

An optimal estimated GFR (eGFR) is higher than 90. Your GFR decreases moderately when you are at Stage 3 of CKD. This stage has two subtypes depending on your eGFR readings. If your eGFR is between 45 and 59, you may be at stage 3a whereas eGFR between 30 and 44 is under stage 3b subtypes. CKD symptoms become more noticeable in stage 3 unlike in stages 1 and 2. The kidneys still function in stage 3 in such a way that they can still remove fluid, potassium, and a moderate amount of waste. Among the stage 3 CKD symptoms include: 

Edema (fluid retention characterized by swelling in the limbs, feet, and hands, puffy skin, stiffness in the joints, and tenderness in the limbs)

  • Orange, dark yellow, or red urine
  • Less or more frequent than normal urination
  • Unexplained fatigue
  • Anemic-like symptoms
  • Sleep problems such as insomnia
  • Lower back pain
  • Increased blood pressure 
Edema

On the other hand, it is possible you will not show symptoms of CKD stage 3. Nevertheless, your body will manifest the impact of declined kidney function including high blood pressure, anemia, and bone disease. If left untreated or if the kidney function worsens, you will be in stage 4 kidney disease, which means your condition has progressed into a  severe state. Stage 4 is the last stage of CKD before kidney failure. Kidney failure will require dialysis or kidney transplant. 

Consult a doctor right away if you experience any of these symptoms. You should follow up with your primary healthcare provider if you have been diagnosed with stage 1 or 2 CKD previously. Although these symptoms aren’t exclusive to CKD, experiencing a combination of these symptoms is alarming. Furthermore, it is still worth checking in with your doctor even if you haven’t been diagnosed with stages 1 or 2 as these stages don’t typically show noticeable symptoms. Your doctor will check your urine, blood pressure, eGFR tests to diagnose CKD stage 3. They will also conduct imaging tests to rule out more advanced CKD.

Consult a doctor

Stage 3 Chronic Kidney Disease Treatment

Managing blood pressure, sugar, weight, and tweaking your lifestyle can help slow the progression of CKD. Kidney disease is incurable, but you can prevent it from worsening. Talk to your doctor about treatment measures you can do to protect your kidneys from further damage. Your doctor may refer you to a renal dietitian to help you make healthier food choices that are gentle for your kidneys.

Stage 3 CKD Diet

A kidney-friendly plan provides you with the right amount of protein, calories, vitamins, and minerals. However, it can be challenging to get enough calories and carbohydrates to nourish your body without getting too much protein or other dangerous nutrients

You can keep a food journal to keep track of what you are eating. Learning to read food labels also allows you to make healthier food choices. When you have a weekly meal plan, it becomes easier to track and follow a renal diet for stage 3 kidney disease.

1.) A plant-based diet for stage 3 CKD

Consuming processed foods can put a strain on your kidneys. Processed foods are loaded with sodium and phosphorus that can be harmful to your kidneys. Plant proteins have been suggested to provide beneficial effects on blood pressure, glomerular filtration rate, proteinuria, and milder kidney tissue compared to animal-based proteins. 

plant-based diet

The National Kidney Foundation recommends vegetarianism or a part-time vegetarian diet, as a plant-based diet may slow down the development of CKD complications. These complications can be cardiovascular disease, progression of kidney damage, and protein loss in urine.

2.) Count your calories

Weight loss is common in more advanced CKD stages due to appetite loss that may risk you for malnutrition. Monitor your weight to see if you need additional or fewer calories based on your doctor’s suggestions for your recommended weight. Consider eating frequent meals throughout the day if you are losing weight. Getting enough calories can prevent weight loss or provide extra calories if you are malnourished.

calories

3.) Watch out for your phosphorus intake

Damaged kidneys are filtering between one-third and two-thirds as much blood as healthy kidneys, causing toxins to build up. More so, nutrients can also accumulate in the blood at unhealthy levels. Phosphorus is among the nutrients you should watch out for, as too much phosphorus, also known as hyperphosphatemia, can cause body changes that pull calcium out of the bones and make them weak. 

phosphorus intake

It can also lead to deposits in blood vessels, lungs, eyes, and heart. Symptoms include muscle cramps, bone and joint pain, weak bones, rash, and itchy skin. Limit consumption of phosphorus sources such as organ meats, whole-grain bread, cola beverages, cheese, liver, peanut butter, chocolate, dairy products, cola beverages, and processed foods. Click this link for a low-phosphorus diet.

4.) Track your potassium levels

Potassium isn’t restricted in stage 3 unless your potassium is too high. Your doctor may prescribe a low-potassium diet or adjust your medication. The American Kidney Fund recommends the dietary potassium intake for people with mild to moderate CKD is 4.7 g (4,700 mg) daily while those with advanced stage CKD and nearing dialysis must limit their potassium intake to 3 g (3,000 mg) a day or less. 

potassium levels

Decrease potassium levels by limiting consumption of high potassium foods such as potatoes, avocado, milk, nuts, cantaloupe, honeydew, legumes, seeds, and yogurt.

5.) Focus on the right kinds of fat

Refrain from consuming unhealthy fats including saturated fats and trans-fats as they exacerbate your co-morbid conditions such as cardiovascular diseases. Consider replacing unhealthy fats with poly- and monounsaturated fats from vegetable oil, canola oil, and olive oil. Limiting foods such as processed meat, fried food, red meat, etc. can help manage your cholesterol levels.

6.) Get your protein from the right sources

Your doctor may recommend a high or low-protein diet based on your lab results. The recommended daily protein intake in stage 3 CKD is 0.8 g/kg body weight. Ensure that you get quality protein from high-quality sources such as egg whites, fish, and poultry. Better yet, swapping animal protein to plant-based sources can help you get your protein without burdening your kidneys. However, when you opt for plant-based options, you may need to monitor your phosphorus and potassium intakes more closely.

plant based protein

7.) Decrease your sodium intake

When kidneys aren’t healthy, extra sodium and fluid can accumulate in the body. It can cause edema and a spike in blood pressure. Monitoring your sodium intake reduces the risk of hypertension. It also helps blood pressure medications to work more effectively. Swap your table salt with spices and non-salt blends to protect your kidneys without sacrificing flavor. The recommended sodium intake for stage 3 CKD is at 750 mg - 2000 mg per day. Speak with your primary healthcare provider to know your exact limit.

sodium intake

The Bottomline

In CKD stage 3, the damage to your kidneys prevents them from working properly to filter waste and extra fluid to your blood. Since your kidney function is declining, your nephrologist may suggest that you follow a certain food and fluid plan. If you are experiencing stage 3 CKD symptoms or were diagnosed with stages 1 and 2 previously,  it would be necessary for you, without hesitation,  to consult with your medical provider for further advice. Your doctor will determine your limited intake of nutrients such as sodium, protein, phosphorus, and potassium as well as fluid. A healthy renal diet can help prevent further damage to your kidneys, slow the progression of CKD, and improve your quality of life.

Sources:

The Importance of Diet for Stage 3 Kidney Disease -
https://www.renaldiethq.com/the-importance-of-diet-for-stage-3-kidney-disease/

What Is Stage 3 Kidney Disease Life Expectancy?What Is Stage 3 Kidney Disease Life Expectancy? -
https://www.webmd.com/a-to-z-guides/what-is-stage-3-kidney-disease-life-expectancy


Vegetarian Diet in Chronic Kidney Disease - A Friend or Foe -
https://pubmed.ncbi.nlm.nih.gov/28394274/


Estimated Glomerular Filtration Rate (eGFR) -
https://www.kidney.org/atoz/content/gfr


Kidney disease stages 3, 4 and 5 (not on dialysis) -
https://kitchen.kidneyfund.org/eating-healthy-with-kidney-disease/kidney-disease-stages-3-4-5-not-on-dialysis/

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