Milk Alternatives for CKD Patients: What are the Options?

The RenalTracker Team

March 17, 2021

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Milk is a versatile beverage that can be drunk alone or mixed with other drinks such as coffee, smoothies, or teas. Drinking milk offers tons of benefits, including dental and bone health, better sleep, muscle growth, stress reduction, and disease prevention (see source 1).

In the United States, the national dietary guidelines recommend adults to drink three cups of milk (732 mL/d) to meet their daily requirements for calcium, animal proteins, and vitamin B12.

Although it is a popular drink for many, people with Chronic Kidney Disease (CKD) have to limit their dairy intake, including milk in their renal diet.

Why CKD Patients Should Limit their Milk Intake

Healthy kidneys remove waste build-up from the blood and help balance salt and minerals in the body. As kidney function declines, it becomes harder to clear the excess minerals such as potassium and phosphorus, abundant in milk. Too much phosphorus in the body can weaken the bones, cause joint pain, and calcify the blood vessels.

Several studies (see source 2) have revealed an increased risk of CKD progression or risk in mortality for CKD patients with high phosphate levels. Furthermore, patients on dialysis with the highest phosphate levels greater than 5.2–7.5 mg/dL had a 39% greater risk of all-cause mortality during 12 to 97.6 months of follow-up than those with normal phosphate levels at 3.0–5.5 mg/dL.

People with normal kidney function are recommended to consume between 700 mg and 1,200 mg of phosphorus daily. Experts suggest at least 4700 mg of potassium per day in general. The National Kidney Foundation suggests that 1,500-2,700 milligrams of daily potassium intake maintain good health without impacting the kidneys.

Clinicians encourage patients to limit their phosphorus intake to minimize the complications of high phosphate levels. The NKF suggests dialysis patients minimize dairy product consumption such as milk to half a cup per day.

Plant-based milk vs. Animal Milk

Plant-based milk has become popular among lactose intolerant, vegan, and those who are seeking a sustainable lifestyle. Most renal dietitians encourage CKD patients to restrict their cow’s milk intake due to its high phosphorus and potassium content.

This nutritional information from Food Data Central between animal milk and plant-based alternatives will give you an overview of its impact on your diet:

Serving Size for nutrients below: 100 g or 3.5 oz of milk

Type of Milk	Calories (kcal)	Sodium (mg)	Protein (g)	Phosphorus (mg)	Potassium (mg)
Cow’s milk (whole)	108	42	3.30	83	134
Camel’s milk	46	63	3.00	63	193
Goat’s milk	69	50	3.60	111	204
Almond milk (unsweetened)	17	75	0.42	17	79
Soy milk	80	47	2.60	43	122
Rice milk (unsweetened)	120	39	0.28	56	27
Coconut milk beverage (unsweetened)	31	19	0.21	0	19

Milk Alternatives for CKD Patients

It can be surprising to learn that lower fat milk has higher levels of potassium and phosphorus than whole milk. A cup serving of 2 percent milk has 224 milligrams of phosphorus and 342 milligrams of potassium. You may choose to focus on low potassium milk or low phosphorus milk, depending on your CKD stage and laboratory results. You can refer to your nephrologist and renal dietitian for renal diet recommendations.

There are great milk alternatives to manage your CKD condition. The American Society for Nutrition mentioned that milk alternatives are lower in calories, fat, and protein that are great for CKD patients.

Consider these great milk substitutes for CKD.

1. Almond Milk

This low phosphorus milk is the most common plant-based substitute. Almond milk is well-loved by vegans due to its creamy texture and nutty flavor. A cup of unsweetened almond milk has 30 calories, 180 mg potassium, 24 mg phosphorus, and 482 mg calcium.

Almond milk is considered low phosphorus compared to cow milk since the body does not easily absorb plant-based phosphorus.

Some great almond milk brands include:

Type of Milk (Serving Size: 1 Cup or 240 ml)	Calories (kcal)	Phosphorus (mg)	Potassium (mg)
Almond Breeze Unsweetened Original Almond milk	30	20	160
Almond Breeze Vanilla Almond milk	80	20	170
Silk, True Almond Vanilla	45	15	30

Almond milk is an excellent alternative if you are a CKD patient with diabetes since it is in sugar. You can use almond milk like regular milk or add it to your baked goods.

2. Rice Milk

A cup of rice milk typically has 115 calories, 2 grams of fat, 66 mg potassium, and 137 mg phosphorus. Rice milk is known to boost the immune system, manage cholesterol, promote bone density and maintain skin health.

Among the great rice milk brands are:

Type of Milk (Serving Size: 1 Cup or 240 ml)	Calories (kcal)	Phosphorus (mg)	Potassium (mg)
Rice Dream Classic	60	30	34
Rice Dream Enriched	67	75	30

Rice milk should be avoided if you have diabetes since it is starchy. A cup of rice milk has 33 grams of carbohydrates, four times higher than almond or soy milk.

3. Soy Milk

Soy milk can be a great option for dialysis patients since the potassium level is not higher than cow’s milk. The phosphorus content of soy milk is lower than cow milk. However, if your diet requires low potassium, soy milk may not be a viable alternative.

Some of the kidney-friendly soy milk brands include:

Type of Milk (Serving Size: 1 Cup or 240 ml)	Calories (kcal)	Phosphorus (mg)	Potassium (mg)
Edenblend, Organic Rice and Soy Beverage	120	140	440
Rice Dream Enriched	150	80	280

Before grabbing the first soy milk, you can find in stores, consider the fact that different brands of the same product have varied formulations. The same brand with different flavors can have unique amounts of nutrients. You can contact the manufacturer directly to get the most updated nutritional information about the milk.

Choosing Dairy-free Milk Alternatives

There’s more to finding alternative milk than choosing their plant-based versions. Read the nutrition label to be more equipped in deciding which milk alternative is excellent for your condition. Unfortunately, some food labels only include calcium and protein on the list. Either way, be wary of products with phosphorus additives such as:

Calcium phosphate
Dicalcium phosphate
Disodium phosphate
Monosodium phosphate
Sodium hexameta-phosphate

Sodium acid pyrophosphate
Sodium tripolyphosphate
Trisodium phosphate
Sodium tripolyphosphate
Tetrasodium pyrophosphate

If you are looking to manage your potassium level, beware of potassium additives in your food. However, the information about the potassium additives in certain foods is limited. According to the data from the Dietary Approaches to Stop Hypertension trial and similar studies, the body’s ability to absorb potassium from whole fruits and vegetables may be as low as 50% to 60%. Including these foods in your diet may help improve your blood pressure without a substantial increase in your potassium levels.

The Bottom line

Choosing milk alternatives for CKD is challenging as they have varying nutrient information and could be rendered as an acquired taste. However, it is important to find non-dairy substitutes to help manage your condition. Knowing how to read the nutritional label allows you to make informed decisions for your renal diet.

If you are unsure where to look and where to start, don’t hesitate to ask for your dietitian’s advice.