Diet for Chronic Kidney Disease (CKD) Patients

You might need more protein on dialysis.

Once you’re on dialysis, your protein needs are usually much higher than before. That is because both haemodialysis (HD) and peritoneal dialysis (PD) treatments cause your body to lose protein.

The type of protein is important.

There are various types of healthy protein sources – including chicken, beans, beef, eggs, fish, turkey, tofu and many others. Choosing fresh, high-quality protein is the healthiest option. You should avoid cured and deli meats to limit the amount of salt you consume daily.

Determining how much protein to take and what kind of protein to take can be challenging. It is always best to consult your clinician or dietitian to find a plan that works best to protect your kidneys.

Tips and Tricks to regulating your protein intake:

Explore your options, look for protein alternatives

Protein does not have to be boring! There are abundant healthy, interesting protein options that you can try out. Some of these include chickpeas, shellfish, and various plant seeds.

Choose fresh proteins

It is best to avoid fast or processed foods as they often contain excessive preservatives, including salt. Preparing fresh meals allows you to better monitor the nutritional content in your daily diet.

Say less to sodium.

In CKD patients, their kidneys have a hard time keeping their bodies’ sodium levels in balance. Accumulation of sodium can cause high blood pressure, shortness of breath, and swelling of the limbs. Chronic kidney disease patients should watch out for the sodium content in all food and drinks they consume daily.

How to limit your sodium daily intake?

It is best for chronic kidney disease patients to stay away from marinated and processed foods, canned foods and ready-to-consume instant food packets. Fresh, healthy, home-cooked meals flavoured with spices and herbs are great alternatives for CKD patients to regulate their daily sodium consumption.

Tips and Tricks to regulating your sodium intake:

Use salt-free seasonings.

Food for kidney disease patients often incorporate salt-free seasonings as a great alternative to bring out the flavour. Explore some of these herbs and spices in your dishes, including basil, turmeric, chilli, and many more. Or it you are feeling adventurous, feel free to make your own salt-free spice blend.

Read your nutrition labels carefully.

Sodium can often be included in much pre-packaged food. In cases where fresh options are unavailable, knowing how to read and understand nutrition labels is handy for choosing suitable alternatives.

Watch out for phosphorus.

Phosphorus works with calcium and vitamin D to keep your bones healthy. When your kidneys are not working well, phosphorus can build up in your blood and lead to severe bone and heart damage, tissue calcification and itching.

Be mindful of phosphates.

Phosphorus can occur naturally in foods. Reducing phosphorous intake can be tricky as they are found not only in fast food and flavoured beverages but also in relatively healthier food choices such as milk, yoghurt, cheese, chocolate, and nuts. Phosphorus can also be added as additives to enhance food colour and flavour as well as extend its shelf-life.

Tips and Tricks to regulating your phosphate intake:

Read your nutrition labels carefully

Do note that phosphorus can also present with many different names as additives, including:

• Dicalcium phosphate
• Disodium phosphate
• Monosodium phosphate
• Phosphoric acid
• Sodium hexameta-phosphate
• Trisodium phosphate
• Sodium tripolyphosphate
• Tetrasodium pyrophosphate

Keep a look out for them on nutrition labels and consult your clinician or dietitian when in doubt.

Choose fresh foods

Phosphorus from artificial additives is absorbed more readily than natural organic phosphorous. Phosphorus from additives is, therefore, more harmful to chronic kidney disease patients. As a rule of thumb, avoid canned, processed and fast food, instant meal, and bottled drinks.

Mind your calcium

Whether you're on PD or HD, the amount of calcium you get from your diet should not be greater than the recommended daily allowance of 2,000 mg. Too much calcium in your body can put you at risk of vascular calcification, which are mineral deposits in your veins and arteries, and other harmful conditions.

Say less to dairy

Certain food groups are naturally high in calcium and should be moderated in dialysis diets. One example are dairy products such as cheeses, creams, milk, yogurt, etc, Calcium can also be artificially added into other foods, like fruit juices and bread, thus it can be helpful to read the nutritional labels and food packaging before you make your purchase.

Tips and Tricks to regulating your calcium intake:

Pay attention to the nutrition label and food packaging

Steer clear of labels that read “calcium-enriched”, “calcium-fortified” or “high in calcium”. A good practice could also be to compare your food alternatives to choose the less calcium option. Calcium levels in food can also be recorded in the nutrition label. You can always reach out to your clinician or dietitian to help you learn to identify your less calcium options.

More fibre is good.

Getting enough fibre from the foods you eat is an important part of maintaining your overall bodily health. Fibre helps your body control its blood sugar levels, keep cholesterol in check, and maintain gut health. You should consume about 20 g to 25 g of fibre each day. This is easy if you eat a diet rich in fruits and vegetables and low-phosphorus grains.

What are my fibre options?

Fibre intake can be difficult for dialysis patients as most high fibre sources tend to also be higher in potassium and phosphorous. Don’t fret! Fresh fruit and vegetables are still the most accessible sources of fibre in your diet, which include apricots, berries, cauliflower, corn, squash, etc.

There are different types of fibre that can help to regulate gut and stool health. Thus, it is important to include plenty of fibre in your diet.

Tips and Tricks to regulating your fibre intake:

Say “Yes!” to fresh fruits and vegetables.

Try to incorporate as many fruits and vegetables as possible into your meals. They are great sources of fibre. You can have even more fibre by eating with the peels on if possible. Craving a drink? Try blending a fresh whole fruit yourself (peel and all) for another refreshing alternative.

Make fibre-rich options a habit.

There are other ways to incorporate fibre discretely into your meals. One is opting for fibre-rich cereals and grains. Love to snack? Try munching on unsalted popcorn and vegetables instead as you go about your day.

Adequate calories are required for your body to function well and prevent malnutrition. Your body gets energy from the calories you eat and drink. Calories come from the protein, carbohydrates and fat in your diet.

If you’re on peritoneal dialysis (PD), some of the calories your body takes in come from the dialysate fluid solution used to clean your blood during treatment. This is because the dialysate fluid contains dextrose, which is a form of sugar. Dextrose provides your body with some of its daily recommended calorie intakes, so you can consume fewer calories from your diet. As a result, PD patients are recommended to eat fewer calorie-rich carbohydrates than HD patients.

Tips and Tricks to regulating your calorie intake:

Learning suitable portion control is key

Eating three meals a day might be a habit for most people, consider breaking them into smaller meals at regular intervals. In addition, having a diet plan might help as an easy guide to follow for the day. Work with your clinician or dietitian to find a suitable plan for your lifestyle.

Potassium is an important mineral that keeps your heart beating right and muscles functioning properly. It is the job of healthy kidneys to ensure potassium remains at the correct amount in the body. In patients with CKD, potassium can accumulate to a dangerous level, which may cause irregular heartbeat or even cardiac arrest.

PD generally removes excess potassium from the body more efficiently than HD. If you are on PD, you are typically able to consume between 3 g to 4 g of potassium per day. But if you’re being treated with HD, you should limit your potassium intake to about 2 g per day to maintain balance. If you're a home haemodialysis (home HD) patient, it is best to speak with your care team or dietician about the level of potassium that is recommended for you.

Tips and Tricks to regulating your potassium intake:

Know your low-potassium options

Moderate potassium intake can be beneficial for your body, so potassium should not be completely excluded from your diet. Instead, you should include a variety of low-potassium options in moderation, such as berries, peppers, onion, and pasta.

Keeping to low-potassium food is one of many ways to maintain potassium balance. Leaching is a common cooking method to pull potassium out of high-potassium vegetables. While leaching does not remove all potassium from food, it can give you more dietary options. Check in with your clinician or dietitian on leaching as a suitable cooking method for you and how many leached vegetables you can have in your diet.

One of the most important functions of your kidneys is keeping the fluid in your body in balance. When you have CKD, your kidneys cannot remove this fluid as effectively as they should. This can lead to a build-up of excess fluid, which can be uncomfortable for your body.

In-centre haemodialysis (In-Centre HD) treatment sessions are shorter in duration and less frequent compared to PD. Thus, in-centre HD patients may experience more fluid imbalance symptoms than PD patients.

If you are treated with PD or home HD, you may not have the same fluid restrictions as someone on in-centre HD. However, it’s still recommended that you stick to a fluid allowance of about 4 cups (1 Liter) of fluid per day, which includes the fluid that is in foods like green peas, celery, and watermelon.

Tips and Tricks to regulating your potassium intake:

Mindful tracking is helpful

Minimising your sodium intake and planning the liquid you drink and eat ahead of time can help you keep your water gains to a minimum.