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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Nutrition

Kidney Health: Nutrition for Kidney Disease (320)

Kidney Health: Nutrition for Kidney Disease (320) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition

320


Nutrition for Kidney Disease

You will need to follow a special diet while your kidneys are not working as they should. This
guide contains specific diet and nutrition information to help you.

A healthy kidney filters out waste products from the blood. When your kidneys are not working
well, you may need to limit certain foods to prevent the build-up of waste products. This guide
will help you learn how to eat to control the amount of waste products that you produce. This
may help your kidneys stay healthier and slow the progression of kidney disease.

Protein
You need a diet with enough protein for the maintenance and growth of body tissue. When you
eat large amounts of protein it can cause more waste products to build up in your blood and may
harm your kidneys. So, you may need to limit the amount of protein in your diet.

Your dietitian will decide the amount of protein that you should have each day to meet your
body’s needs. Meat, poultry, fish, eggs, and dairy products contain large amounts of high quality
protein. Protein from plants such as nuts, beans, soy, and seeds are not as high quality of protein,
but may be easier for your kidneys to handle. You should include small amounts of proteins
should in each meal. Breads, cereals and vegetables also have small amounts of protein.

Listed below is the number of servings you should eat each day from the meat, milk, and starch
food groups to maintain a proper protein intake.

Your Daily Protein Needs with kidney disease are:
Height Grams protein per day Ounces/servings per day
5’2” or less 38-50 4-5
5’3” – 5’7” 42-56 5-6
5’8” – 5’11” 47-62 6-7
6’0” – 6’4” 52-70 7
*This is an approximate number, and may vary depending on your health condition.

Each of these is equal to one choice or serving, and contains ~7 grams of protein.
ξ 1 oz. beef, lamb, pork, poultry or fish
ξ ¼ cup salmon, tuna, crab, poultry, fish,
lobster, or clams
ξ ¼ cup cottage cheese
ξ 1 oz. or 5 medium shrimp
ξ 1 egg or ¼ cup egg substitute
ξ *2 Tbsp. Peanut butter
ξ *1 oz or ¼ cup of nuts
ξ 4 oz. tofu
ξ *½ cup cooked dried beans, peas, lentils,
and soybeans (edamame)
ξ *1 oz natural cheese (Swiss, Cheddar,
etc.)
*Choices higher in phosphorus and/or potassium.





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Milk is a protein source and you will need to limit it to <1 or up to 3 servings daily
depending on your potassium and phosphorus levels.

Each of these milk choices contains 8 grams of protein.
ξ 1 cup milk
ξ 1 cup regular yogurt
ξ ¾ cup custard
ξ 2-3 oz or ½ carton of
Greek yogurt
ξ 1 cup cream (milk-based)
soup
ξ ½ cup ice cream
ξ 1 cup milk-based pudding

ξ 2.5 cups non-dairy
substitute* (make sure
non-dairy substitute does
not contain phosphorus
additives)

Vegetarian Diets
Many new studies have shown that eating a vegetarian-type diet that includes plant-based
proteins like nuts and beans may help your kidneys stay healthier. A vegetarian diet requires
balance because foods like nuts and beans have more potassium. If you are interested in eating
more vegetarian foods, please talk to a dietitian.

Starch:
Starches are important to watch if you have diabetes. If you keep your diabetes under good
control it can help keep your kidneys healthier. Try to make at least half of your starches whole
grains. Whole grains often have a little more potassium and phosphorus than white grains, so you
need to monitor amounts. You should aim for about 1-4 carbohydrate choices per meal
depending on your diabetes and calorie needs.

Each of these is equal to one starch choice. One choice contains 15 grams of carbohydrate and
~2-4 grams of protein.
ξ Biscuit (2”)
ξ 1 dinner roll
ξ 1 slice bread
ξ ½ cup cooked cereal
ξ ½ hamburger bun
ξ ¾ cup dry cereal
ξ 1 muffin
ξ ¼ cup Grapenuts
ξ 2 pancakes (4”)
ξ 3 graham crackers (2 ½”
sq.)
ξ 6 saltines
ξ 2 ½ Tbsp. Flour
ξ ½ cup rice, cooked
ξ ½ cup pasta, cooked
ξ ½ English muffin
ξ 3 cups popcorn
ξ ½ cup potatoes
ξ ½ bagel
ξ ½ pita (6”)
ξ 1 flour tortilla (7”)
ξ 2 breadsticks, 4” long x
½’’

Fruits and Vegetables
Because fruits and vegetables have little protein, you can use them freely in your low protein diet.
Fruits and vegetables add vitamins, calories, fiber and flavor to your meals. They contain many
nutrients that keep your heart, blood vessels, and kidneys healthy. Try to eat at least 5 servings of
vegetables and fruits daily. Some fruits and vegetables are big sources of potassium and you may need
to limit them.


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Sodium and Fluid
Limit your diet to moderate amounts of sodium and fluid. The goal of sodium and fluid control is to
lessen fluid weight gain and keep your blood pressure under control.

Fluid
Fluid intake will vary depending on your type and stage of kidney disease, but you may need to limit
it. The more urine that you produce, the less restrictive you need to be. Fluids include water, soups,
drinks, and any foods that are liquid at room temperature. This includes ice cream, sherbet, popsicles
and jello. The table below shows the fluid content of various foods.

Food Item Portion size Fluid oz.
Ice Cream, Sherbet
Jello, plain
Jello, with fruit or
vegetables
Popsicle
Yogurt
½ cup
½ cup
½ cup

1 twin bar
4 oz
3
4
2

2
3

Sodium
To limit your sodium intake:
ξ Do not use salt at the table.
ξ Use only half the amount of salt (or less) normally used in recipes and in cooking.
ξ Read food labels on all packaged foods. Limit sodium to less than 2000 mg per day.
ξ Avoid foods high in sodium as listed below.

 All salted or smoked meat or fish, such as:
ξ Bacon ξ Smoked fish ξ Ham
ξ Canadian Bacon ξ Luncheon meats ξ Herring, sardines
ξ Corned Beef ξ Smoked sausage ξ Canned meat entrees
ξ Frankfurters/hot dogs ξ Bratwurst ξ Canned tuna

 Cheeses:
ξ Camembert ξ Processed cheese (Velveeta, American)
ξ Cheese spreads ξ Gorgonzola
ξ Roquefort ξ Party Dips

 Breads and rolls with salt toppings

 Convenience and processed foods, such as:
ξ Frozen dinners ξ Tomato juice
ξ Oriental foods ξ Canned tomatoes, sauce and paste
ξ Spaghetti (commercial) ξ Sauerkraut
ξ Pot pies ξ Bouillon cubes
ξ Packaged entrees, rice ξ Gravy and sauce mixes
ξ Potato and noodle mixes ξ Pickles, olives, relish
ξ Potato chips ξ Salted snack crackers
ξ Pretzels ξ Soups: canned, frozen or dehydrated

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 Seasonings that contain sodium:
ξ Celery salt ξ Lite salt
ξ Chili sauce ξ Meat sauces
ξ Garlic salt ξ Meat tenderizers
ξ Lemon pepper ξ Monosodium glutamate (MSG)
ξ Horseradish ξ Seasoned salt
ξ Onion salt ξ Worcestershire sauce
ξ Soy sauce ξ Barbeque sauce

 Condiments that may be high in sodium (use in moderation):
ξ Peanut butter
ξ Catsup
ξ Commercial salad dressing

Substitutes: Try these spices and herbs to cut the salt but not the flavor:
ξ Spike Salt Free
ξ Herbal Bouquet
ξ Mrs. Dash (all
varieties)
ξ Durkee Smart
Seasons
ξ Lawry’s Seasoned
Pepper
ξ Dried horseradish
ξ Onion powder
ξ Garlic powder
ξ Fresh garlic
ξ Scallions, onions,
shallots
ξ Fresh, dried herbs
ξ Pepper (white, red,
black)
ξ Pleasoning Mini-Mini
Salt
ξ Tabasco sauce
ξ Veg-it

Phosphorus
You may also need to control your phosphorus intake through diet and medicines. If phosphorus
builds up in the blood it can cause weak and brittle bones and skin itching. Over time, your heart
and blood vessels can become damaged. To control phosphorus levels, phosphorus-binding
medicines must be taken at the proper time. Take Tums (Calcium Carbonate), Phoslo, Fosrenol,
Renvela, or Renagel with meals as directed by your doctor.

Phosphorus is in many foods, but is especially high in the foods listed below. Ask your dietitian
if you may use them.

 Dairy products:
ξ Milk and cream
ξ Cheeses and cottage cheese
ξ Yogurt
ξ Custard and pudding
ξ Ice cream and ice milk
ξ Casseroles with cheese

 Protein foods:
ξ Meat
ξ Poultry and fish
ξ Eggs
ξ Organ meats
ξ Dried beans and peas
ξ Nuts, seeds and peanut butter
ξ Soybeans and tofu
ξ Lentils
ξ Salmon and sardines


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 Some whole grain foods:
ξ Bran products
ξ Oatmeal
ξ Whole grain breads and cornbread
ξ Wheat germ

 Other foods:
ξ Chocolate, cocoa
ξ Caramel
ξ Beer
ξ Carbonated colas
ξ Dried fruit
ξ Molasses
ξ Pizza
Phosphorus content of carbonated drinks:

High phosphorus:
ξ Cola
ξ Diet cola
ξ Dr. Pepper
ξ Cherry cola

Low Phosphorus:
ξ Ginger ale
ξ Grape soda
ξ Root beet
ξ Slice
ξ Club soda
ξ Sprite /7 Up
ξ Orange soda (except Nehi )








Phosphorus Additives
Many packaged food products and fast foods now contain phosphorus additives. Phosphorus
additives in food are absorbed nearly 100% into your blood, whereas the phosphorus in more
natural foods like meats, beans, and nuts are only absorbed 20-60%. Because of this, you should
avoid foods with phosphorus additives if you are trying to limit phosphorus.

Phosphorus additives can be found on the food label in the ingredients list as words that
contain “phos,” such as phosphoric acid, hexametaphosphate, or tricalcium phosphate. Always
read the ingredients list of packaged foods for “phos” foods, and try to avoid them.

Potassium
Some people with kidney disease may need to limit their potassium intake. In fact, some
medicines, (i.e. lisinopril or enalapril) may be prescribed to help preserve kidney function, but
may have a side effect that causes high potassium levels. Your doctor or dietitian will tell you if
your potassium level is too high or too low. You are able to control some of your potassium
level by watching how much potassium you eat.

The foods that contain the most potassium are the foods high in protein (dairy products, nuts,
beans, and meats), fruits and vegetables. You should avoid most salt substitutes since they also
contain potassium. Be sure to check the labels on “low sodium” or “low salt” foods and avoid
those that use potassium salts like “potassium chloride.”


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These tables that follow, list fruits and vegetables that contain low, medium, and high amounts of
potassium. If your potassium is high, try to choose mostly those in the low potassium group.


Fruits and Vegetables

Low Potassium Group
(serving sizes are ½ cup unless otherwise noted.)
These foods have less than 150 milligrams potassium (or 4 milliequivalents) per choice.

Fruits
ξ Apple juice
ξ Applesauce
ξ Apple, med, w/o skin
ξ Apricots, canned
ξ Blackberries
ξ Blueberries
ξ Boysenberries
ξ Cranberries
ξ Cranberry sauce
ξ Cranberry juice

ξ Figs, canned
ξ Fruit cocktail, canned
ξ Gooseberries
ξ Grapes, canned or
fresh
ξ Lemon, 1 medium
ξ Lime, 1 medium
ξ Nectars: peach, pear,
or apricot
ξ Mandarin oranges
ξ Peaches and pears,
canned
ξ Pear, fresh, 1 medium
ξ Pineapple, raw or
canned
ξ Plums, canned
ξ Raspberries
ξ Rhubarb
ξ Strawberries
ξ Tangerine

Vegetables
ξ Bamboo shoots,
canned
ξ Bean sprouts
ξ Beans, green or wax
ξ Broccoli, fresh or
boiled
ξ Cabbage
ξ Cauliflower
ξ Celery, 1 stalk, fresh
ξ Cucumber
ξ Eggplant
ξ Greens, raw, cooked:
collard, dandelion,
kale, mustard, turnip
ξ Hominy
ξ Leeks
ξ Lettuce: cos, romaine,
iceberg, leaf, endive,
watercress
ξ Mushrooms
ξ Onion: green, red,
yellow, white
ξ Pease, green
ξ Peppers, sweet or hot
ξ Potatoes, soaked**
ξ Squash: summer,
spaghetti
ξ Radishes, fresh
ξ Turnips
ξ Water chestnut
**Instructions for soaking potatoes: Peel the potato, cut into ¼ inch pieces and soak in 10 times
the amount of water to the amount of potato for at least 2 hours. Discard the water and cook
until tender in 5 times the amount of water.



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Medium Potassium Group: Limit to 1-2 per day if trying to limit potassium intake.
(Choice sizes are ½ cup unless otherwise noted.)
These foods have 150-250 milligrams of potassium (4-6.5 milliequivalents) per choice.

Fruit
ξ Apple-1 medium with
skin
ξ Apricots, fresh—2
medium
ξ Casaba, cubed
ξ Cherries—15 fresh or
canned
ξ Figs, fresh—2 medium
ξ Grape juice, canned
ξ Grapefruit—1/2
medium
ξ Grapefruit juice
ξ Orange, 1 medium
ξ Orange juice: frozen,
concentrate

ξ Peach, fresh—1
medium
ξ Pineapple juice
ξ Plums, fresh—2
medium
ξ Watermelon, 1 cup,
cubed

Vegetables
ξ Asparagus, frozen,
cooked
ξ Artichoke hearts,
boiled
ξ Brussels sprouts
ξ Carrots
ξ Cauliflower
ξ Corn, canned or 1
small ear
ξ Garbanzo beans
ξ Greens, frozen,
cooked: kale, turnip
ξ Mixed vegetables
ξ Okra
ξ Peas, green
ξ Summer squash:
yellow, crookneck,
white scallop


High Potassium Group: Limit to less than one serving per day if you need to limit
potassium intake.
(Choice sizes are for ½ cup unless otherwise noted.)
These foods have more than 250 milligrams potassium (more than 6.5 milliequivalents) per
choice.

Fruit
ξ Avocado-1/2 fruit
ξ Banana-1/2 medium
ξ Cantaloupe, ¼ medium
ξ Dried fruits: apricots,
dates, figs, prunes,
raisins
ξ Kiwi fruit, 1 medium
ξ Mango, 1 medium
ξ Nectarine, 1 medium
ξ Prune Juice
ξ Tangelo
Vegetables
ξ Artichoke, 1 medium
ξ Asparagus, raw,
cooked
ξ Beets, beet greens
ξ Dried beans and peas:
kidney, lima, navy,
pinto, black eyed peas,
split peas
ξ Kohlrabi
ξ Okra, raw, cooked
ξ Potato: baked, boiled
or fried and unsoaked
ξ Pumpkin
ξ Rutabaga, cooked
ξ Spinach
ξ Sweet potato or yams
ξ Tomato, fresh or
canned
ξ Unsalted tomato juice
ξ Unsalted vegetable
juice
ξ Winter squash: acorn,
butternut, hubbard

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Calories
The calories that you eat should be enough to maintain or achieve a proper body weight. If your
weight is below what has been determined “normal” for you, we suggest adding extra foods to
your meals from these groups below. These foods provide calories but are mostly free of protein,
potassium, sodium, and phosphorus.

Fat: 2-5 servings per day (45 calories per serving)
Certain fats are healthier for your heart. Try to choose more “unsaturated” fats like those found
in olive oil, canola oil, fatty fish like salmon.
ξ 1 teaspoon margarine, butter,
shortenings
ξ 1 teaspoon mayonnaise, cooking oils
ξ 1 tablespoon salad dressings
ξ 1/3 of an avocado*
ξ 2 tablespoons sour cream or liquid
cream
ξ 1 tablespoon powdered creamer
ξ ¼ cup whipped topping
ξ 1.5 oz. non-dairy milk substitute
ξ 2 T peanut butter or ¼ cup of nuts*
*Nuts and avocados are a good source of healthy fat, but are higher in potassium.

Sweets: (50 calories per serving)
ξ 1 tablespoon honey and jellies
ξ 1 tablespoon sugar
ξ 5 lifesavers
ξ ½ oz. jelly beans
ξ ½ oz hard candy
ξ ½ oz. gum drops
ξ 2-3 marshmallows (large)
ξ 1 tablespoon syrup (corn or maple)


Drinks help add calories to your diet because some drinks contain sugar. Don’t forget to count
these as part of your daily fluid allowance.
ξ Limeade ξ Cranberry juice ξ Apple Juice
ξ Lemonade ξ Sorbet, Italian Ice ξ Popsicles


Food Labels
The sodium content contained in a food is labeled in milligrams (mg) per serving of that food.
Protein content contained in a food is labeled grams (g) per serving of that food.

The Percent Daily Value listed on food labels is another way to assess sodium content. It is the
percent of 2400 mg of sodium (the recommended daily intake) contained in one serving of this
food.

Potassium and phosphorus, by law, do not need to be included on the label. Sometimes
potassium will be listed. Even if there is no number for potassium the food most likely still has
potassium in it. Look at the ingredient list. Ingredients are listed in order of most to least in
quantity.


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Nutrition Facts
Serving Size ½ Cup (114 g)
Serving per container 4
Amount per serving
Calories 90
Calories from fat 30
% Daily Value
Total fat 3 g 5%
Saturated fat 0 g 0%
Cholesterol 0 mg 0%
Sodium 300 mg 13%
Potassium 400mg 10%
Total Carbohydrates 13 g 4%
Dietary Fiber 3 g 12%
Sugars 3 g
Protein 3 g



Resources
There are many cookbooks designed for people with kidney failure. These may help you add
variety to your diet.

Carbohydrate and Sodium Controlled Recipes (for Diabetic, Hemodialysis and PD patients) by
Council on Renal Nutrition/ Northern California/Nevada; (1983), Helen Christensen, 1542
Queenstown Ct., Sunnyvale, CA 94087.

The Gourmet Renal Nutrition Cookbook by Sharon Stall, RD, MPH, Sol Goldman Renal
Therepy Center, Lenox Hill, 100 E 77th St. New York, NY 10021
Phone: (212) 434-3266
Fax: (212) 434-4528

Cooking the Renal Way by Council on Renal Nutrition of Oregon; (revised 1993), Oregon CRN,
P.O. Box 29133, Portland, OR 97210-9133.

The Renal Gourmet by Mardy Peters-A Kidney Patient;
Emenar, Inc.
13N625 Coombs Rd
Elgin, IL 60123

Amount of food in
one serving
Amount of sodium
in one serving
% of 2400 mg sodium contained
in one serving
Amount of protein in one
serving

10
Websites:
www.ikidney.com
www.Davita.com
www.culinarykidneycooks.com
www.kidney.org
www.kidneydirections.com/us/recipe/index.htm


Teach Back

What is the most important thing you learned from this handout?


What changes will you make in your diet/lifestyle, based on what you learned today?



If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.
Nutrition clinics for UW Medical Foundation (UWMF) can be reached at:
(608) 287-2770














Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 2/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department
of Nursing. HF#320