The kidneys keep fluids in our body at normal levels. When kidneys no longer work well, you can change your diet to help keep fluids and certain nutrients at normal levels. These nutrients include: protein, sodium (salt), phosphorus, potassium and fluid. You must watch the amount of these nutrients you get each day. That way, if your doctor tells you to cut back, you will know how much you were eating or drinking and about how much less to eat or drink.
In general, a renal diet is high in calories, low in fluids, protein, and sodium.
Balancing Salts, Fluids and Electrolytes
Healthy kidneys remove waste and fluids from the blood and balance the salts in our body. Once kidneys stop working, you need to limit the amount of certain nutrients you eat and drink. Too much of these nutrients in your blood can cause problems. Your doctor will set limits and restrictions for your diet based on how much kidney function you have. If you are on hemodialysis, when you go to the clinic for dialysis, they take blood for lab tests to measure how much of these nutrients are in your blood. If the lab tests results tell you too much of these nutrients are in your blood, then you are getting too much of them in your diet. Therefore, you need to change your diet to cut back on foods that contain those nutrients until your next lab work. It is a constant effort of monitoring, testing and balancing your fluids, electrolytes and salts. If the results of your blood work are good, then you can continue eating and drinking as you had been. There is usually a dietitian at the dialysis clinic that can help you adjust your diet to better control these nutrients.
It will also be helpful to understand food labels including nutritions facts and ingredient listings.
In addition to a special diet, you may be on medicines to help control these nutrients. There is usually a social services person at the clinic who can help you understand your medicines and tell you or your doctor (nephrologist) if your medicines need adjusting or changed.
- 1/4 cup = a golf ball
- 1/2 cup = a tennis ball
- 1 cup = one fist
- one small fruit = baseball
- one pancake = the size of a DVD
- one potato = the size of a computer mouse
5 Nutrients to Monitor
- Sodium (Normal levels for serum sodium are 135-145 mEg/L)
- Phosphorus (Normal levels for serum phosphorus are 1.8-2.6 mEg/L)
- Potassium (Normal levels for serum potassium are 3.5-5 mEg/L)
Protein is important to help build and maintain muscle mass and the immune system. Too much protein can cause nausea, vomiting, and more damage to the kidneys. Usually, protein is limited with renal failure. A low-protein diet reduces the end products of protein metabolism that the kidneys can no longer get rid of. However, protein may be increased once you start hemodialysis. Your doctor will tell you how many grams of protein you can have each day. (80 grams is a common daily limit for people on hemodialysis.) The protein should come from foods that contain all of the essential amino acids to prevent the breakdown of body protein (muscle). These foods include eggs, milk, poultry and meat. A high calorie diet will also help prevent the breakdown of body protein.
Vegetables, grains, meats, fish, poultry, and legumes (beans and peas) have protein. Most of the protein you eat should come from meats, fish, poultry (chicken) and legumes (beans and peas). Use the list below to plan your meals. g = grams, 1000 mg = 1 gram
- 1 ounce cooked meat, fish, poultry = 7 g
- 1 large egg = 7 g
- 1/2 cup cooked dried beans, peas, lentils = 8 g
- 1/2 cup tofu = 7 g
- 2 tablespoons peanut butter = 7 g
- 1 cup milk, soy milk, or yogurt = 8 g
- 1/2 cup putting or custard = 4 g
- 1 slice or 1 inch cubed cheese = 7 g
- 1/2 cup cottage cheese or ricotta cheese = 7 g
- 2 tablespoons Parmesan cheese = 7 g
Never add salt to your food—get rid of the salt shaker!Sodium makes us thirsty and want to drink more. As we drink more fluids, we retain fluid and our blood pressure goes up which puts a strain on our kidneys and heart. Avoiding foods high in salt and sodium helps control fluid. You may eat 2000 mg (2 grams) of sodium per day. Table salt has sodium and chloride; 1 teaspoon of salt equals 2 g of sodium which is equal to your sodium allowance for the day. Salt substitute: does not contain sodium; is usually made from potassium; talk with your doctor before using a salt substitute.
High Sodium Foods to Avoid
- canned vegetables and soups
- packaged seasonings and meal starters
- processed meats
- ham, bacon, sausage
- chips, pretzels, nuts, salty snack foods
- pickled meats and vegetables
- butter, garlic salt, seasoned salt
- barbecue sauce, soy sauce, ketchup, mustard
- processed cheeses and cheese foods
Tips to lowering sodium in your diet
- leave the salt shaker in the cabinet—out of sight out of mind
- seasoned with herbs and spices; garlic, onion, sage, rosemary, thyme, lemon juice, fruit
- read medication labels and content talk with your doctor
- beware of medicines that contain sodium such as antacids and laxatives
- dining out: ask for meals made without salt or MSG (monosodium glutamate)
- choose foods with less than 200 mg of sodium per serving
- avoid foods with salt or sodium listed as one of the 1st 4 ingredients
Most foods have phosphorus in them. Too much phosphorus can cause calcium to come out of bones, making bones brittle and easier to fracture or break. Your doctor may prescribe a phosphorus-binding medicine to reduce the amount of phosphorus in your body. Tums is a phosphate-binding medicine.
Most people with kidney failure should limit phosphorus to 800-900 mg a day. It is recommended that you that you limit or avoid the following foods:
- baking powder
- bran cereals
- breads raised with baking powder
- cheese (except cottage cheese)
- dark cola beverages
- dried beans
- dried peas
- milk and milk products
- organ meats (brain and liver)
- peanuts and peanut butter
- whole grains, whole wheat bread
Potassium helps muscles including the heart muscles to contract and relax. Too much potassium can cause your heart to beat irregularly or even stop. Too much potassium in your blood can cause hyperkalemia and emergency treatment should be started. Unless your doctor tells you otherwise, limit potassium to 2000 mg each day. The following list will help you with lower potassium options. Choose fruits from the medium and low potassium groups.
Low potassium foods less than 150 mg per serving
|Apples||Cottage cheese||Lemonade||Raw cucumber|
|Applesauce||Cranberry juice||Onion||Sliced cheddar or Swiss cheese|
|Bean sprout||Diced turnips||Parmesan cheese||Sour cream|
|Bell Pepper||Frozen pea||Pears or papaya not nectar||Strawberries|
|Black or green olives||Grapes||pineapple||Summer squash|
|Brewed tea||Instant coffee||Raspberries|
Medium potassium foods 150 to 300 mg per serving
|Apple juice||Celery||Hot cocoa||Pears|
|Asparagus||Corn||Ice Cream (1/2 Cup)||Pineapple Juice|
|Broccoli||Eggplant||Milk (1/2 Cup)||Raw Cabbage|
|Carrots||Grape juice||Mushrooms||Ricotta Cheese|
|Cauliflower||Grapefruit (one half)||Okra||Turnip/Mustard Greens|
|Grapefruit juice||Peaches||Zucchini Squash|
High Potassium Foods Greater Than 300 Mg per Serving
|Apricots||Honeydew Melon||Prune Juice||Tofu|
|Avocado||Milk (1 Cup)||Prunes||Tomato Juice|
|Buttermilk||Orange Juice||Salt Substitutes||Vegetable Juice|
|Dried Beans/Peas||Papaya||Sunflower Seeds||Winter Squash|
You can prepare some vegetables in a way that reduces the amounts of sodium and potassium in them, called dialyzing vegetables. Follow these directions exactly. Be sure your doctors know you are using these methods.
- Use fresh potatoes, carrots, beets, rutabaga
- Peel and I, placing cold water new line
- Slice 1/8 inch thick slices
- Soak in warm water for 2 hours. Use 10 times the amount of water to vegetables.
- Rinse under warm water.
- Cook for 5 min. in 5 times the amount of water to vegetables.
- Serve only one portion
- You may freeze the left overs
Monitoring Your Fluid Intake
Because your kidneys can’t make urine, your body can’t get rid of fluids, you will need to limit the amount of fluids you take in. Your doctor will tell you how much fluid you can have each day, this amount may be adjusted based on your dialysis treatments. For instance, your limit may be 3 pints per day (6 cups). There are 16 fluid ounces (oz) in a pint, 8 oz in a cup, 2 tablespoons in an ounce.
Fluid is anything that is a liquid at room temperature. All fluids count towards your daily limit including foods that contain a lot of fluid.
- gelatin (Jell-O)
- ice cream
- ice cubes (one full cup of ice = 1/2 cup of water)
- liquid medicines
- beverages (clear soft drinks)
- 1500 mL = 50 ounces = 6 1/4 cups
- 1000 mL = 33 ounces = 4 cups
- 300 mL = 10 ounces = 1 1/4 cups
- 240 mL = 8 ounces = 1 cup
- 120 mL = 4 ounces = 1/2 cup
- 60 mL = 2 ounces = 1/4 cup
- 30 mL = 1 ounce = 1/8 cup = 2 Tbs
Recording Your Daily Fluid Intake
This table shows you how to break down your fluid intake throughout the day. Don’t forget to save enough fluid for taking your medicines; this fluid is counted in the “other” column.
Another way to keep track of your daily fluid intake is to fill a jar/jug with water with the total daily fluid allowance prescribed by your doctor.
- Measure each item you eat or drink that counts as liquid
- For each item, remove the same amount of water from the jar/jug
- When jar/jug of water is empty, you are finished with your fluid allowance for the day.
What You Can Eat
By now, I’m sure you’re wondering what can you eat? This table shows foods that may be OK for you to eat. You may have other health issues that keep you from eating some of these foods. For example, if you have diabetes or heart disease, some of these foods may have to be limited or cut out of your diet. Take this list to your doctor or dietitian and ask them if these foods are OK for you.
|beef||bagels, muffins, English muffins||apples, applesauce||beets||butter||cake||ginger ale, Sprite, 7-Up|
|pork||yeast rolls, popovers||blueberries, cherries||cabbage||margarine||cookies (ginger snaps,|
lemon or vanilla filled, sugar, shortbread)
|chicken||bread ( white, wheat, rye, pita)||cranberries sauce||carrots (cooked)||cooking oil||cheesecake||weak tea|
|wild game||crackers, unsalted||fruit cocktail||celery, cucumbers||cream cheese||cinnamon rolls, doughnuts|
|turkey||dry cereal, no nuts or dried fruit||grapes||broccoli and cauliflower, cooked||mayonnaise||fruit tarts||water|
|fish||noodles, rice||lemons, limes, tangerines||corn||nondairy creamer||pies (apple, blueberry,|
cherry, lemon, strawberry)
|eggs||pancakes, waffles||pears, plums, pineapples||eggplant||salad dressing||Popsicles|
|popcorn||raspberries||green beans, peas||rice Krispie treats|
|tortillas, corn or flour||strawberries||onions||honey, jam, jelly, syrup|
|peppers (green and red)|
|squash (yellow), zucchini|
Below are a couple of sample menus plans made from the list of foods you can eat. Use day 3 to come up with a menu plan of your own.
|Day 1||Day 2||Day 3|
|Starch||Bagel||Cinnamon toast, jelly|
|Drink/Fat||Coffee w/nondairy creamer||Coffee w/nondairy creamer|
|Protein||Tuna Salad made with Eggs||Beef patty|
|Protein||Fried chicken||Grilled Fish|
|Vegetable||Squash (yellow), Green Beans||Grilled Asparagus and Corn on the Cob|