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Renal Diet for People with Kidney Failure or Disease

by Cindy Schmidler

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Renal Diet for People with Kidney Failure or Disease

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

Nutrition Label
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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.

Serving Sizes

5 Nutrients to Monitor

Protein

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

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Sodium

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
Tips to lowering sodium in your diet
Phosphorus

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:

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Potassium

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

Blueberries

Green beans

Radishes

Tangerine

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

Beets

Dates (4)

Kiwi

Plums

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

Banana

Molasses

Pumpkins

Tomato Sauce

Bran Cereal

Nectarine

Raisins

Tomatoes

Buttermilk

Orange Juice

Salt Substitutes

Vegetable Juice

Chard

Oranges

Spinach

Watermelon

Dried Beans/Peas

Papaya

Sunflower Seeds

Winter Squash

Figs

Potatoes

Sweet Potatoes

Yogurt

Dialyzing Vegetables

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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.

  1. Use fresh potatoes, carrots, beets, rutabaga
  2. Peel and I, placing cold water new line
  3. Slice 1/8 inch thick slices
  4. Soak in warm water for 2 hours. Use 10 times the amount of water to vegetables.
  5. Rinse under warm water.
  6. Cook for 5 min. in 5 times the amount of water to vegetables.
  7. Serve only one portion
  8. 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.

Fluid Formulas

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.

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Total Daily
Fluid Allowance

Breakfast

Lunch

Dinner

Other

Measuring Fluid

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.

  1. Measure each item you eat or drink that counts as liquid
  2. For each item, remove the same amount of water from the jar/jug
  3. 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.

Protein

Starches

Fruits

Vegetables

Fats

Sweets

Drinks

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)

lemonade

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
(glazed, jelly)

weak coffee

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

turnips, rutabagas

Sample Menus

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

Breakfast

Breakfast

Breakfast

Protein

Egg

Canadian bacon

Starch

Bagel

Cinnamon toast, jelly

Fruit

Strawberries

Fruit Cocktail

Fat

Cream cheese

Margarine

Drink/Fat

Coffee w/nondairy creamer

Coffee w/nondairy creamer

Lunch

Lunch

Lunch

Protein

Tuna Salad made with Eggs

Beef patty

Starch

Bread

Hamburger bun

Vegetable

Celery

Lettuce, onions

Fruit

Pear

Pineapple

Fat

Mayonnaise

Mayonnaise

Sweet

Cookies

Apple Pie

Drink

Tea

Lemonade

Dinner

Dinner

Dinner

Protein

Fried chicken

Grilled Fish

Starch

Cornbread

Yeast Roll

Vegetable

Squash (yellow), Green Beans

Grilled Asparagus and Corn on the Cob

Fruit

Strawberries

Blueberries

Fat

Margarine

Margarine

Sweet

Pound cake

Cheesecake

Drink

Tea

Tea

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