Your Wellbeing, LLC Kidney Disease Guide

The following are a list of educational material available to Your Wellbeing, LLC patients. This information (including diet plans) can be found on Your Wellbeing’s health portal under the Diet section tab. Please note that each educational listing is specifically designed to assist a patient’s eating habits based off the correlating condition specified in the diet. These diets may not be used by anyone and everyone. If you have other health related issues that might be affected by our diet plans please contact a doctor for further guidance.

Stages of Chronic Kidney DiseaseYour kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage.  Kidneys are always busy and have many important functions.  They remove waste products and maintain fluids in your body.  They increase the production of urine when body fluid is too high, and they retain fluid when body fluid is too low.  They also maintain the right balance of minerals it needs like sodium, phosphorus, and potassium because excess levels of these minerals can be harmful.  The kidneys also help regulate your blood pressure. Kidney failure results when your kidneys no longer work well enough to remove wastes and excess fluids from the body. This extra "waste" builds up in the bloodstream and can make you very sick. Total kidney failure or chronic kidney disease (CKD) is diagnosed as End Stage Renal Disease (ESRD), when kidney function falls to 5-10% of capacity.  Too much sodium, potassium, protein, phosphorus, calcium and/or fluid in the diet can cause dangerous changes in your body.  Therefore a special diet is critical in managing your kidney disease.  The type of diet that may be prescribed to you depends on the stage of your kidney failure as well the type of dialysis treatment you are receiving. Chronic kidney disease usually occurs over a number of years as the kidneys are slowly damaged.  Proper diagnosis and treatment in the early stages of kidney disease can save the remaining function of your kidneys for many years.  The National Kidney Foundation (NKF) recently published information on the stages of Chronic Kidney Disease (CKD). In the table below, the "GFR level," or glomerular filtration rate, is a measure of how well your kidneys are cleaning your blood. Your doctor can calculate your GFR, based on a formula.

Stages of Chronic Kidney DiseaseStage Description GFR LevelNormal kidney function Healthy kidneys 90 mL/min or more

Stage 1 Kidney damage with normal or high GFR 90 mL/min or more

Stage 2 Kidney damage and mild decrease in GFR 60 to 89 mL/min

Stage 3 Moderate decrease in GFR 30 to 59 mL/min Stage 4 Severe decrease in GFR 15 to 29 mL/min

Stage 5 Kidney failure Less than 15 mL/min or on dialysis

Nutrients in Chronic Kidney Disease (Stages 1-4)  When your kidneys fail, some waste products and excess nutrients can build up in your blood. Each nutrient has a different effect on your body. The following contain information about waste products and nutrients, which you might be asked to regulate:

Protein provides amino acids for your body to build, maintain, and repair cells and muscle tissue, heal wounds, and support the immune system. In your body, protein breaks down into a waste product called urea. Blood levels of urea are referred to as blood urea nitrogen (BUN).  When your kidneys are not working well, urea accumulates in the blood. This can make your kidneys work harder. You can become very sick with high levels of BUN.   Protein intake should be controlled to avoid high levels of BUN and thus reduce the workload placed on your kidneys. Some studies of low protein diets show that they can actually slow the progression of kidney failure. The amount of protein you may eat depends on the stage of your kidney failure, your treatment plan and your body weight. There are two kinds of protein found in foods: "high quality" and "low quality". High-quality protein or animal protein contains all the essential amino acids your body needs to grow body tissue. High-quality proteins come from dairy products, lean meat, fish, poultry, nuts, and eggs (especially egg whites). Getting most of your protein from these sources are highly encouraged.  Low quality protein or plant protein may not contain all the essential amino acids that your body needs but are still a necessary part of your diet. Plant protein comes from vegetables, breads, and cereals. There are some exceptions to this like peas, beans (both can be rather high) and some starchy vegetables (like potatoes and corn which are in the medium range). Fruits and most vegetables have little or no protein.  Sodium. Sodium is a mineral that affects your body fluids and blood pressure. Some salt or sodium is needed for body water balance. But when your kidneys begin to fail, they lose the ability to regulate sodium and water.  If sodium intake is not restricted, the body may retain sodium and water and you may experience thirst, edema, swelling of lower limbs, high blood pressure, discomfort during dialysis and/or congestive heart failure. By using less sodium in your diet, you can control these symptoms.  The level of sodium restriction needed depends on the sodium content of your urine and blood, and the degree of high blood pressure and fluid retention. Sodium is found naturally in foods and is the major part of table salt. You need to control your salt intake and avoid foods with high sodium content. You should aim for less than 2,000 mg/day.  High sodium foods include processed foods like "deli" meats and cheese, canned foods, frozen foods, convenience and "fast" foods, pickles, salty snacks and salty seasonings. You can refer to the Diet Analysis section (under the Diet Tools) to help determine the sodium content of a specific food.  Potassium. Potassium is a mineral which helps keep your heartbeat regular and your muscles working right. Potassium is necessary for good health, but too much can be dangerous to the heart. Healthy kidneys keep the right amount of potassium in the blood to keep the heart beating at a steady pace. However, when your kidneys begin to fail, potassium will build up in the blood. High potassium levels in the blood may cause diarrhea, nausea, and weakness, breathing difficulty, numbness or tingling in your fingers and toes, irregular heart beat and even death. Potassium can be controlled by the foods you eat. Your potassium level should be checked regularly with a blood test. If your levels are too high, your doctor will ask you to start a low potassium diet. You may need to limit your potassium intake anywhere from 2,000-4,000 mg of potassium a day depending what your blood levels are .You can refer to the Diet Analysis section (under the Diet Tools) to help determine the potassium content of a specific food.  Phosphorus. Phosphorus is the second most common mineral in the body (after calcium). Phosphorus is a mineral found in many foods, mostly in dairy products and meats and it is plays an important role in the formation of healthy bones and teeth.  The kidneys play an important role in balancing the phosphorus and calcium in the body.  Healthy kidneys can remove excess phosphorus from your blood; but, when your kidneys begin to fail the phosphorus begins to build up in the blood and causes many problems including itching, muscle aches and pains, calcification of the heart, skin, joints and blood vessels.   Also, your

body may try to correct this imbalance by taking calcium from your bones. When calcium is lost, joints become painful and bones become weak causing them to break easily. Your phosphorus level can be checked with a blood test. You may need to limit your phosphorus intake depending what your blood levels are. Some experts think 800 to 1,200 mg. of phosphorus per day is a good target.  Phosphorus is found in high-quality protein foods like meats and dairy products; and in low-quality protein foods like nuts and dried beans. Food labels are not required to list phosphorus, so you will need to talk to a renal dietitian or you can refer to the Diet Analysis section (under the Diet Tools) to help determine the phosphorus content of a specific food. Fluid. Healthy kidneys are able to regulate the amount of fluid in your body.  When your kidneys are not working you cannot get rid of the extra fluid in your body. Fluid and salt restriction goes hand in hand.  Salt acts like a sponge by keeping extra fluid in your body and causing your heart to work harder to circulate the extra fluid.  Excess fluid in your body can result in body swelling, especially in you ankles and feet; fluid buildup around your lungs leading to shortness of breath and high blood pressure. The amount of fluid you can drink depends on how much urine you make, the presence of swelling, congestive heart failure, and/or your diuretic therapy.  Your fluid intake must match your urine output or volume removed during treatment in addition to any urine output remaining.Chronic Kidney Disease (Stages 1-4 pre-dialysis) Purpose: The purpose of this diet is to maintain a balance of electrolytes, minerals and fluid in people with impaired kidney function. Use: The diet is used for persons with chronic renal failure who are not on dialysis.  This food list can be used as a guide to help plan nutritious meals. Diet Guidelines Kidney failure results when your kidneys no longer work well enough to remove wastes and excess fluids from the body. This extra "waste" builds up in the bloodstream and can make you very sick. Nutrition is an important part of your treatment plan. The goal of this diet is to slow down the progression of your kidney disease. Protein intake should be controlled to reduce the workload placed on your kidneys. Sodium should also be limited to improve blood pressure control and to avoid fluid accumulation. You may need to limit your potassium depending what your blood levels are.  Potassium can accumulate and result in dangerous heart rhythms. Your potassium level should be checked regularly with a blood test. If your levels are too high, your doctor will ask you to start a low potassium diet. You will need to limit the amounts of protein, and sodium in your diet.  If your potassium levels are too high, you may need to limit potassium as well. 

• Be as physically active as you are able to on your "good" days.  Exercise is very important (always check with your doctor first).

• Foods listed under the Milk & Dairy Products and Meat & Meat Substitutes [meat, fish, poultry, nuts, beans, and eggs (especially egg whites)] are high in protein.

• High sodium foods include processed foods like "deli" meats and cheese, canned foods, frozen foods, convenience and "fast" foods, pickles, salty snacks and salty seasonings.  High potassium foods include fruits and vegetables and most dairy products.

Diet for Chronic Kidney Disease (Stage 5 Hemodialysis) Purpose: The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in your body. This is very important because dialysis alone does not effectively eliminate all waste products and is much less efficient than healthy working kidneys.

Use: The diet is used for persons with chronic renal failure who are on hemodialysis.  This food guide can be used as a guide to help plan nutritious meals. Diet Guidelines Before you were on dialysis, your doctor may have told you to follow a low-protein diet. Being on dialysis changes this. You are now encouraged to eat moderate amounts of high-quality protein. The better nourished you are, the healthier you will be. You will also have greater resistance to infection and recover from surgery more quickly. You will need to limit the amounts of sodium, potassium, phosphorus and fluids in your diet. Diet for Chronic Kidney Disease (Stage 5 Peritoneal Dialysis) Purpose: The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in your body while on Peritoneal Dialysis (PD). This is very important because dialysis alone does not effectively eliminate all waste products and is much less efficient than healthy working kidneys. Use: The diet is used for persons with chronic renal failure who are on peritoneal dialysis.  This food guide can be used as a guide to help plan nutritious meals. Diet Guidelines Your diet should be relatively high in protein while limiting the amounts of sodium, phosphorus and fluids in your diet. The following are guidelines to follow while you are on peritoneal dialysis:

• You need to increase your intake of protein:  foods listed under the Milk & Dairy Products and Meat & Meat Substitutes [lean meat, fish, poultry, nuts, beans, and eggs (especially egg whites)] are high in protein.

• You need to limit your intake of sodium (salt):  foods listed in green are high in sodium.  High sodium foods include processed foods like "deli" meats and cheese, canned foods, frozen foods, convenience and "fast" foods, pickles, salty snacks and salty seasonings.

• You need to limit foods high in phosphorus:  Phosphorus is found in high-quality protein foods like meats and dairy products; and in low-quality protein foods like nuts and dried beans. This can be a challenge because most foods that are high in phosphorus are also high in protein.

Nutrients in the Renal Diet- Peritoneal Dialysis When the kidneys fail, some waste products and excess nutrients build up in your blood and dialysis of some form must be initiated to take over the work of your failed kidneys. There are two types of kidney dialysis: hemodialysis and peritoneal dialysis (PD).    Hemodialysis is the process of cleaning your blood by passing it through a machine with a dialyzer, or artificial kidney.  Extra water and waste products are removed and the blood is then pumped back into your body. Peritoneal Dialysis (PD) is based on the same filtering process as hemodialysis. But instead of using an artificial kidney as the filter, the lining of your abdomen is used.  This lining is called the peritoneal membrane and acts as the artificial kidney.   The diet for peritoneal dialysis over hemodialysis is less restrictive. With peritoneal dialysis, you're removing wastes from your body slowly but constantly, while in hemodialysis, wastes may build up between treatments. The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in your body. This is very important because dialysis alone does not effectively eliminate all waste products and is much less efficient than healthy working kidneys. The following contain general advice about waste products and nutrients, which you might be asked to regulate while you are on peritoneal dialysis:

Protein provides amino acids for your body to build, maintain, and repair cells and muscle tissue, heal wounds, and support the immune system. While in the earlier stages of kidney disease you had to restrict protein but because of dialysis your diet should be relatively high in protein.  Dialyzing the blood causes excess losses of protein in the form of amino acids and peptides that would normally remain in your body for tissue repair and muscle building. Since retaining enough protein for these body functions is so important to overall health, you now have to make up for lost protein by eating more.  If you don't eat enough protein—and you lose protein from dialysis—your body will start to use up protein in your muscles for fuel. This can cause muscle wasting over time. Even though your protein needs are increased it doesn’t mean you can have unlimited amounts. Over consumption of protein can create unpleasant symptoms such as nausea, vomiting, fatigue, and taste changes by contributing too many waste products to be filtered by your dialysis treatments. There are two kinds of protein found in foods: "high quality" and "low quality". High-quality protein or animal protein contains all the essential amino acids your body needs to grow body tissue. High-quality proteins come from dairy products, lean meat, fish, poultry, nuts, and eggs (especially egg whites). Getting most of your protein from these sources are highly encouraged.  Low quality protein or plant protein may not contain all the essential amino acids that your body needs but are still a necessary part of your diet. Plant protein comes from vegetables, breads, and cereals. There are some exceptions to this like peas, beans (both can be rather high) and some starchy vegetables (like potatoes and corn which are in the medium range). Fruits and most vegetables have little or no protein.  Calories are present in the dialysis fluid. The dialysis fluid used in peritoneal dialysis (PD) is normally a sugar solution, some of which is absorbed by the body. Too many calories absorbed this way may lead to undesirable weight gain. To minimize the risk of unwanted weight gain, your calorie intake may need to be decreased primarily by reducing concentrated sweets and fats.  Potassium is a mineral which helps keep your heartbeat regular and your muscles working right. Potassium is necessary for good health, but too much or too little can be dangerous to the heart; therefore, your blood levels should be regularly monitored to make sure that normal levels are being maintained. You may need to eat extra potassium foods as peritoneal dialysis provides continuous dialysis and cleans potassium very well. Your potassium level should be checked regularly with a blood test. If your levels are too high, your doctor will ask you to start a low potassium diet.  Sodium is a mineral that affects your body fluids and blood pressure. One of the important functions of the healthy kidney is its ability to regulate sodium (salt) and fluid balance. Some sodium is needed for body water balance. But when your kidneys begin to fail, they lose the ability to regulate sodium and water. If sodium intake is not restricted, your body may retain sodium and water and you may experience thirst, edema, swelling of lower limbs, high blood pressure, discomfort during dialysis and/or congestive heart failure. By using less salt in your diet, it may lower your use of high-sugar solutions that can help to control your thirst and weight gain.  The level of salt restriction needed depends on the sodium content of your urine and blood, and the degree of high blood pressure and fluid retention.  Your doctor will choose the right dialysate for you to control your blood pressure and fluid level.  Sodium is found naturally in foods and is the major part of table salt. You need to control your salt intake and avoid foods with high sodium content. You should aim for less than 2,000 mg/day.  High sodium foods include processed foods like "deli" meats and cheese, canned foods, frozen foods, convenience and "fast" foods, pickles, salty snacks and salty seasonings. You can refer to the Diet Analysis section (under the Diet Tools) to help determine the sodium content of a specific food.

Phosphorus. Phosphorus is a mineral that plays an important role in the formation of healthy bones and teeth. It is found mostly in foods that are high in protein such as dairy products and meats. The kidneys play an important role in balancing the phosphorus and calcium in the body.  Phosphorus is not very well removed by dialysis. If your phosphorus begins to build up in the blood it can cause many problems including itching, muscle aches and pains, calcification of the heart, skin, joints and blood vessels.  Your body will try to correct this imbalance by taking calcium from your bones. When calcium is lost, joints become painful and bones become weak causing them to break easily. So following a low phosphorus diet is crucial. Phosphorus restriction depends on your dialysis, phosphate binders, and phosphorus intake in foods that you eat. Some experts think 800 to 1,200 mg. of phosphorus per day is a good target. Phosphorus is found in high-quality protein foods like meats and dairy products; and in low-quality protein foods like nuts and dried beans. Food labels are not required to list phosphorus, so you will need to talk to a renal dietitian or you can refer to the Diet Analysis section (under the Diet Tools) to help determine the phosphorus content of a specific food. It is very difficult to avoid all phosphates in your diet. So your doctor may order a medicine called a phosphate binder, such as an antacid, calcium supplement, or a non-calcium phosphorus binder for you to take with your meals and snacks. These medications can prevent phosphorus from being absorbed into your blood by binding some of the phosphorus in your food and sending it out through your stool.   The amount of binders that need to be taken is determined by your blood levels of phosphorus and your intake of phosphorus-containing foods in the diet. You should only take the phosphate binder ordered by your doctor or dietitian. Fluid. Dialysis can't do all of the fluid removal by itself.  Excess fluid in your body can result in body swelling, especially in your ankles and feet; fluid buildup around your lungs leading to shortness of breath and high blood pressure. The amount of fluid you can drink depends on how much urine you make, the presence of swelling, congestive heart failure, and/or your diuretic therapy.  Your fluid intake must match your urine output or volume removed during dialysis in addition to any urine output remaining. Fluid and salt restriction goes hand in hand.  Salt acts like a sponge by keeping extra fluid in your body and causing your heart to work harder to circulate the extra fluid.  It is important to know what foods and beverages are considered fluids. Fluids are foods that are liquid or melt at room temperature.