Renal Failure (Chronic Kidney Disease (CKD) Diet)

What is a chronic kidney disease (CKD) diet?

A CKD diet limits protein, phosphorus, sodium, and potassium. Liquids may also need to be limited in later stages of CKD. This diet can help slow down the rate of damage to your kidneys. Your diet may change over time as your health condition changes. You may also need to make other diet changes if you have other health problems, such as diabetes.

What kind of diet changes are needed?

There are 5 stages of CKD. The diet changes you need to make are based on your stage of kidney disease. Work with your dietitian or healthcare provider to plan meals that are right for you. You may need any of the following:

• Limit protein in all stages of kidney disease. Limit the portion sizes of protein you eat to limit the amount of work your kidneys have to do. Foods that are high in protein are meat, poultry (chicken and turkey), fish, eggs, and dairy (milk, cheese, yogurt). Your healthcare provider will tell you how much protein to eat each day.

Limit sodium as directed. You may need to limit sodium to less than 2,300 milligrams (mg) each day. Ask your dietitian or healthcare provider how much sodium you can have each day. The amount depends on your stage of kidney disease. Table salt, canned foods, soups, salted snacks, and processed meats, like deli meats and sausage, are high in sodium.

• Limit the amount of phosphorus you eat. Your kidneys cannot get rid of extra phosphorus that builds up in your blood. This may cause your bones to lose calcium and weaken. Foods that are high in phosphorus are dairy products, beans, peas, nuts, and whole grains. Phosphorus is also found in cocoa, beer, and cola drinks. Your healthcare provider will tell you how much phosphorus you can have each day.
• Limit potassium if your potassium blood levels are too high. Your dietitian or healthcare provider will tell you if you need to limit potassium. Potassium is found in fruits and vegetables.
• Limit liquids as directed. Your healthcare provider may recommend that you limit liquids in stages 4 and 5 of kidney disease. If your body retains fluids, you will have swelling and fluid may build up in your lungs. This can cause other health problems, such as shortness of breath.

What foods can I include?

Your dietitian will tell you how many servings you can have from each of the food groups below. The approximate amount of these nutrients is listed next to each food group. Read the food label to find the exact amount.

• Bread, cereal, and grains: These foods contain about 80 calories, 2 grams (g) of protein, 150 mg of sodium, 50 mg of potassium, and 30 mg of phosphorus.
  • 1 slice (1 ounce) of bread (French, Italian, raisin, light rye, or sourdough white), small dinner roll, or 6-inch tortilla
  • ½ of a hamburger bun, hot dog bun, or English muffin or ¼ of a bagel
  • 1 cup of unsweetened cereal or ½ cup of cooked cereal, such as cream of wheat
  • ⅓ cup of cooked pasta (noodles, macaroni, or spaghetti) or rice
  • 4 (2-inch) unsalted crackers or 3 squares of graham crackers
  • 3 cups of air-popped, unsalted popcorn
  • ¾ ounce of unsalted pretzels
• Vegetables: A serving of these foods contains about 30 calories, 2 g of protein, 50 mg of sodium, and 50 mg of phosphorus.
  • Low potassium (less than 150 mg):
    • ½ cup cooked green beans, cabbage, cauliflower, beets, or corn
    • 1 cup raw cucumber, endive, alfalfa sprouts, cabbage, cauliflower, or watercress
    • 1 cup of all types of lettuce
    • ¼ cup cooked or ½ cup raw mushrooms or onions
    • 1 cup cooked eggplant
  • Medium potassium (150 to 250 mg):
    • 1 cup raw broccoli, celery, or zucchini
    • ½ cup cooked broccoli, celery, green peas, summer squash, zucchini, or peppers
    • 1 cup cooked kale or turnips
• Fruits: A serving of these foods contains about 60 calories, 0 g protein, 0 mg sodium, and 150 mg of phosphorus. Each serving is ½ cup, unless another amount is given.
  • Low potassium (less than 150 mg):
    • Apple juice, applesauce, or 1 small apple
    • Blueberries
    • Cranberries or cranberry juice cocktail
    • Fresh or canned pears (light syrup or packed in water)
    • Grapes or grape juice
    • Canned peaches (light syrup or packed in water)
    • Pineapple or strawberries
    • 1 tangerine
    • Watermelon
  • Medium potassium (150 to 250 mg):
    • Fresh peaches or pears
    • Cherries
    • Cantaloupe, mango, or papaya
    • Grapefruit or grapefruit juice
• Meat, poultry, and fish: These foods have about 75 calories, 7 g of protein, an average of 65 mg of sodium, 115 mg of potassium, and 70 mg of phosphorus. Do not use salt to prepare these foods.
  • 1 ounce of cooked beef, pork, or poultry
  • 1 ounce of any fresh or frozen fish, lobster, shrimp, crab, clams, tuna, unsalted canned salmon, or unsalted sardines
• Other protein foods: These foods have about 90 calories, 7 g of protein, an average of 100 mg of sodium, 100 mg of potassium, and 120 mg of phosphorus.
  • 1 large whole egg or ¼ cup of low-cholesterol egg substitute
  • 1 ounce of cheese
  • ¼ cup of cottage cheese or tofu
  • 1 ounce of unsalted nuts or 2 tablespoons of peanut butter
• Fats: These foods have very little protein and about 45 calories, 55 mg of sodium, 10 mg of potassium, and 5 mg of phosphorus. Include healthy fats, such as unsaturated fats, which are listed below.
  • 1 teaspoon margarine or mayonnaise
  • 1 teaspoon oil (safflower, sunflower, corn, soybean, olive, peanut, canola)
  • 1 tablespoon oil-based salad dressing (such as Italian) or 2 tablespoons mayonnaise-based salad dressing (such as ranch)

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

• furosemide
• Lasix
• Demadex
• Edecrin
• Sodium Edecrin

What foods should I limit or avoid?

• Starches: The following foods have higher amounts of sodium, potassium, or phosphorus.
  • Biscuits, muffins, pancakes, and waffles
  • Cake and cornbread from boxed mixes
  • Oatmeal and whole-wheat cereals
  • Salted pretzel sticks or rings and sandwich cookies
• Meat and protein foods: The following are high in sodium and phosphorus.
  • Deli-style meat, such as roast beef, ham, and turkey
  • Canned salmon and sardines
  • Processed cheese, such as American cheese and cheese spreads
  • Smoked or cured meat, such as corned beef, bacon, ham, hot dogs, and sausage
• Legumes: These foods have about 90 calories, 6 g of protein, less than 10 mg of sodium, 250 mg of potassium, and 100 mg of phosphorus.
  • ⅓ cup of black beans, red kidney beans, black-eye peas, garbanzos, and lentils
  • ¼ cup of green or mature soybeans
• Dairy: The following foods have about 8 g of protein, an average of 120 mg of sodium, 350 mg of potassium, and 220 mg of phosphorus.
  • 1 cup of milk (fat-free, low-fat, whole, buttermilk, or chocolate milk)
  • 1 cup of low-fat plain or sugar-free yogurt or ice cream
  • ½ cup of pudding or custard
  • Nondairy milk substitutes: These foods have 75 calories, 1 gram of protein, and an average of 40 mg of sodium, 60 mg of potassium, and 60 mg of phosphorus. A serving is ½ cup of almond, rice, or soy milk, or nondairy creamer.
• Vegetables: The following vegetables are high in potassium. Each serving has more than 250 mg of potassium. A serving is ½ cup, unless another amount is given.
  • Artichoke or ¼ of a medium avocado
  • Brussels sprouts, beets, chard, collard or mustard greens
  • Potatoes, sweet potatoes, pumpkin, and yams
  • ¾ cup of okra
  • Raw tomatoes and low-sodium tomato juice, or tomato sauce
  • Winter squash, cooked asparagus, and cooked spinach
• Fruit: The following fruits are high in potassium. Each serving has more than 250 mg of potassium.
  • 3 fresh apricots
  • 1 small nectarine (2 inches across)
  • 1 small orange and ½ cup of orange juice
  • ¼ cup of dates
  • ⅛ of a small honeydew melon
  • 1 six-inch banana
  • ½ cup of prune juice or prunes and kiwifruit
• Fats: Limit unhealthy fats, such as saturated fats, which are listed below.
  • Butter, lard, cream cheese, whipped cream, and sour cream
  • Powdered coffee creamer
• Other: The following foods are high in sodium.
  • Frozen dinners, soups, and fast foods, such as hamburgers and pizza (see the food label for serving sizes)
  • Table salt and seasoned salts, such as onion or garlic salt
  • Barbecue sauce, ketchup, mustard, soy sauce, steak sauce, and teriyaki sauce

When should I call my nephrologist or dietitian?

• You are gaining or losing weight very quickly.
• You have shortness of breath.
• You have nausea and are vomiting.
• You feel very weak and tired.
• You are having trouble following the CKD diet.