Diet in Renal Failure and CKD

 'Kidney Diet Home'

from EdREN, the website of the Renal Unit of the Royal Infirmary of Edinburgh


On this page - What's in food?
On our other diet pages
Diet for the failing kidney and CKD Diet on peritoneal dialysis
Diet on haemodialysis Diet after a transplant

Eating out, our Festive supplement, and Adapting your own recipes - see Downloads at the foot of the page


There isn't a 'Renal Diet'
There is no single renal diet, best advice will vary according to you, and your tests. On these pages we can only give some general ideas and advice.

Detailed advice for patients with severe kidney disease (less than 30% function, stages 4 and 5 CKD) is best from a renal dietitian.

Cartoon by Peter Quaife from The Lighter Side of Dialysis (Jazz Communications), with permission.


What's in food?


Protein

About protein
A typical daily intake in the UK is 60-80g, about 1g/kg of ideal body weight. If you are eating enough calories you can manage with 45-60g (0.75g/kg). The richest sources of protein are Animal protein - meat, fish, cheese, eggs, milk, and Vegetable protein - nuts, pulses (beans, lentils etc), tofu, quorn.
See the table below for a rough guide to protein content, or Resources for further places to look.

Excessive intake of protein must be avoided in CKD, and sometimes a low protein diet has been advised for patients with renal failure. We don't usually do this. This is explained in diet for the failing kidney.

In CKD protein intake should be normal - not high, not too low. Read more about diet for the failing kidney and in CKD.

On haemodialysis a slightly higher protein intake is recommended. Read more about diet on haemodialysis.

On PD a higher protein intake is recommended due to a small loss of protein from the drained fluid (dialysate). Read more about diet on CAPD.

How much protein does food contain?
Milk 500ml (a pint is 568ml) 17g
Yoghurt (1 pot) 7g
40g portion of cheese 10g
Tin of beans (small, 135g) 7g
Cooked meat 100g 26-28g
Egg (1 medium) 8g


Sodium (salt)

About sodium (salt)
A typical daily intake in the UK is 150 - 200mmol (9-12g of salt, or 3-5g of sodium). We need less than half of this.
Only around 10% of sodium is found in fresh food, the rest is added as salt or sodium bicarbonate in cooking and food processing, and as table salt sprinkled on the food after cooking.
Download a short leaflet about keeping salt intake down (pdf file) - salty foods are listed, with alternative ways of flavouring food.

Common salt is sodium chloride. Modern diets contain too much salt, and sick kidneys cannot cope. High salt intake leads to high blood pressure and to fluid retention and overload. Many blood pressure tablets only work properly if combined with a reduced salt intake.

In most patients with kidney disease or on dialysis we recommend keeping salt down to 'no added salt' levels of less than 100mmol/day (6g of salt, which is just over 2g of sodium - and still a lot more than we need). This allows small amounts of salt to be used in cooking, but means limiting very salty foods, and not adding salt to food after it has been cooked. Less salt may be better still!

Salt substitutes such as 'Lo-Salt' are not suitable for patients with renal failure, because they contain large amounts of potassium.

Many pre-cooked meals and a lot of canned or preserved food have a high salt content.

Sodium can also be found in some medicines. Effervescent or soluble painkillers are a particular problem - don't use them if you need to control your salt intake.


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Potassium

About potassium
A typical daily intake in the UK is 50-150mmol
Potassium is found particularly in leafy vegetables and most fruit and fruit juice, and in potatoes, especially if they are fried or baked.
Download a short leaflet about Cutting Down Potassium (pdf file) - a short list of foods to watch out for if your potassium is high.

Potassium levels can be high in severe renal failure and on dialysis, but potassium intake should not be restricted routinely - only if tests show high potassium levels. This is because potassium-containing foods include many healthy foods.
Very high potassium levels (e.g. 6.5 or higher) can be dangerous as they can lead to a cardiac arrest. As well as diet, some drugs can cause high potassium in patients with CKD, and there are some other causes. More detail is available from the links below.

Read about diet for the failing kidney | Read about diet on haemodialysis | Read about diet on CAPD.


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Fluid (liquids)

About fluid
Most people drink 1-2 litres a day and don't need to reduce fluid intake until kidney disease is very severe. But if you are a dialysis patient who doesn't produce urine, you have to cut down the amount you drink - that's obvious.

Click here to see an animation of what happens if a haemodialysis patient drinks too much fluid, from the Kidney Patient Guide (Wrexham Maelor Hospital, Wales). You need Flash Player on your PC (or Mac) to see it work (links to get this free are provided).

Download a short leaflet about fluid (pdf file) - how to measure it without jugs, and hints for fluid control.
Cartoon by Peter Quaife from The Lighter Side of Dialysis (Jazz Communications), with permission.


All drinks contain mostly water. Fluids refer to all drinks taken per day. If you are not on dialysis, you should not restrict fluids unless you have a particular problem with fluid overload, you should just drink when you are thirsty. For most patients there is no special benefit from drinking extra water.

If you have a problem with fluid retention, it is very important to limit salt intake. It is impossible to control your fluid intake if you are taking too much salt - you just get too thirsty.

On haemodialysis the fluid allowance for each patient often needs to be quite strictly controlled. Read more about diet on haemodialysis. On peritoneal dialysis things may be a little easier. Read more about diet on PD


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Phosphate

About phosphate
Phosphate is found in association with protein, especially in milk and cheese. Only a few other foods contain a lot of phosphate like wholegrain cereals, baking powder, shellfish. Other sources are convenience foods which have phosphates added by food manufacturers.
Download a short leaflet about controlling phosphate (pdf file) - including foods that contain phosphate, and information about phosphate binders.

Too much phosphate in the blood (hyperphosphataemia) usually becomes a significant problem in the later stages of renal failure (stages 4 and 5 CKD, usually less than 20% kidney function). The problem continues for most dialysis patients, as dialysis does not remove enough phosphate unless it is very frequent or intensive. A combination of diet and medicines are usually needed.

Calcium and phosphate are a major problem for kidney patients, causing serious bone disease across the years if they cannot be controlled. High calcium and phosphate also makes you itch very badly, and is probably damaging to arteries too. People with very poor phosphate control don't do so well on dialysis.

Diet alone is rarely enough to control phosphate in severe renal failure, and medicines called phosphate binders are also used. These are taken with food, and work by keeping the phosphate in your food in the gut, preventing it being absorbed into the blood when the food is digested. It is important that these are taken at the right time just before food (or with it) as they won't work otherwise.

In both CKD and dialysis patients, the aim is to keep phosphate levels below 1.8mmol/l. Download short information from the box above about phosphate in food and phosphate binders.

Read about calcium and phosphate in CKD | Read more about diet on haemodialysis | Read more about diet on PD

Up to Contents


 

Energy

High energy foods

Download info on foods to increase your calorie intake (pdf file)

Download info on weight control (pdf file)


Too few calories lead to the breakdown of muscle to provide energy. If you lose muscle you become weak and debilitated. Once this has happened it takes months to recover strength. Appetite is decreased in many patients with kidney disease, and in some it is necessary to provide supplements.

Malnutrition can be a serious problem in severe kidney disease and in some dialysis patients. It tends to be a particular problem in people who have had other illnesses, or a complicated time as they have developed kidney failure. Help from expert dietitians is very valuable if this occurs.


 


Summary of downloads

Keeping salt intake down

Cutting Down Potassium

A short leaflet about Fluid

Controlling phosphate

Increasing your calorie intake

Weight control

Renal Diets for Christmas and other holidays

Eating out - Asian food

Eating out - British food

Eating out - Indian food

Eating out - Italian food

Adapting your own recipes for a renal diet

Further information

An excellent resource for patients is the information from the Arizona Dietetic project.

The NKF(US) diet resources look good and include a whole cookbook.

A quite good list of further info links from the Life Options site (a commercially sponsored site about living on dialysis)

Look up a food to find what's in it - two links that give quite technical and detailed information, from the USDA or from the Nephron Info Centre Foodvalues site. These are especially suitable for professionals.

History: Read about the history of diet in renal disease from our pages on the History of Dialysis and Transplantation in Edinburgh.

 

This information is published from the Renal Unit at the Royal Infirmary of Edinburgh, Scotland, UK, renal@ed.ac.uk The authors of this page were Elizabeth Sloan, Hazel Elliott and Susan Reed. It was first published in January 2001, extensively revised in August 2006, and last updated Friday, September 18, 2009.

Please be aware that while we have made all efforts to ensure that this information is accurate, we cannot guarantee that there are no mistakes. Also that the best management for individual patients may differ from that outlined here. Only the doctors caring for the patient will be able to advise on this.


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