Renal diet

A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium.[1] Calories may also be supplemented if the individual is losing weight undesirably.[1]

The diet may help limit the buildup of waste products within the body and reduce strain on the kidneys, as well as reduce blood pressure and lower the risk of fluid build-up around the heart and lungs.[2][3][4][5] Phosphorus restriction can help maintain bone health, as phosphorus buildup in the blood results in the leaching of calcium from bones and subsequently an increased fracture risk.[6] The evidence supporting uptake of a renal diet and a reduction in cardiovascular events and mortality is limited, but dietary interventions may increase health-related quality of life and estimated Glomerular Filtration Rate (eGFR) while lowering serum albumin and serum cholesterol levels.[4]

The restrictiveness of a renal diet depends on the severity of the patient's kidney disease, and the diet should be undertaken with the advice of a dietician.[5][7] Patients with comorbid conditions like diabetes may need to further alter their diets to meet the needs of those conditions simultaneously.[7]

Who should be on a renal diet?

Diet modification is recommended in those diagnosed with CKD stage 3-5 or GFR <60 mL/min/1.732 that are NOT on dialysis. Those with eGFR greater than or equal to 60 mL/min/1.732 are recommended to follow the general population dietary recommendations (DASH diet).[8]

Sodium

Sodium restriction in CKD has been studied and recommended in individuals w/ coexisting hypertension, volume overload or proteinuria. Sodium restriction to <2 g/day (<5 g/day of salt) has shown improved blood pressure control, improved volume control and reduced proteinuria.[9][10][11][12] High sodium intake of above 6g/day has been shown to increase rates of cardiovascular disease, stroke and overall mortality.[13][14]

Avoid: High-sodium foods
  • Condiments
  • Canned vegetables/meats/fish/soups
  • Cured or smoked bacon, sausage, meats
  • Deli meats
  • Frozen dinners
  • Pickles
  • Pizza
  • Processed/packaged foods
  • Seasonings
  • Tomato sauces/marinades
Guide to reading sodium nutrition labels
Salt/sodium-free Less than 5 mg of sodium per serving
Very low sodium 35 mg or less of sodium per serving
Low sodium 140 mg or less of sodium per serving
Reduced sodium At least 25% less sodium than the regular product
Light or lite in sodium At least 50% less sodium than the regular product
No salt added or unsalted No salt is added during processing, but these products may not be salt/sodium-free unless stated

Potassium

Potassium management for individuals with CKD is variable and dependent on various factors including CKD stage/eGFR, serum potassium levels and concomitant use of potassium altering medications such as ACE inhibitors/ARBs. Potassium regulation requires an individualized approach with the assistance of a dietician and physician.

Avoid: High-potassium food
Fruits Vegetables Proteins Dairy Other
Bananas

Oranges

Raisins

Avocado

Coconut

Figs

Kiwi

Mango

Prunes

Nectarines

Cantaloupe

Artichokes

Baked beans

Beets

Brussels sprouts

Chard

Olives

Potatoes

Pickles

Pumpkin

Tomato

Acorn squash

Butternut squash

Beans (black/kidney/pinto)

Lobster

Salmon

Sardines

Scallops

Whitefish

Milk

Ice cream

Processed cheese

Yogurt

Chocolate

Peanuts

Peanut butter

Sports drinks

Low-potassium foods
Fruits Vegetables Proteins Grain Fluids Snacks
Apples

Blueberries

Cherries

Dried fruits: apples, blueberries, cherries, coconut, cranberries

Grapes

Lychee

Pear

Persimmon

Pineapple

Plum

Raspberries

Strawberries

Tangerines

Watermelon

Asparagus

Bean sprouts

Broccoli

Cabbage

Carrots

Cauliflower

Celery

Cherry tomatoes

Corn

Cucumber

Eggplant

Green or wax beans

Greens: collard, mustard, turnip

Jicama

Kale

Leeks

Lettuce

Mushrooms

Okra

Onion

Peas: green, sugar snap, snow

Peppers: green, red, yellow, jalapeño

Radish

Spinach (raw)

Squash: spaghetti, yellow

Turnips

Water chestnuts

Beans

Beef

Chicken

Edamame

Eggs (whole or egg whites)

Fish

Lamb

Lentils

Pork

Tofu

Turkey

Veal

Wild game

Bagel (half)

Bread loaf

Cereal

Corn tortilla

Couscous

English muffin (half)

Old-fashioned or steel-cut oatmeal

Pasta

Pita (half)

Quinoa

Rice

Rice cakes

Slow-cook Cream of Wheat

Slow-cook grits

100% fruit juices: apple, cranberry, grape, pineapple

Fresh-brewed coffee

Fresh-brewed tea: black, herbal

Fresh-squeezed lemonade

Nectars: apricot, guava, mango, papaya, peach, pear

Sodas: club, lemon-lime

Water: sparkling, tap

All-natural fruit leather

Animal crackers

Applesauce

Frozen fruit bars

Fruit cocktail

Homemade desserts: fruit pie or cobbler

Italian ice

Nuts, seeds and natural nut butters (2 tablespoons)

Rice Krispies Treats®

Sherbet

Unsalted snacks: crackers, pita chips, popcorn, pretzels, tortilla chips

Phosphorus and calcium

Increased serum phosphate levels in CKD is associated with poor bone health, increased risk of cardiovascular events and mortality.[15][16] Although there isn't enough evidence that dietary restriction of phosphorus leads to decreased serum phosphorus, KDOQI recommends a maximum of 0.8 to 1 g/day intake restriction of dietary phosphorus.[17]

Serum phosphate levels in CKD are heavily influenced by calcium and parathyroid hormone levels. In CKD,  the kidneys are unable to make adequate amounts of vitamin D, resulting in decreased calcium absorption. Low calcium leads to parathyroid hormone release, which moves calcium and phosphorus out of bones and into the blood. Therefore calcium supplementation in CKD patients results in decreased PTH and decreased phosphorus levels. KDOQI recommends a calcium intake goal of 800 to 1000 mg/day (diet and medications combined).[17] Excessive calcium supplementation of 2000 mg/day for CKD patients may result in calcium deposition in other tissues leading to calcification.[18]

Avoid: High-phosphorus foods
Protein Grains Dairy Fluids
Pre-packaged or breaded meats and fish

Deli meats

Hot dogs

Processed meats

Biscuits

Muffins

Corn bread

Pancakes

Waffles

Processed cheeses

Cheese sauces

Ice cream

Milk

Pudding

Frozen yogurt

Beer

Hot cocoa

Canned soup

Some carbonated beverages, flavored waters and teas

Milk

Milkshakes

Some protein shakes

Low-phosphorus foods
Protein Grains Dairy Fruits
Fresh meats without breading or marinades

Turkey breast/thigh, skinless

Chicken breast/thigh skinless

Pork chop/roast

Salmon

Sea bass

Shrimp

Yellowfin

Flour tortillas: without baking powder

White pita bread

White bread

Sourdough bread

Almond milk

Sour cream

Soy milk

Egg whites

Cream cheese: 2 tablespoons

Parmesan cheese: 2 tablespoons

Apple

Cherries

Peach

Pineapple

Strawberries

Protein

A low protein diet for individuals with non-dialysis CKD has shown to lower the rate of CKD progression and electrolyte balance. Low protein diets of <0.8 g/kg/day have shown improved CKD management with reduced serum phosphorus, serum urea nitrogen and reduced protein in the urine.[19][20][21] A very low protein diet (0.28 g/kg/day) is not recommended due to the possibility of malnutrition. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a low protein diet of 0.55-0.6 g/kg/day but specific levels of protein intake varies for each individual and should be altered with the advice of a dietician and/or physician.[22][23]

See also

References

  1. ^ a b "Diet - chronic kidney disease: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-03-23.
  2. ^ Hershey, Kristen (December 2018). "Renal Diet". The Nursing Clinics of North America. 53 (4): 481–489. doi:10.1016/j.cnur.2018.05.005. ISSN 1558-1357. PMID 30388974. S2CID 53272380.
  3. ^ Akchurin, Oleh M. (February 2019). "Chronic Kidney Disease and Dietary Measures to Improve Outcomes". Pediatric Clinics of North America. 66 (1): 247–267. doi:10.1016/j.pcl.2018.09.007. ISSN 1557-8240. PMC 6623973. PMID 30454747.
  4. ^ a b Palmer, Suetonia C.; Maggo, Jasjot K.; Campbell, Katrina L.; Craig, Jonathan C.; Johnson, David W.; Sutanto, Bernadet; Ruospo, Marinella; Tong, Allison; Strippoli, Giovanni Fm (2017-04-23). "Dietary interventions for adults with chronic kidney disease". The Cochrane Database of Systematic Reviews. 2017 (4): CD011998. doi:10.1002/14651858.CD011998.pub2. ISSN 1469-493X. PMC 6478277. PMID 28434208.
  5. ^ a b "Eating Right for Chronic Kidney Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-03-23.
  6. ^ "Mineral & Bone Disorder in Chronic Kidney Disease | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2022-03-23.
  7. ^ a b CDC (2019-09-19). "Diabetes & Kidney Disease: What to Eat?". Centers for Disease Control and Prevention. Retrieved 2022-03-23.
  8. ^ Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi:10.1053/j.ajkd.2020.05.006. ISSN 1523-6838. PMID 32829751. S2CID 221282344.
  9. ^ Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi:10.1053/j.ajkd.2020.05.006. ISSN 1523-6838. PMID 32829751. S2CID 221282344.
  10. ^ Garofalo, Carlo; Borrelli, Silvio; Provenzano, Michele; De Stefano, Toni; Vita, Carlo; Chiodini, Paolo; Minutolo, Roberto; De Nicola, Luca; Conte, Giuseppe (2018-06-06). "Dietary Salt Restriction in Chronic Kidney Disease: A Meta-Analysis of Randomized Clinical Trials". Nutrients. 10 (6): 732. doi:10.3390/nu10060732. ISSN 2072-6643. PMC 6024651. PMID 29882800.
  11. ^ Chen, Yanrong; Wang, Xiangyu; Jia, Yijie; Zou, Meina; Zhen, Zongji; Xue, Yaoming (June 2022). "Effect of a sodium restriction diet on albuminuria and blood pressure in diabetic kidney disease patients: a meta-analysis". International Urology and Nephrology. 54 (6): 1249–1260. doi:10.1007/s11255-021-03035-x. ISSN 1573-2584. PMID 34671892. S2CID 239042207.
  12. ^ McMahon, Emma J.; Campbell, Katrina L.; Bauer, Judith D.; Mudge, David W.; Kelly, Jaimon T. (2021-06-24). "Altered dietary salt intake for people with chronic kidney disease". The Cochrane Database of Systematic Reviews. 2021 (6): CD010070. doi:10.1002/14651858.CD010070.pub3. ISSN 1469-493X. PMC 8222708. PMID 34164803.
  13. ^ Malta, Daniela; Petersen, Kristina S.; Johnson, Claire; Trieu, Kathy; Rae, Sarah; Jefferson, Katherine; Santos, Joseph Alvin; Wong, Michelle M. Y.; Raj, Thout Sudhir; Webster, Jacqui; Campbell, Norm R. C.; Arcand, JoAnne (December 2018). "High sodium intake increases blood pressure and risk of kidney disease. From the Science of Salt: A regularly updated systematic review of salt and health outcomes (August 2016 to March 2017)". Journal of Clinical Hypertension (Greenwich, Conn.). 20 (12): 1654–1665. doi:10.1111/jch.13408. ISSN 1751-7176. PMC 8030856. PMID 30402970.
  14. ^ Strazzullo, Pasquale; D'Elia, Lanfranco; Kandala, Ngianga-Bakwin; Cappuccio, Francesco P. (2009-11-24). "Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies". BMJ (Clinical Research Ed.). 339: b4567. doi:10.1136/bmj.b4567. ISSN 1756-1833. PMC 2782060. PMID 19934192.
  15. ^ Newsome, Britt; Ix, Joachim H.; Tighiouart, Hocine; Sarnak, Mark J.; Levey, Andrew S.; Beck, Gerald J.; Block, Geoffrey (June 2013). "Effect of protein restriction on serum and urine phosphate in the modification of diet in renal disease (MDRD) study". American Journal of Kidney Diseases. 61 (6): 1045–1046. doi:10.1053/j.ajkd.2013.01.007. ISSN 1523-6838. PMID 23415016.
  16. ^ Palmer, Suetonia C.; Hayen, Andrew; Macaskill, Petra; Pellegrini, Fabio; Craig, Jonathan C.; Elder, Grahame J.; Strippoli, Giovanni F. M. (2011-03-16). "Serum levels of phosphorus, parathyroid hormone, and calcium and risks of death and cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis". JAMA. 305 (11): 1119–1127. doi:10.1001/jama.2011.308. hdl:10453/117870. ISSN 1538-3598. PMID 21406649.
  17. ^ a b Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi:10.1053/j.ajkd.2020.05.006. ISSN 1523-6838. PMID 32829751. S2CID 221282344.
  18. ^ Spiegel, David M.; Brady, Kate (June 2012). "Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets". Kidney International. 81 (11): 1116–1122. doi:10.1038/ki.2011.490. ISSN 1523-1755. PMC 3352985. PMID 22297674.
  19. ^ Rhee, Connie M.; Ahmadi, Seyed-Foad; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar (April 2018). "Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials". Journal of Cachexia, Sarcopenia and Muscle. 9 (2): 235–245. doi:10.1002/jcsm.12264. ISSN 2190-6009. PMC 5879959. PMID 29094800.
  20. ^ Yan, Bingjuan; Su, Xiaole; Xu, Boyang; Qiao, Xi; Wang, Lihua (2018). "Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis". PLOS ONE. 13 (11): e0206134. Bibcode:2018PLoSO..1306134Y. doi:10.1371/journal.pone.0206134. ISSN 1932-6203. PMC 6221301. PMID 30403710.
  21. ^ Hahn, Deirdre; Hodson, Elisabeth M.; Fouque, Denis (2020-10-29). "Low protein diets for non-diabetic adults with chronic kidney disease". The Cochrane Database of Systematic Reviews. 10 (10): CD001892. doi:10.1002/14651858.CD001892.pub5. ISSN 1469-493X. PMC 8095031. PMID 33118160.
  22. ^ Menon, Vandana; Kopple, Joel D.; Wang, Xuelei; Beck, Gerald J.; Collins, Allan J.; Kusek, John W.; Greene, Tom; Levey, Andrew S.; Sarnak, Mark J. (February 2009). "Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study". American Journal of Kidney Diseases. 53 (2): 208–217. doi:10.1053/j.ajkd.2008.08.009. ISSN 1523-6838. PMID 18950911.
  23. ^ Ikizler, T. Alp; Burrowes, Jerrilynn D.; Byham-Gray, Laura D.; Campbell, Katrina L.; Carrero, Juan-Jesus; Chan, Winnie; Fouque, Denis; Friedman, Allon N.; Ghaddar, Sana; Goldstein-Fuchs, D. Jordi; Kaysen, George A.; Kopple, Joel D.; Teta, Daniel; Yee-Moon Wang, Angela; Cuppari, Lilian (September 2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update". American Journal of Kidney Diseases. 76 (3 Suppl 1): S1–S107. doi:10.1053/j.ajkd.2020.05.006. ISSN 1523-6838. PMID 32829751. S2CID 221282344.

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