Creating a specific kidney-friendly diet is a crucial step for individuals managing chronic kidney disease (CKD). When kidneys fail, their ability to control or influence many bodily systems diminishes, necessitating significant adjustments, particularly in diet. Without proper nutritional monitoring by a physician and a renal dietitian, a person's health can deteriorate rapidly, potentially leading to severe illness. While certain foods must be limited, the challenge lies in doing so without inadvertently eliminating essential protein, vitamins, and minerals. This often requires prescribed supplements and medications to manage electrolyte levels, making the renal diet a delicate balancing act.

A renal dietitian is an indispensable member of the healthcare team for anyone with kidney failure. Each dialysis unit typically has one on staff. The dietitian regularly reviews blood studies and is responsible for educating patients on how to adjust their diets to maintain optimal health. It's helpful for patients to ask their dietitian to focus on what they can eat, rather than a discouraging list of restrictions.

Having another family member, especially the primary cook, present during nutrition discussions is highly beneficial for clarifying points and taking notes, ensuring dietary recommendations are clearly understood and followed. Beyond restrictions, dietitians can share recipes, plan menus, offer grocery shopping tips, and guide wise restaurant choices, all aimed at helping patients achieve their dietary goals.

Fluid Balance and Dietary Choices

When kidneys fail, the body's ability to balance fluid is severely compromised, leading to fluid buildup. This fluid overload can cause weight gain, swelling (edema) in the legs, feet, hands, and face, and elevate blood pressure. If untreated, fluid can accumulate around vital organs like the lungs (pulmonary edema), causing shortness of breath, in the abdomen (ascites), or around the heart, increasing the risk of congestive heart failure. Even with dialysis, patients must carefully monitor fluid intake between treatments, as all ingested fluid remains until the next session. Excessive fluid removal during dialysis can lead to sudden blood pressure drops, dizziness, cramping, nausea, and vomiting, underscoring the importance of adhering to fluid restrictions.

"Dry weight" refers to the lowest weight a patient can tolerate without symptoms or low blood pressure, representing the goal weight after all excess fluid is removed during dialysis. Failing to reach this dry weight or skipping treatments can lead to dangerous fluid accumulation.
Here are some foods considered fluids (liquid at room temperature):

• Soups

• Ice cream/sherbet

• Gelatin

• Ice

• Watermelon

• Sauces and Gravies

• Water and other beverages

Mineral Management and Food Choices

Sodium (salt) is crucial for fluid balance and blood pressure, but too much leads to fluid retention, thirst, high blood pressure, and swelling. Processed foods are often high in sodium, so checking labels is vital.
Foods often high in sodium (salt) include:

• Frozen, prepared meals

• Canned soups and entrees

• Snack foods/crackers/chips

• Cured meats such as ham (e.g., bologna, hot dogs)

• Prepared seasonings

• Most restaurant foods

• Iodized salt, lite salt, and sea salt

• Foods typically low in sodium (salt):

• Fresh vegetables and fruit

• Poultry, fresh-water fish, and uncured meats

• Most plain, frozen vegetables

• Minimally processed foods such as breads, rolls, and pasta

Potassium is another mineral regulated by healthy kidneys, essential for cell function, especially in the heart and muscles. For dialysis patients, potassium levels rise between treatments, requiring limitation or elimination of high-potassium foods.
Foods and beverages high in potassium:

• Apricots, Bananas, Beets, Brussel sprouts

• Carrot juice, Chocolate, Collard Greens

• Dried Beans, Dried fruits

• Grapefruit, Grapefruit juice

• Kiwi, Lemonade (fresh)

• Mangoes, Melons, Milk Products (Milk, Soymilk, Yogurt)

• Molasses, Nuts, Orange juice, Oranges

• Pears, Potatoes (not soaked), Prune juice

• Salt substitute, Spinach, Tomato juice, Tomatoes, Winter squash

• Foods and beverages low in potassium (some considered low in ½-cup portions):

• Apple juice, Apples

• Bell peppers, Blackberries, Blueberries

• Bread products, Cabbage, Carrots, Celery

• Cookies (without chocolate), Cranberries, Cranberry juice

• Cucumbers, Eggplant, Fruit cocktail

• Grape juice, Grapes, Green beans

• Noodles/pasta, Peach (1 or canned), Pineapple, Plum (1 or canned)

• Popcorn, Raspberries, Rice, Snow peas, Soaked potatoes

• Tea/coffee, Tortillas, Unsalted crackers, Unsalted pretzels

Phosphorus is vital for bones and teeth, and its levels must be carefully monitored. High phosphorus levels are common in CKD, often requiring phosphate binders to excrete it from food.
Foods high in phosphorus:

• Beer, Biscuits/breads, Bran & wheat cereals

• Cheeses, Cocoa, Cornbread, Cottage cheese

• Dried beans, Garbanzo beans, Lentils

• Meats/fish/seafood, Milk, Organ meats

• Peanut butter, Peas, Puddings made with milk

• Soymilk, Yogurt

Foods and beverages low in phosphorus:

• All fruits, All vegetables (except beans & peas)

• Butter/margarine, Coffee/tea, Cranberry juice

• Cream Cheese, Fruit drinks, Ginger ale

• Hard candy, Lemon/lime sodas, Mayonnaise

• Nondairy creamer, Peanuts, Root beer

• Salad dressing, Shortening, Sorbet, Sour cream

• Syrups, Vegetable oils

Protein Intake and Personalized Plans

Protein intake is essential for maintaining health, developing and healing body tissue, building muscle tone, and resisting infection. It also helps regulate enzymes and hormones. Since each patient's health situation is unique, there is no one-size-fits-all protein plan. Patients should always follow the advice of their physician and renal dietitian, who consider individual needs, health status (including blood test results), and personal tastes. High-protein foods include fish, poultry, beef, eggs, and dairy.

Dietitians can provide prepared menus or help patients plan meals tailored to their preferences while adhering to necessary restrictions. This approach focuses on what foods a person can eat, rather than solely emphasizing what they cannot, which can be very discouraging. While the renal diet can be challenging, renal dietitians are available to suggest strategies to make it tolerable, and patients are encouraged to ask for help!