If you have end-stage kidney disease, this means that your kidneys are having trouble balancing certain minerals and filtering toxins from digestion. This can lead to loss of calcium from the bones, trouble with your heart rhythm, and severe pain and symptoms that affect your ability to do simple daily tasks. Whether you are on dialysis or not, having a healthy diet and reducing these symptoms may be a challenge. The kidneys are also fragile and complex, making your nutritional needs and diet restrictions vary from one week to the next. Keep reading to learn some great nutrition tips for end-stage kidney disease.
When you are experiencing kidney failure, or end-stage kidney/renal disease (ESRD) your kidneys are no longer able to filter the blood to keep your organs functioning correctly. This is the last stage of kidney disease (stage 5), where your kidneys are typically functioning at or below 10-15% of their typical ability, and the damage to the kidneys is now irreversible. People in stage 5 typically cannot live more than a few weeks without dialysis or a kidney transplant. You should note that when you have ESRD, your diet guidelines may fall into one of the 3 groups:
Depending on where you are in your ESRD journey, your dietary restrictions of protein, potassium, and phosphorous may differ drastically.
If you have kidney disease (stage 3 or above), you are likely already seeing a dietitian, or are speaking with a nephrologist (or kidney specialist), and regularly drawing blood to watch your body’s levels of minerals and other indicators. Talk with your clinical team about how and how much to limit various food groups.
There are 4 common minerals that kidneys must balance: potassium, sodium, phosphorous, and calcium. Apart from these, dietary protein also has a significant effect on the kidneys.
Too much of any of these 4 minerals can cause a backup of minerals in the blood, causing all kinds of symptoms related to mineral imbalance. You may also develop anemia, or low blood iron or B12 levels while on dialysis. While a diet high in minerals can cause an imbalance, too much dietary protein can be toxic. When protein is digested, a main product of digestion is uric acid - this is toxic in high amounts, so the kidneys naturally eliminate it. During end-stage kidney disease, a backup of uric acid can lead to a condition known as uremia, which is toxic, painful, and also deadly.
Talk to your renal dietitian to help you know the exact amount depending on your needs.
In all cases, limit dietary sources of potassium by avoiding foods that have high levels of it. When on dialysis, get regular blood tests to know if you need to further restrict dietary potassium, or add some back. Follow this link for a great article about potassium and its effects on the kidneys, with a complete list of foods containing high, medium, and low amounts of potassium. But for now, here’s a short list of foods to limit
Avoid foods below that are high phosphorous when you have ESRD and are not on dialysis, or if you are on dialysis and your doctor recommends to avoid them. Also read labels carefully, because finding added phosphorous is tricky: usually words in the ingredients list with “…phos…” in the name will be foods you should avoid.
Talk with your renal dietitian or kidney specialist to help you understand your bloodwork results, and manage the confusing changes in your dietary restrictions.