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What Should I Eat for My Kidney Health? Nutrition for Stage 3 to 4 Kidney Disease

Nina Ghamrawi, MS, RD, CDE
5
March 10, 2022

While exercising regularly and taking medicines as prescribed by your health care provider may help slow down the progression of kidney disease, when you already have kidney disease, how you eat makes a huge difference. Since your kidneys are constantly filtering blood, their level of function changes from one moment, and one meal, to the next - based on blood pressure, glucose, stress levels, what you ate, and what your kidneys are having trouble processing right now. There is not one eating plan that is right for everyone with kidney disease. Read more to learn the some great nutrition tips for kidney disease in all the different stages.

Why What We Eat is Important

Your kidneys help keep nutrients and minerals balanced in your body and remove the waste products from your blood. With kidney disease, your kidneys are already 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. Regardless of your stage of kidney disease (there are 5), having a healthy diet and reducing these awful symptoms may be a huge challenge. The kidneys are also fragile and complicated, making your nutritional needs and diet restrictions vary from one week to the next.

While you’re in stage 1 or 2, no changes in your diet are necessary. In stages 3 and 4, you will need to begin limiting extra protein, salt and sodium, and fluids, as well as watch blood pressure and blood sugar. In stages 1 to 4, the damage done to the kidneys may still be reversible, to a degree. In the last stage of kidney disease, stage 5, your kidneys are typically functioning very little, and people typically cannot live more than a few weeks without dialysis or kidney transplant.

Though we are discussing all stages here, the diet for stages 1 and 2 is not specific for kidney disease. If you are in stage 5, you’ll have very different nutrition requirements: read this article, instead.

Watch out, though. At any stage, uncontrolled diabetes or elevated blood pressure can cause damage and speed up progression of kidney disease. You will also still need to follow diet recommendations for any other conditions you have, like for hypertension or diabetes. The good news is that these diets are all similar.

Planning a Kidney-Friendly Meal with Stage 3-4 Kidney Disease

Fill a 9-inch or 10-inch plate with kidney-friendly habits:

  • Eat less protein: eat less protein than you typically did. Too much protein can stress out the kidneys.
  • Get fruits and/or vegetables: These protect your heart, help manage diabetes, and reduce risks of other complications. Eat at least 5 servings of fresh or frozen fruits and vegetables daily.
  • Control the breads, cereals, or grains: These help fill you up and give you valuable vitamins and energy. But they also raise blood sugars. Eat around 6 servings of grains daily and choose whole grains for half or all those servings.
  • Get heart healthy fats: each meal should contain around 10 to 20g total fat, depending on your conditions and needs. Choose the heart healthy fats whenever possible.
  • Avoid extra salt and sodium: Do this by eating fresh, healthy, and natural foods when possible. Limit how much salt you add to foods or avoid it altogether. Use salt-free seasonings like herbs, spices, lemon juice, and vinegar for flavor instead.

Protein

Your body needs protein to help build muscle, repair tissue, and fight infection. But the amount of protein you should eat depends on your stage of kidney disease. In kidney disease stages 3, 4 and 5 (not on dialysis), you should eat less protein to prevent your kidneys from having to work even harder to filter more protein waste, which could wear them out faster.

  • Eat less red meat such as beef or pork. Choose healthy omega-3 rich fish or plant protein instead.
  • Eat smaller protein amounts at each meal to not stress the body
  • A meal-sized protein serving is 1/3 to 1⁄2 the size of your palm, around 2 to 3oz of meat (or approx. 14 to 21g protein).

Sodium

You can find the amount of sodium in foods by checking the nutrition label. Sodium plays many important roles in the way our bodies function, but too much sodium can be harmful for people with kidney disease. When your kidneys are not working as well as they should, they may not be able to remove extra sodium from your body.

This can make your body retain (hold onto) fluid, which makes your heart and kidneys work harder, raise your blood pressure, and cause your kidney disease to get worse.

The amount of sodium found in natural foods is typically enough for the body’s needs, but it is usually added to many processed foods, restaurant foods, and in our home-cooking.

  • Choose snacks, ingredients, and condiments with 200 mg or less sodium per serving.
  • Too tired to cook? Get frozen or packaged meals with 600 mg or less sodium per serving.

High sodium foods usually come from:

  • Soda and sports drinks
  • Ice cream
  • Frozen dinners and and frozen or packaged snacks (TV dinners, pot pie, chips, pretzels, nuts, etc.)
  • Fast food and food from restaurants
  • Bakery items (bread, bagels, pies, cakes, etc.)
  • Condiments (ketchup, salad dressings, hot sauce, soy sauce, etc.)
  • Canned and jarred foods (tomatoes, beans, corn, pickles, etc.)
  • Seasoning mixes and spices with salt (garlic salt, celery salt, seasoned salt, taco seasoning, seafood seasoning, etc.)
  • Baking soda, baking powder, and soup stock or base.

The recommended amount of sodium to consume depends on your stage, but generally, a good sodium goal is 2300 mg or less per day. This is the exact same recommendation as is in the DASH Diet to Stop Hypertension. Ask your doctor and dietitian how much sodium is ideal for your specific blood results.

Fluid

Your health care provider will let you know if you need to limit fluid intake. Less fluid will help you control how much urine you make, and may help avoid fluid retention. Fluid retention can cause a variety of symptoms such as shortness of breath, swelling, high blood pressure, and lead to increased strain on your heart and blood vessels.

Takeaways

While limiting and avoiding foods is important with kidney disease, you need to start by knowing what stage of kidney disease you are in. Generally, when your kidneys are high functioning, like in stage 1 or 2, no changes in your diet are necessary, and you can generally handle all the same foods that you did before. In stage 3 and 4, you’ll need to start limiting some foods, like protein and sodium, and in stage 5, you’ll need to limit a lot more. At any and all stages, you’ll still need to follow diet recommendations for any other conditions you have, like for hypertension or diabetes, since these can make your kidney disease worsen much faster if not managed. Always talk with your doctor and dietitian every time you get new bloodwork, as your diet recommendations may change.