You may need to change what you eat to manage your chronic kidney disease (CKD). Work with a registered dietitian to develop a meal plan that includes foods that you enjoy eating while maintaining your kidney health.

The steps below will help you eat right as you manage your kidney disease. The first three steps (1-3) are important for all people with kidney disease. The last two steps (4-5) may become important as your kidney function goes down.

The first steps to eating right

Step 1: Choose and prepare foods with less salt and sodium

Why? To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.

• Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the supermarket or at restaurants.
• Cook foods from scratch instead of eating prepared foods, “fast” foods, frozen dinners, and canned foods that are higher in sodium. When you prepare your own food, you control what goes into it.
• Use spices, herbs, and sodium-free seasonings in place of salt.
• Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the food is high in sodium.
• Try lower-sodium versions of frozen dinners and other convenience foods.
• Rinse canned vegetables, beans, meats, and fish with water before eating.

Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly salted.

Step 2: Eat the right amount and the right types of protein

Why? To help protect your kidneys. When your body uses protein, it produces waste. Your kidneys remove this waste. Eating more protein than you need may make your kidneys work harder.

• Eat small portions of protein foods.
• Protein is found in foods from plants and animals. Most people eat both types of protein. Talk to your dietitian about how to choose the right combination of protein foods for you.

Animal-protein foods:

• Chicken
• Fish
• Meat
• Eggs
• Dairy

A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards. A portion of dairy foods is ½ cup of milk or yogurt, or one slice of cheese.

Plant-protein foods:

• Beans
• Nuts
• Grains

A portion of cooked beans is about ½ cup, and a portion of nuts is ¼ cup. A portion of bread is a single slice, and a portion of cooked rice or cooked noodles is ½ cup.

Step 3: Choose foods that are healthy for your heart

Why? To help keep fat from building up in your blood vessels, heart, and kidneys.

• Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
• Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
• Trim fat from meat and remove skin from poultry before eating.
• Try to limit saturated and trans fats. Read the food label.

Heart-healthy foods:

• Lean cuts of meat, such as loin or round
• Poultry without the skin
• Fish
• Beans
• Vegetables
• Fruits
• Low-fat or fat-free milk, yogurt, and cheese

Limit alcohol
Drink alcohol only in moderation: no more than one drink per day if you are a woman, and no more than two if you are a man. Drinking too much alcohol can damage the liver, heart, and brain and cause serious health problems. Ask your health care provider how much alcohol you can drink safely.

The next steps to eating right

As your kidney function goes down, you may need to eat foods with less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan.

Step 4: Choose foods and drinks with less phosphorus

Why? To help protect your bones and blood vessels. When you have CKD, phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.

• Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS”—on ingredient labels.
• Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.

Your health care provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood. A phosphate binder is a medicine that acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into your blood. Instead, your body removes the phosphorus through your stool.

Step 5: Choose foods with the right amount of potassium

Why? To help your nerves and muscles work the right way. Problems can occur when blood potassium levels are too high or too low. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Your food and drink choices can help you lower your potassium level, if needed.

• Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt substitutes.
• Drain canned fruits and vegetables before eating.

Some medicines also can raise your potassium level. Your health care provider may adjust the medicines you take.

Get the Right Amount of Protein

With kidney disease, eating the right amount of protein can help protect your kidney function. A dietitian can help you make a meal plan that will keep you feeling your best if you have a health problem.

What is Protein?

Proteins are long strings of amino acids that make up part of each cell in your body. There are many kinds of proteins. Your body uses these proteins as building blocks to make cells. Each cell membrane has protein. So do your muscles. Even your bones are held together by a protein support structure.

Animal-based Foods Have Complete Proteins

Some proteins have ALL of the amino acids your body needs. These are “complete” or “high-quality” proteins. They tend to be animal-based, like eggs, meat, poultry, fish, and dairy.

Plant-based Foods Have Incomplete Proteins

Other proteins have only some of the essential amino acids. They are “incomplete proteins,” and tend to be plant-based, like rice, beans, and corn. You can get all the amino acids you need in a plant-based diet — but you will need to eat a variety of foods. Ask your dietitian for help if you prefer a vegetarian diet.

Wastes from Protein Can Stress the Kidneys

When your body breaks down protein, the kidneys get rid of the wastes. If your kidneys don’t work as well as they once did, eating too much protein can stress your kidneys. Your care team may suggest that you limit the amount of protein you eat each day to a moderate amount. (Most Americans eat far more protein than they really need.) Your dietitian can help you make this work in your meal plan.

Protein Serving Size

Eating less protein may help slow kidney disease. A piece of meat the size of the palm of your hand, or a deck of cards, is about 4 oz of protein. This is one serving. Your care team may prescribe an amount of protein for you to eat each day. So, if you have chronic kidney disease and are not on dialysis, you might not want to eat big pieces of a protein food. Small pieces in a kebab, salad, or stir-fry are a good way to get enough, but not too much.

If your kidneys fail and you do start dialysis, you may need to eat EXTRA protein. Each dialysis treatment can cause you to lose a little bit of protein. You need protein, or your body may start to break down muscle—like your heart. Eating the right amount of protein for your body can help you make sure that your muscles stay strong. Your dietitian will help you.

Protein, Phosphorus, and Fat

Some protein foods like beans, nuts, and dairy can have a lot of phosphorus. When your kidneys don’t work well, the phosphorus can build up in your blood and lead to bone problems. Eating lean, high-quality protein can help you get the right amount of protein—without too much fat or phosphorus. Some good choices include fish, chicken, lean red meat, a bit of low-fat dairy, and eggs.

What Else CAN You Eat?

When you don’t eat as much protein, you need something else to fill you up! Try to focus on vegetables the most. Include fruits and foods made from grains, like rice and pasta, to fill out your meals. You may need to add olive oil or another healthy fat to get enough calories. Your dietitian will help you with this.

Can’t Face Protein? Talk to Your Care Team

If you find that you can’t stand the smell of protein foods, like meat—or can’t eat much at all, see your health care team right away. Nausea and loss of appetite can occur with kidney problems, or can be a symptom of another illness. Keeping track of your symptoms can help you get the care you need to feel your best.

How and Why to Limit Phosphorus

With kidney disease, having too much phosphorus in your body can be a real problem for your skin, joints, and bones. A dietitian can help you make a meal plan that will keep you feeling your best.

What is Phosphorus?

It’s a mineral element and part of the “stone” foundation that holds up your body. Your bones and teeth are mostly made of phosphorus and calcium as calcium phosphate—stone!

Phosphorus + Calcium Make Up Bones

Phosphorus is stored in your bones and teeth, along with calcium. Small amounts of each mineral are also in your blood. When your body needs them, they are removed from your bones.

Phosphorus is an Electrolyte

In your blood, tiny but precise amounts of dissolved phosphorus help your cells talk to each other. Phosphorus is an electrolyte. It helps your body use energy from food and helps keep your blood at the right pH (acid/base) level. But, if your kidneys don’t work as well as they should, they can’t remove excess phosphorus. The phosphorus builds up in your blood.

Calcium + Phosphorus Can Harden Blood Vessels

When your kidneys don’t work, having too much calcium and phosphorus in your blood is a problem. The two minerals can join and form deposits in your skin, causing painful itching. Or, they can form in blood vessels and may cut off blood flow to a limb. Your doctor may prescribe phosphate binders for you so your blood levels of phosphorus don’t go too high. Track your calcium and phosphorus so you know what they are.

Know the Food Sources of Phosphorus

Phosphorus is found in MANY foods. Even foods you need to eat to stay healthy, like high-quality protein, have phosphorus. Your care team may want you to limit some foods that are high in phosphorus, like nuts, beans and peas, seeds, whole grains, dairy products, cola, chocolate, and beer. There are many other foods that are high in phosphorus.

Phosphorus Can Hide—Look for It!

Phosphorus is injected into some meat and turkey. Be sure to read fresh meat labels if your care team wants you to limit phosphorus. Look for meats that don’t have phosphate or phosphorus as an added ingredient. If the letters “PHOS” are in the label, you don’t want to eat it. Some fast foods may also have phosphorus added! Ask the restaurant to be sure what you are eating.

Phosphate Binders Remove Some Phosphorus

Your doctor may prescribe drugs for you called “phosphate binders.” Like a magnet, binders attract and hold phosphorus before it can get into your bloodstream. The phosphorus passes through your gut and is removed in your stool.

You take binders WITH food. With ALL food. ONLY with food. They only work if they are in your gut at the same time that food is in your gut. When you eat a snack, you’ll take a small number of binders. With a larger meal, you’ll take more binders. Your dietitian will go over your lab test results with you to see if your phosphorus level is in the target range.

Taking phosphate binders and watching what you eat go hand in hand to help you feel your best.

Manage Your Potassium

Potassium is the MOST important mineral to have in the right amount in your blood. Having too much or too little can stop your heart! A dietitian can help you make a meal plan that will keep you feeling your best—and help keep you safe.

What is Potassium?

It is a mineral that helps your whole body work the way it should. It’s like a power cord that lets your nerves talk to your muscles. This includes your heart muscle. Potassium controls your heart rhythm. You need to have potassium in your blood in very precise amounts at all times.

Potassium is an Electrolyte

In your blood, potassium is an electrolyte. It helps all of your muscles work. But, if your kidneys don’t work as well as they should, they can’t remove excess potassium. It can build up in your blood to unsafe levels. One way to prevent this is to eat less potassium in your diet so there is not as much for your kidneys to remove from your blood.

Limit High Potassium Foods

Dried fruits—like raisins and apricots—and tropical fruits have a LOT of potassium. Beans, potatoes, tomatoes, and avocados have a lot of potassium, too. Most salt substitutes also have potassium.

If you take a diuretic, your doctor may change your dose or check your blood potassium often.

Limit High Potassium Dairy Foods

Dairy foods like milk, cheese, and ice cream, can also have a lot of potassium. In some parts of the U.S., you can buy “diabetic” milk at the store. This type of milk has less sugar, phosphorus, and potassium. If you can find it, it may be a better choice for you. Talk to your dietitian about how much dairy to include in your diet.

Watch Your Coffee Servings

If you drink coffee, watch your serving sizes. Black coffee has 116 mg of potassium per 8-ounce cup. If you are a coffee lover, you may find that you need to cut back to keep your potassium in the safe range.

Soak Vegetables to Remove Potassium

Some vegetables are high in potassium, too, like potatoes, carrots, hard squash, beets, and sweet potatoes. This doesn’t mean you can never eat these foods. If you plan ahead, you can lower the potassium. Cut the foods into small pieces and soak them in lots of water for at least 4 hours, or overnight. Drain out the water, rinse with fresh water, then cook. Soaking can remove as much as ³⁄₄ of the potassium, which can put these foods into the safe range for you. Or, boil them for 5 minutes and drain out the water to remove some potassium.

Some canned fruits or vegetables can be drained and rinsed to have less potassium, too.

Potassium Can Hide—Watch for It!

Some fresh meats are injected with a fluid that may have potassium in it. Don’t buy meat that has potassium added to it.

Avoid Salt Substitutes—They Have Potassium

Salt substitutes may be high in potassium, which is harmful for you. If you need to watch your sodium, it’s better to use herb products, which come in lots of flavors.

Pay Attention to Your Sodium and Fluid

With kidney disease, having too much sodium or fluid in your body can be a real problem. A dietitian can help you make a meal plan that will keep you feeling your best.

What is Sodium?

It is a mineral that helps your body balance fluid levels. Sodium and chloride combine to form salt. In your body, salt is like a sponge—it pulls in water.

Sodium is an Electrolyte

In your blood, sodium is an electrolyte. It helps you move your muscles, helps your brain work as it should, and controls your blood pressure.

Fluids are Liquid at Room Temperature

You know that fluids are liquids you can drink. But some foods are also fluids if they have a lot of water in them. Foods like soups and stews, ice cream, and gelatin “count” as fluids. Ice cubes count. Even watermelon—which doesn’t melt but is still mostly water—is a “fluid.” A trick some people use is to eat soup, stew, or breakfast cereal with a fork instead of a spoon. That way, you get the solid part, but not the fluid.

If you have a fluid limit, your care team will tell you how much fluid you can have each day. Your dietitian will help you figure out how to follow your limit.

Water and Salt Can Build Up in Your Body

Kidneys that don’t work well don’t remove all of the excess water and salt from the body. Think of your body as a bathtub. When your kidneys work well, you fill up the “tub” by drinking—and then the water and salt go down the drain. But when your kidneys don’t work well, water and salt stay in the “tub” and only drain out slowly. If your kidneys fail, the water and salt don’t drain out at all, and you need treatment to live.

You CAN have a good life even if your kidneys fail. Some people have lived for decades with kidney transplants or one of the many ways to do dialysis.

Swelling in the Hands, Feet, and Face

Excess water and salt can build up in the hands, feet, or face (often under the eyes). This problem is most common in kidney diseases that cause protein to leak out into the urine (called proteinuria). Cutting back on salt in your diet can help because salt holds water in your body.

Medications may help, too. Diuretics (water pills) prescribed by a doctor can help your body get rid of some excess water and salt (as long as your kidneys are working). Blood pressure pills called ACE-inhibitors or ARBs may help slow the types of kidney problems that cause swelling.

Put Away the Salt Shaker

If you are one of the many people who are salt sensitive, eating less salt, or sodium, can help you bring down your blood pressure. Here are some things you can do to cut down on the salt you eat:

• Take the salt shaker off the table.
• When you cook, cut the salt in half.
• Avoid salt substitutes. They may be high in potassium, which can harm you if your kidneys don’t work well.
• Use herbs and spices to add flavor to your food. There are lots of low sodium choices.

The American Heart Association says we should ALL limit sodium in our diets to 1,500 mg per day. Many people find that once they get used to eating less salt, food tastes better.

Avoid High-salt Fast Food

Did you know that many Americans eat fast food every day? A lot of fast food is very high in salt—along with fat, trans fats, starch, and just plain calories. It’s cheap and tasty, but it’s not good for you OR your kidneys. You can get a whole day’s worth of salt with just one menu item!

When you go out to eat, choose restaurants where they cook to order, and ask for your food with no added salt, MSG, salty sauces, or cheese on top. This may help you control your blood pressure.

When you want a snack, try:

• Fresh fruit or raw vegetables
• Baked chips
• Plain popcorn
• Low sodium pretzels
• Low fat, low sodium crackers
• Low fat, light yogurt and pudding
• Sugar free Jell-O or fruit-flavored popsicles

Avoid High-salt Processed Foods

About ³⁄₄ of all salt in most people’s diets comes from processed foods. These foods come in a bag, box, bottle, or can. Not all processed foods are bad. But some have a lot of sodium. Soups and breads are some of the worst—look for low sodium versions. Some meats, like bacon, and deli meats like cold cuts and salami have too much salt to be good choices. Salty snack foods, like pretzels, crackers and potato chips have lots of salt, too.

Condiments like ketchup and soy sauce have a lot of salt. Boxed side dishes and “helper” foods usually have much too much salt, too. Many canned vegetables have lots of salt; fresh, frozen, or low-sodium vegetables are better choices.

Read Food Labels for Sodium

Does this look like a good food choice to protect your kidneys? The answer is NO! There is almost 1,500 mg of sodium in one serving of this food—a whole day’s worth!

Most foods have labels like this, to help you make good choices. Keep a close eye on serving sizes:

• A serving size may be in grams or ounces
• A food that comes in a bag could be two or three servings, not one
• If you eat more than one serving, you get more salt

Watch Your Fluid Servings

If you have fluid limits, your care team and dietitian will talk with you about them. You’ll need to watch portion sizes—drinking cups can be very different! You may want to bring your own cup with you until you get a good feel for how many ounces there are in a serving. You can also keep track of fluid weight gains by weighing yourself each day.

Did you know kidney disease is often referred to as a “silent disease,” because there are usually no symptoms during its early stages? In fact, as many as 90% of Americans who have chronic kidney disease (CKD) don’t know they have the disease until it is very advanced.

The good news is the earlier you find out you have kidney disease, the sooner you can take steps to protect your kidneys from further damage. Protecting your kidneys may allow you to continue to work, spend time with family and friends, stay physically active, and do other things you enjoy.

Finding out if your kidneys are struggling before you have symptoms gives you the opportunity to make changes to help keep your kidneys healthier for longer. Even if you have symptoms, you can take steps to slow the disease.

Take Steps to Help Protect Your Kidneys

Know Your Risk

Even if you feel healthy, if you are over 60 or have risk factors like diabetes, high blood pressure, or heart disease, consider talking with your doctor about getting tested for kidney disease. Your doctor can use your test results to work with you to develop a kidney care plan. Having a plan may reduce your risk for serious health problems, like heart attack and stroke, and give you more healthy moments.

Schedule Your Test

Your doctor will use two quick tests to check for kidney disease—a urine test to check for damage and a blood test to check how well your kidneys are removing wastes from your blood. If your kidneys show signs of damage, your doctor may refer you to a kidney specialist, called a nephrologist, or recommend annual or more frequent testing.

Follow Your Kidney Health

Your doctor can work with you to create a treatment or monitoring plan that fits your lifestyle, mobility, health status, and dietary needs. Your plan may include managing your existing risk factors for kidney disease, collaborating with a registered dietician to create a meal plan, or getting help to quit smoking. Because chronic kidney disease is progressive, it is very important to continue to follow your kidney health and to update your care plan as needed.