Nutrition advice for patients with chronic kidney disease

Dietary manipulation is an important part of the management of chronic kidney disease. Diet may delay end stage disease, maintain homeostasis and control uraemic symptoms.

Dietary advice in renal disease is complex and differs according to the type and severity of the kidney disease. The advice offered usually involves multiple nutrient modifications (eg potassium, phosphorus and protein) and considers other comorbities such as diabetes, hypertension and hyperlipidemia.

For those with chronic kidney disease there are 3 key nutrients which usually require modification:

1.  Protein

A relatively low protein diet of 0.8-1g / kg of ideal body weight may be required to help delay progression of renal disease. It can also aid in reducing uraemic symptoms if adequate calories are also taken. A low protein diet should contain adequate amounts of high biological value protein to avoid essential amino acid deficiencies. Additional calories from fat and or carbohydrate are usually required to spare muscle stores and maintain body weight. An inadequately balanced low protein diet can contribute to malnutrition. Advice to avoid particular food groups should be avoided.

2.  Potassium

It is impossible to have a potassium free diet as this nutrient is found in all food groups. Foods that are high in potassium include fruit juices, dried fruit, potato and pumpkin, bananas, tomato and tomato products, wholegrain, bran and bran based cereals, dairy products and liquorice. Eliminating whole food groups or foods high in potassium is not advised as it can lead to poor compliance, constipation and poor food variety. Patients should be encouraged to choose lower potassium choices from each food group and include a small serve of a high potassium food once per day. Other useful advice for a low potassium diet includes:

  • Draining tinned fruit if used

  • Peeling vegies and finely dicing and boiling them before consuming

  • Limiting cereals with bran or dried fruit – trial tinned fruits such as pears and peaches instead.

3.  Sodium

A diet with less than 100 mol of sodium per day is recommended but often very difficult in practice to achieve. A diet that approaches this level of sodium restriction is used to assist with aggressive control of hypertension. Patients should be advised to:

  • Limiting salty processed foods such as cracker biscuits, bacon, ham, salami etc

  • Choosing processed foods with sodium < 400mg per 100g

  • Avoid adding salt to food when cooking or at the table

  • Using herbs such as basil and spices such as sumac as flavour enhancers

  • Avoiding the use of artificial salt substitutes (eg No Salt or Lite Salt) as these are very high in potassium.

  • Avoiding other condiments very high in salt such as rock salt, sea salt, vegie salt, salt flakes, flavoured salts, soy sauce and oyster sauce.

For further advice please contact your local Renal Unit to speak with the Renal Dietitian or to find an Accredited Practicing Dietitian in your local area look under D in the yellow pages or contact the Dietitians Association of Australia on 1800 812 942.