Nutrition in Kidney Disease
Nutrition in Kidney Disease
When kidney function starts to decrease, patients need to take their food intake into consideration to prevent excess wastes and fluid from building up. Dietary needs of a renal patient may change at different stages of their kidney disease.

Diets for Chronic Kidney Disease (CKD) can vary, depending on a person's size, symptoms, stage of CKD, age, activity level and other health conditions. The goal of the CKD diet is to preserve existing kidney function and to delay the later stages of CKD, particularly stage 5, which then necessitates dialysis or transplant.

When CKD progresses on to dialysis, diet continues to play a vital role in a patients' rehabilitative care. A well-balanced diet is necessary for them to stay fit as their kidneys are no longer functioning at its full capacity i.e. to get rid of the waste products and fluid from their blood. It is essential for dialysis patients to have the right amount of protein, calories, fluids, vitamins and minerals each day.

To strive towards being healthy and happy dialysis patients, they would need to:
  • Eat the right kind and amount of food on a daily basis
  • Take their medication correctly as prescribed by the doctor
  • Comply with their dialysis treatment, for instance, not "miss" any dialysis session
Dialysis patients require a much higher intake of protein than the average person. Too little protein and calorie intake often leads to protein energy malnutrition. To achieve good dialysis outcome, dialysis patients need to closely and careful monitor their diet so as to help control the waste products and fluids accumulated between dialysis treatments.

A Healthy Diet for a dialysis patient is:
  • adequate in protein
  • adequate in calories
  • low to moderate in potassium
  • low in sodium
  • low in phosphorus
  • controlled in fluids
Protein for CKD (not requiring dialysis)
Protein needs for CKD patients not requiring dialysis would be less than those needing dialysis. In the earlier stages of CKD, the kidneys although still functioning, have a hard time getting rid of protein waste products. Consuming more protein leads to overworked kidneys which can cause more damage, therefore, taking in less protein sources helps to preserve kidney function and prevent additional stress on the kidneys.

Protein for Dialysis
Protein is essential for building and repairing of muscles in the body and daily growth. During peritoneal or haemodialysis, some amount of proteins is lost and therefore patients require a higher protein intake compared to people who are not on dialysis. Eating the right amount of protein will help dialysis patients stay fit as insufficient protein intake could result in weight loss, reducing the ability to fight infections and thus, leading to malnutrition.

Protein can be divided into two categories: high and low quality. For dialysis diet, high-quality protein, for example, meat, poultry, fish and egg whites are more desirable. Most dairy products such as yogurt, milk and cheese also contain high-quality protein.

REMEMBER, RIGHT KIND and CORRECT AMOUNT of protein is vital for dialysis patients to stay healthy. Protein food contains phosphate. Therefore it is very IMPORTANT that dialysis patients take their phosphate binders with ALL their meals.

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Potassium for CKD (not requiring dialysis)
A mineral that is important for the nerves and muscles function, potassium needs to be maintained at a safe amount in the blood. Excessive potassium level in the blood can cause muscle weakness, abnormal heart rates and in extreme cases, heart failure. Potassium needs can be varied for the different stages of CKD. If a patient's dietary potassium requires restriction, the following information provided below can be followed.

Potassium for Dialysis
Patients on peritoneal dialysis may not need to restrict their potassium intake very much. On haemodialysis, however, potassium will build up between treatments so they need to be more careful with the amount of potassium in their diet.

Since haemodialysis can only remove a fixed amount of potassium, it is crucial to control the amount accumulated through patients' dietary intake. Potassium is found mainly in fruits and vegetables, with small quantities found in nuts, dry beans and dairy and meat products. It is important to avoid foods that are high in potassium and to take in moderation, foods that have low to moderate content.

Fruits (less than 150mg of potassium per serving)
Apple, lemon, pear - 1 small
Grape, longan - 10 small
Mangosteen, rambutan, water apple - 4 medium

Vegetables (less than 200mg of potassium per serving)*
Bean spout, cabbage, French bean, gourd, kang kong, long bean, onion, tempeh, winter melon, zucchini
Fruits (150 to 250 mg of potassium per serving)
Orange - 1 small
Peach, Tangerine - 1 medium
Papaya - 1 slice

Vegetables (200mg - 350mg of potassium per serving)*
Asparagus, Chinese cabbage, cauliflower, leek, lima bean, snow pea, pumpkin, sweet corn, tomato (raw/canned)
Fruits (more than 250mg of potassium per serving)
Avocado pear, custard apple, kiwi, nectarine - 1 medium
Banana - 1 small
Rockmelon, soursop - 1 slice

Vegetables (more than 350mg of potassium per serving)*
Bamboo shoot, broccoli, mustard green (chye sim), kale (kai lan), thorn box (kau kei), petai, potato, seaweed, spinach, sweet potato, sweet potato leaves, tomato (paste/puree), water chestnut, yam

* Potassium can be reduced during the preparation of vegetables by leaching or soaking. Once leached, the potassium content will be lower than pre-preparation.

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Phosphate for CKD (not requiring dialysis)
As the kidneys become less effective at filtering waste products, blood phosphate level rises and when it begins to build up in the blood, calcium is drawn from the bone. The calcium phosphate product forms hard deposits in patients' tissues leading to skin itchiness, joint pain, and eye irritation and hardens their blood vessels. Over time, patients' bones become weak and brittle which may lead to fractures and constant pain. CKD patients not requiring dialysis may need to restrict phosphate in their diet as their Glomerular Filtration Rate (GFR) decreases and blood tests show higher phosphate levels.

Phosphate for Dialysis
Both haemodialysis and peritoneal dialysis patients need to control the amount of phosphate in their diet. Almost all patients with high phosphate levels will also need to take phosphate binders as most foods contain some amount of phosphate. Phosphate binders prevent the body from absorbing the phosphate from the foods eaten and thus helping to prevent renal bone disease.

Food rich in phosphorus that patients need to avoid when they have high serum phosphate level include:
  • All sorts of seafood and sardines, anchovies (ikan bilis) and dried shrimp paste
  • Dairy products e.g. milk, cheese, yogurt
  • Bean products e.g. all forms of nuts, seeds, bean soup
  • Malted drinks e.g. Milo, Horlicks
  • Oats, cereals
  • Chocolate
  • Organ meats e.g. liver, intestine
  • Bone-based soups e.g. chicken feet and pork bone
  • Colas
For more information, please click here: English, Chinese and Malay.
Sodium in Kidney Disease
Most people should limit the amount of sodium in their diet regardless of kidney disease. Even if salt ( a major source of sodium) is not used at the cooking table, sodium can still be found in other food sources. This is because sodium is naturally found in all different types of foods, and more commonly in packaged foods and adding salt in cooking. Sodium is like-hydrated sponge that absorbs fluid and makes you thirsty and wanting to drink more. As a result, fluid weight gain arises and thus, an increase in blood pressure can be observed.

Sodium restriction in kidney disease helps to maintain normal fluid balance.

To help restrict salt intake:
  • Limit the salt added to your cooking
  • Avoid using stock cubes and gravy browning e.g. Bovril, Marmite
  • Avoid taking bottled chicken extracts
  • Read labels on processed foods and avoid items that has more than 250 mg of sodium per serving
  • Minimise the usage of canned food. If you do choose to use them, do drain the brine
  • Try using fresh herbs and whole spices in replace of salt in cooking
  • Try to use fresh lime or lemon juice or vinegar to flavour food
* Renal patients should exercise caution with salt substitutes as they are often high in potassium and should not be used without consulting you doctor or dietitian.

For more information, please click here: English (*Mandarin and Malay resources are under construction).
Fluids for CKD (not requiring dialysis)
Fluids are generally not restricted in CKD patients unless they reach end stage renal failure.

Fluids for Dialysis
Dialysis patients can no longer excrete large quantities of fluid consumed; therefore, excess fluid can be retained in the body resulting in overloading of the blood circulation. Symptoms such as shortness of breath, high blood pressure and swelling of the legs can occur. Thus, both peritoneal dialysis and haemodialysis patients will need to consider urine output, kidney function, and body size and restrict their fluid intake. Peritoneal dialysis patients will also need to see how much fluid is released during an exchange.

Daily allowance for fluid intake can vary from 500 to 1000 ml per day, depending on the patient's urine output, if any. Limited urine output does not indicate dehydration in dialysis patients. However, it means that it is an indication of further deterioration of kidney functions.

Your daily fluid allowance includes plain water, tea, coffee, milk gravy, soup and porridge. Other fluids that are liquid at room temperature such as ice-cube, ice cream, jellies are considered as fluid too.

REMINDER: It is important that dialysis patients follow the fluid regime designed by your nurse or doctor.

For more information, please click here: English, Chinese and Malay.
Diet after Kidney Transplant
Good nutrition continues to be important after kidney transplant. The right amount of protein, calories and nutrients are essential for good health. Unless your doctor or dietitian has instructed you otherwise, patients generally should be able to transition to a regular diet incorporating a variety of foods.
Kidney Recipes
Breakfast Recipes by NKF Patients
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NKF Tasty Meals Made Healthy Cookbook Recipes
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Other Recipes
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For more information on diet in kidney failure and transplant, please contact your local hospital or dialysis centre dietitian.