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 renal patients may vary with the progression of their kidney disease.

The renal diet depends on a person’s body 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 progression of CKD, particularly stage 5, which then necessitates dialysis or transplant.

Protein for Pre-dialysis

Protein needs for CKD patients not requiring dialysis would be less than those having dialysis. Even though the impaired kidneys are able to function in the earlier stages of CKD, they still have hard time to remove all waste products from the body. Consuming more protein leads to overworked kidneys which can cause more damages. Therefore, eating less protein helps to preserve kidney function and prevent additional stress on the kidneys. Your dietitian or doctor will tell you how much of protein you need to consume a day.

Find out how 1 portion of protein looks like.

Diet low in Sodium

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 added during cooking, 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 and processed foods. Sodium is like-hydrated sponge that absorbs fluid. It makes you feel thirsty and intend to drink more. As a result, weight gain from fluid arises and consequently, increasing 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
  • Use fresh herbs and whole spices in replace of salt in cooking
  • Use fresh lime, lemon juice or vinegar to flavour food

Read more about a low sodium diet.

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.

Potassium for Pre-dialysis

Potassium is a mineral which is important for nerves and muscles function. Potassium in blood needs to be maintained at a safe level. Excessive potassium level in the blood can cause muscle weakness, abnormal heart rates and in extreme cases, heart failure. Potassium needs can be varied with the different stages of CKD.

If a patient’s dietary potassium requires restriction, the following information provided below can be followed.


AVOID high potassium foods such as:

  • Wholegrain cereals, bread and biscuit.
  • Nuts, seeds and related products, e.g. chocolate, peanut butter.
  • Coconuts and related products, e.g. coconut milk, kaya.
  • Brown sugar, molasses, maple syrup, toffees, liquorice

  • All fresh/canned fruit and vegetable juice, herbal medicine drinks, strong tea/coffee, cocoa and malted beverage, milk, wine
  • High potassium salt substitute, bottled sauces, meat and vegetables extract, essence of chicken, stock cube.
  • Fruits and vegetables from the high potassium group

Read more on potassium

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

Phosphate for Pre-dialysis

As the kidneys become less effective at filtering waste products, blood phosphate level rises. 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, eye irritation and hardening blood vessels. Overtime, patients’ bones become weak and brittle. This may lead to fractures and constant pain. CKD patients who do not require dialysis may need to restrict phosphate intake in their diet as their Glomerular Filtration Rate (GFR) decreases and blood tests show higher phosphate levels.

Food rich in phosphorus that patients need to avoid when they have high serum phosphate levels include:

  • All sorts of seafood, sardines, anchovies (ikan bilis) and dried shrimp paste
  • Processed food and canned food (e.g. canned meat or fish, sausage, meat patty)
  • Dairy products (e.g. milk, cheese, yogurt)
  • Bean products (e.g. all forms of nuts, seeds, bean soup)
  • Malt drinks (e.g. Milo, Horlicks, Ovaltine)
  • Oats, cereals
  • Chocolate and related products
  • Wholegrain and related products (e.g. wholemeal bread, brown rice, wholemeal noodles)
  • Organ meats (e.g. liver, intestine)
  • Bone-based soups (e.g. chicken feet and pork bone)
  • Colas

Read more about phosphate

Fluids for Pre-dialysis

Fluids are generally not restricted in CKD patients unless they reach end stage renal failure.


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