UW Health Nutrition for Kidney Disease Instructions

: June 10, 2024
: UW Health

Table of Contents

UW Health Nutrition for Kidney Disease
Product Information: Nutrition for Kidney Disease
Diet and Kidney Disease
Your Daily Protein Needs
Protein

UW Health Nutrition for Kidney Disease

UW-Health-Nutrition-for-Kidney-Disease-product-img

Product Information: Nutrition for Kidney Disease

If you are experiencing kidney disease, you will need to follow a special diet to maintain your health. This guide contains specific diet and nutrition information to help you manage your kidney disease effectively. A healthy kidney filters out waste products from the blood, and when your kidneys are not functioning as they should, you may need to limit certain foods to prevent the build-up of waste products. This guide will help you learn how to eat to control the amount of waste products that you produce, which may help your kidneys stay healthier and slow the progression of kidney disease.

Diet and Kidney Disease

When your kidneys are not working well, you need to limit certain foods to prevent the build-up of waste products. Your dietitian will help you determine which foods to limit and which ones to include in your daily diet. This guide will help you learn how to eat to control the amount of waste products that you produce, which may help your kidneys stay healthier and slow the progression of kidney disease.

Your Daily Protein Needs

The table below shows the amount of protein you should eat each day. This includes protein from meat, milk, and starch food groups. Please note that these are not exact numbers and may vary based on your health condition.

Height	Grams per day	Ounces/protein per day	Servings per day
5’2 or less	38-50	4-5	5-6
6-7	52-70	7	*These are not exact numbers and may vary based on your health

condition.

Protein

Your body needs a diet with enough protein to maintain and grow body tissue. When you eat large amounts of protein, more waste products can build up in your blood and may harm your kidneys. So, you may need to limit the amount of protein in your diet. Your dietitian will decide the amount of protein that you should have each day to meet your body’s needs. Meat, poultry, fish, eggs, and dairy products contain large amounts of high-quality protein. Protein from plants such as nuts, beans, soy, and seeds are not as high quality of protein but may be easier for your kidneys to handle. You should include small amounts of protein in each meal. Breads, cereals, and vegetables also have small amounts of protein.

Protein Serving Sizes

Each of the following is equal to one choice or serving and contains about 7 grams of protein:

1 ounce of meat, fish, or poultry
1 egg
1/2 cup cooked dried beans or peas
1/2 cup tofu or soy milk
1/3 cup nuts or seeds
1/2 cup cottage cheese or ricotta cheese
1 cup milk (not included in the above table)
*Choices higher in phosphorus and/or potassium.

Milk

Milk is a protein source. You may need to limit it to control the amount of phosphorus and potassium in your diet. Your dietitian will help you determine how much milk you should have each day.

Product Usage Instructions

Consult with your dietitian to determine the appropriate daily protein intake for your specific health condition.
Use the table provided to determine the amount of protein you should eat each day based on your height.
Include small amounts of protein in each meal, such as meat, fish, poultry, eggs, dairy products, nuts, beans, soy, or seeds.
Limit your intake of milk to control the amount of phosphorus and potassium in your diet.
Choose foods that are low in phosphorus and potassium to prevent the build-up of waste products in your blood.
Follow your dietitian’s recommendations to maintain a healthy diet and slow the progression of kidney disease.

You will need to follow a special diet while your kidneys are not working as they should. This guide contains specific diet and nutrition information to help you.

Diet and Kidney Disease

A healthy kidney filters out waste products from the blood. When your kidneys are not working well, you may need to limit certain foods to prevent the build-up of waste products. This guide will help you learn how to eat to control the amount of waste products that you produce. This may help your kidneys stay healthier and slow the progression of kidney disease.

Protein

Your body needs a diet with enough protein to maintain and grow body tissue. When you eat large amounts of protein, more waste products can build up in your blood and may harm your kidneys. So, you may need to limit the amount of protein in your diet.
Your dietitian will decide the amount of protein that you should have each day to meet your body’s needs. Meat, poultry, fish, eggs, and dairy products contain large amounts of high-quality protein. Protein from plants such as nuts, beans, soy, and seeds are not as high quality of protein but may be easier for your kidneys to handle. You should include small amounts of protein in each meal. Bread, cereals, and vegetables also have small amounts of protein.

Your Daily Protein Needs
The table below shows the amount of protein you should eat each day. This includes protein from meat, milk, and starch food groups.

Height| Grams

protein per day

| Ounces/

Servings per day

---|---|---
5’2” or less| 38-50| 4-5
5’3” – 5’7”| 42-56| 5-6
5’8” – 5’11”| 47-62| 6-7
6’0” – 6’4”| 52-70| 7

These are not exact numbers and may vary based on your health condition.

Protein Serving Sizes Each of these is equal to one choice or serving and contains about 7 grams of protein:

1 oz. beef, lamb, pork, poultry, or fish
¼ cup salmon, tuna, crab, poultry, fish, lobster, or clams
¼ cup cottage cheese
1 oz. or 5 medium shrimp
1 egg or ¼ cup egg substitute
*2 Tbsp. Peanut butter
*1 oz or ¼ cup of nuts
4 oz. tofu, 1 oz tempeh
*½ cup cooked dried beans, peas, lentils, and soybeans (edamame)
*1 oz natural cheese (Swiss, Cheddar, etc)

Choices higher in phosphorus and/or potassium.

Milk
Milk is a protein source. You may need to limit it to <1 or up to 3 servings daily depending on your potassium and phosphorus levels.

Milk Serving SizesEach of these milk choices contains 8 grams of protein:

1 cup milk
1 cup regular yogurt
¾ cup custard
2-3 oz or ½ carton of Greek yogurt
1 cup cream (milk-based) soup
½ cup ice cream
1 cup milk-based pudding
2.5 cups non-dairy substitute* (make sure non-dairy substitute does not contain phosphorus additives)

Vegetarian Diets Many new studies have shown that eating a vegetarian- type diet that includes plant-based proteins like nuts and beans may help your kidneys stay healthier. A vegetarian diet requires balance because foods like nuts and beans have more potassium. If you want to eat more vegetarian foods, please talk to a dietitian.

Starch
Starches are important to watch if you have diabetes. If you keep your diabetes under good control it can help keep your kidneys healthier. Whole grains should make up at least half of your starches. Whole grains often have a little more potassium and phosphorus than white grains, so you may need to watch the amounts you eat. Aim for about 1-4 carbohydrate (starch) choices per meal depending on your diabetes and calorie needs.

Starch Serving Size
Each of these is equal to one starch choice. One choice contains 15 grams of carbohydrates and about 2-4 grams of protein:

Biscuit (2”)
1 dinner roll
1 slice bread
½ cup cooked cereal
½ hamburger bun
¾ cup dry cereal
1 muffin
¼ cup Grape-Nuts cereal
2 pancakes (4”)
3 graham crackers (2 ½” sq.)
6 saltines
2 ½ Tbsp. Flour
½ cup rice/grains, cooked
½ cup pasta, cooked
½ English muffin
3 cups popcorn
½ cup potatoes
½ bagel
½ pita (6”)
1 flour tortilla (7”)
2 breadsticks, 4” long x ½’’

Fruits and Vegetables
Because fruits and vegetables have little protein, you can use them freely in a low-protein diet. They add vitamins, calories, fiber, and flavor to your meals. They contain many nutrients that keep your heart, blood vessels, and kidneys healthy.
Try to eat at least 5 servings of vegetables and fruits daily. Some fruits and vegetables are big sources of potassium and you may need to limit them. These are listed in the potassium section below.

Sodium and Fluid
Limit your diet to moderate amounts of sodium and fluid. The goal of sodium and fluid control is to lessen fluid weight gain and keep your blood pressure under control.

Fluid
Fluid intake will vary depending on your type and stage of kidney disease, but you may need to limit it. Fluids include water, soups, drinks, and any foods that are liquid at room temperature. This includes ice cream, sherbet, popsicle jello, and soup.

Food| Portion Size| Fluid

Content (fl oz)

---|---|---
Ice cream| ½ cup| 3 fl oz
Sherbet| ½ cup| 4 fl oz
Jello, plain Jello with fruit

or vegetables

Sodium
Keep your sodium intake to around 2000-2400 milligrams per day or less. To limit your sodium intake:

Do not use salt at the table.
Use only half the amount of salt (or less) normally used in recipes and in cooking.
Read food labels.
Avoid foods high in sodium as listed.

High sodium meats

Bacon
Canadian bacon
Corned beef
Hot dogs
Smoked fish
Luncheon meats
Smoked sausage
Bratwurst
Ham
Herring, sardines
Canned meat entrees
Canned tuna

High sodium cheeses

Camembert
Cheese spreads
Roquefort
Processed cheese (Velveeta, American)
Gorgonzola
Party dips

Convenience and processed foods

Bread and rolls with salt toppings
Frozen dinners
Oriental foods
Pot pies
Packaged entrees, rice
Potato and noodle mixes
Potato chips
Tomato juice
Canned tomatoes, sauce, paste
Sauerkraut
Bouillon cubes
Gravy, sauce mixes
Pickles, olives, relish
Salted snack crackers
Pretzels
Soups, canned, frozen or dehydrated

Seasonings that contain sodium

Celery salt
Chili salt
Garlic salt
Lemon pepper
Horseradish
Onion salt
Soy sauce
Lite salt
Meat sauces
Meat tenderizers
Monosodium glutamate (MSG)
Seasoned salt

Condiments (use in moderation)

Peanut butter
Ketchup
Store-bought salad dressing
Seasoned vinegar
Bottled sauces: such as soy, fish, oyster, barbeque, Worcestershire sauce

Sodium-Free Substitutes
Try these spices and herbs to cut the salt but not the flavor:

Spike Salt-Free
Herbal Bouquet
Mrs. Dash (all kinds)
Durkee Smart Seasons
Lawry’s Seasoned Pepper
Dried horseradish
Onion powder
Garlic powder
Fresh garlic
Scallions, onions, shallots
Fresh, dried herbs
Pepper (white, red, black)
Reasoning Mini-Mini Salt
Tabasco sauce
Veg-it

Phosphorus

You may also need to control your phosphorus intake through diet and medicines. If phosphorus builds up in the blood it can cause weak and brittle bones and itchy skin. Over time, your heart and blood vessels can become damaged.
To control phosphorus levels, you must take phosphorus-binding medicines at the proper time. Take Tums (calcium carbonate), Phoslo, Fosrenol, Renvela, Auryxia, or Renagel with meals as directed by your doctor.

High-phosphorus dairy products

Milk
Cheeses
Yogurt
Custard and pudding
Ice cream and milk
Casseroles with cheese

High phosphorus protein foods

Meat
Poultry and fish
Eggs
Organ meats
Dried beans and peas
Nuts, seeds and peanut butter
Soybeans and tofu
Lentils
Salmon and sardines

High phosphorus whole grain foods

Bran products
Oatmeal
Whole grain bread and cornbread
Wheat germ

High phosphorus drinks

Cola
Diet cola
Dr. Pepper
Cherry cola

Low phosphorus drinks

Ginger ale
Grape soda
Root beer
Slice
Club soda
Sprite/7 Up
Orange soda (except Nehi)

Phosphorus Additives
Many packaged food products and fast foods now contain phosphorus additives. Phosphorus additives in food are absorbed nearly 100% into your blood, whereas the phosphorus in more natural foods like meats, beans, and nuts are only absorbed 20-60%. Because of this, you should avoid foods with phosphorus additives if you are trying to limit phosphorus. Phosphorus additives can be found on the food label in the ingredients list as words that contain “phos,” such as phosphoric acid, hexametaphosphate, or tricalcium phosphate. Always read the ingredients list of packaged foods for “phos” foods and try to avoid them.

Potassium
Some people with kidney disease may need to limit their potassium intake. In fact, some medicines (i.e. lisinopril or enalapril) may be prescribed to help preserve kidney function but may have a side effect that causes high potassium levels. Your doctor or dietitian will tell you if your potassium level is too high or too low. You can control some of your potassium levels by watching how much potassium you eat.

High Potassium Foods
The foods that contain the most potassium are foods high in protein (dairy products, nuts, beans, and meats), and fruits and vegetables. You should avoid most salt substitutes since they also contain potassium. Be sure to check the labels on “low sodium” or “low salt” foods and avoid those that use potassium salts like “potassium chloride.” If your potassium is high, try to choose mostly low-potassium foods.

Low Potassium Foods
These foods have less than 150 milligrams of potassium (or 4 milliequivalents) per choice. Serving sizes are ½ cup cooked or 1 cup raw unless otherwise noted.

Fruits

Apple juice
Applesauce
Apple, med, w/o skin
Apricots, canned
Blackberries
Blueberries
Boysenberries
Cranberries
Cranberry sauce
Cranberry juice
Figs, canned
Fruit cocktails, canned
Gooseberries
Grapes, canned or fresh
Lemon, 1 medium
Lime, 1 medium
Nectars: peach, pear, or apricot
Mandarin oranges
Peaches and pears, canned
Pear, fresh, 1 medium
Pineapple, raw or canned
Plums, canned
Raspberries
Rhubarb
Strawberries
Tangerine

Vegetables

Bamboo shoots, canned
Bean sprouts
Beans, green or wax
Broccoli, fresh or boiled
Cabbage
Cauliflower
Celery, 1 stalk, fresh
Cucumber
Eggplant
Greens, raw, cooked: collard, dandelion, kale, mustard, turnip
Hominy
Leeks
Lettuce: cos, romaine, iceberg, leaf, endive, watercress
Mushrooms, raw
Onion: green, red, yellow, white
Please, green
Peppers, sweet or hot

Medium Potassium Group
Limit these foods to 1-2 per day if trying to limit potassium. These foods have 150-250 milligrams of potassium (4-6.5 milliequivalents) per choice. Serving sizes are ½ cup cooked or 1 cup raw unless otherwise noted.

Fruits

Apple-1 medium with skin
Apricots, fresh—2 medium
Casaba cubed
Cherries—15 fresh or canned
Figs, fresh—2 medium
Grape juice, canned
Grapefruit—1/2 medium
Orange, 1 medium
Orange juice: frozen, concentrate
Peach, fresh—1 medium
Pineapple juice
Plums, fresh—2 medium
Watermelon, 1 cup, cubed

Vegetables

Asparagus, frozen, cooked
Artichoke hearts, boiled
Brussels sprouts
Carrots
Cauliflower
Corn, canned or 1 small ear
Garbanzo beans
Greens, frozen, cooked: kale, turnip
Mixed Vegetables
Okra
Peas, green
Potatoes, double-cooked (see below)
Summer squash: yellow, crookneck, white scallop

Double Cooking Potatoes
This process will help lower the potassium in potatoes.

Wash and peel the potato.
Slice into thin slices.
Place the sliced potato in room-temperature water. Use two times the amount of water to the amount of potato.
Bring to a boil.
Drain the water and add two times the amount of water to the number of potatoes of fresh room temperature water.
Boil again.

High Potassium Group
Limit these to less than one serving per day if you need to limit potassium. These foods have more than 250 milligrams potassium (more than 6.5 milliequivalents) per choice. Serving sizes are ½ cup cooked or 1 cup raw unless otherwise noted.

Fruits

Avocado-1/2 fruit
Banana-1/2 medium
Cantaloupe, ¼ medium
Dried fruits: apricots, dates, figs, prunes, raisins
Kiwi fruit, 1 medium
Mango, 1 medium
Nectarine, 1 medium
Prune Juice
Tangelo

Vegetables

Artichoke, 1 medium
Asparagus, raw, cooked
Beets, beet greens
Dried beans and peas: kidney, lima, navy, pinto, black-eyed peas, split peas
Kohlrabi
Okra, raw, cooked
Potato: baked, boiled or fried and unsoaked
Pumpkin
Rutabaga, cooked
Spinach
Sweet potato or yams
Tomato, fresh or canned
Unsalted tomato juice
Unsalted vegetable juice
Winter squash: acorn, butternut, Hubbard

Calories
The calories that you eat should be enough to keep proper body weight. If your weight is below what is “normal” for you, try adding extra foods to your meals from the list below. These foods provide calories but are mostly free of protein, potassium, sodium, and phosphorus.

Fats

1 tsp margarine, butter, shortenings
1 tsp mayo, cooking oils
1 Tbsp salad dressings
1/3 of an avocado*
2 Tbsp sour cream or liquid cream
1 Tbsp powdered creamer
¼ cup whipped topping
1.5 oz. non-dairy milk substitute
2 Tbsp peanut butter or ¼ cup nuts*

Nuts and avocados are good sources of healthy fat but are higher in potassium.

Sweets

1 tablespoon honey and jellies
1 tablespoon sugar
5 lifesavers
½ oz. jelly beans
½ oz hard candy
½ oz. gum drops
2-3 marshmallows (large)
1 tablespoon syrup (corn or maple)

Drinks

Limeade
Lemonade
Cranberry juice
Sorbet, Italian ice
Apple juice
Popsicles

Food Labels

Sodium
Sodium content in food is labeled in milligrams (mg) per serving of that food. The Percent Daily Value listed on food labels is another way to assess sodium content. It is the percent of 2400 mg of sodium (the recommended daily intake) contained in one serving of this food.

Protein
The protein content contained in a food is labeled grams (g) per serving of that food.

Potassium and Phosphorus
Potassium and phosphorus, by law, do not need to be included on the label. Even if there is no number for potassium the food most likely still has potassium in it. Look at the ingredient list. Ingredients are listed in order of most to least in quantity.

UW-Health-Nutrition-for-Kidney-Disease-fig-1

Resources
There are many cookbooks designed for people with kidney failure. These may help you add variety to your diet.

Books
Renal Diet Cookbook: The Low Sodium, Low Potassium, Healthy Kidney Cookbook, by Susan Zogheib Creative Kidney Cooking for the Whole Family, by Rebekah Engum, CreativeKidneyCooking.com.

The Vegetarian Diet for Kidney Disease: Preserving Kidney Function With Plant- based Eating by Joan Brookhyser Hogan The Gourmet Renal Nutrition Cookbook by Sharon Stall, RD, MPH Cooking the Renal Way by Council on Renal Nutrition of Oregon The Renal Gourmet by Mardy Peters-A Kidney Patient.

Websites
www.ikidney.com.
www.Davita.com.
www.culinarykidneycooks.com.
www.kidney.org.
www.kidneydirections.com/us/recipe/index.htm.

Who to Call
If you are a UW Health patient and have more questions, please contact UW Health at one of the phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition. Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital (AFCH) can be reached at 608-890-5500. Nutrition clinics for UW Medical Foundation (UWMF) can be reached at 608-287-2770.

Your healthcare team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your doctor or others on your healthcare team when using this information. If you have an emergency, please call 911. Copyright © 12/2021 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#320