Running head: CKD DIET 1

Therapeutic Nutrition: Introduction to CKD Diet

Victoria Getek, Rachel Powers, Erin Sagers, Tara Scopa, & Emily Toth

University of North Carolina at Wilmington

THERAPEUTIC NUTRITION: INTRODUCTION TO CKD DIET

Therapeutic Nutrition: Introduction to CKD Diet

According to the National Kidney Foundation, or NKF, one of the most important

functions of the kidneys is to remove waste products and excess fluid from the body through

urine output (2016). In doing this, the kidneys assist the body in maintaining a stable balance of

chemicals while keeping bodily fluid volume at an appropriate level for hemostasis (American

Kidney Fund [AKF], 2016). Chronic kidney disease occurs when some pathological condition

damages the kidneys ability to filter waste products and remove fluid from the body (NKF,

2016). There are five stages of CKD, with stages one through four occurring before dialysis and

stage five requiring dialysis and/or a kidney transplant. CKD progresses differently in each

individual based on factors such as environment, lifestyle, risk factors and family history (NFK,

2016). The primary goal in treating this condition is to retain kidney function at the highest and

most effective levels for as long as possible (AKF, 2016).

Early detection and treatment is often very successful at preventing chronic kidney

disease from progressing into full renal failure (NKF, 2016). As such, healthcare providers

advocate for many nutritional and lifestyle changes to help reduce the workload on kidneys

compromised by CKD. One of the most important of these changes is known as the chronic

kidney disease diet, or CKD diet (AKF, 2016). This diet is most effective for CKD patients who

are in stages one through four of the disease, or before dialysis. As with all of the other

treatment interventions for kidney disease, the main function of the CKD diet is to assist diseased

kidneys in maintaining as much functioning ability for as long as possible by reducing buildup of

excess fluid and waste products (AKF, 2016). The hope is that this diet will prevent toxicity,

dehydration, acidosis, and electrolyte imbalances that further damage kidney tissue. Another

benefit is that this diet helps the body control blood pressure, which often causes or acts as a

secondary complication of CKD. High blood pressure leads to many of the cardiovascular
THERAPEUTIC NUTRITION: INTRODUCTION TO CKD DIET

comorbidities that make CKD patients very ill as they progress through the various stages of

renal disease (NKF, 2016). This is done by eating a diet low in protein, and limiting the

consumption of certain micro and macro nutrients such as potassium and phosphorus (AKF,

2016).

Although the CKD diet does have some base guidelines, it is important to note that this is

a diet which must be tailored to each individuals needs. It is essential that each patient work

with a registered dietician to determine which guidelines work best for them. Chronic kidney

disease does not progress the same way in every instance, but there are still several general rules

that all CKD patients should follow. In this diet, protein should be limited to 0.6-1.0g/kg/day in

favor of more nutritious carbs from grains, fruits, and vegetables (Grodner, Roth, &

Walkingshaw, 2012). This is because protein in the diet is converted to urea and other protein

waste products, which are difficult to remove by urine output. Reducing this type of waste

buildup will remove stress from the kidneys. Sodium intake should be lowered to 1-3 grams per

day, with lower on the scale being the more desired intake level. This will help keep blood

pressure lower and prevent fluid retention, which also reduces stress on the heart and kidneys.

High blood pressure has also been shown to negate the beneficial effects of a low-protein diet, so

reducing sodium intake also combats this problem (Grodner et al., 2012). Another nutrient that

should be limited in the CKD diet is phosphorus, which should be reduced to 0.8-1.2 grams per

day (Grodner et al., 2012). Phosphorus is often found in dairy and meat products, but diseased

kidneys lose the ability to remove phosphorus from the body. This results in injury to bone and

enamel, which can be very painful for patients to endure and can also lead to further nutritional

deficiencies such as malnutrition (NKF, 2016). Phosphorus is often not included on most food

labels, so dietary consultation or nutrition reference guides are essential to maintain appropriate
THERAPEUTIC NUTRITION: INTRODUCTION TO CKD DIET

intake levels. In the CKD diet fluid intake recommendation and vitamin supplementation occurs

based on individual patient needs. These parameters are based on current levels of kidney

function, stage of disease, comorbidities, and other risk factors.

One of the benefits of the CKD diet is that it is not overly restrictive in terms of food

items. This diet requires a lot of patient education regarding nutritional content of food as well as

information regarding appropriate substitutions for certain foods. In order to lower protein intake

cereals, legumes and nuts should be avoided in favor of egg whites, low-fat milk, limited

amounts of chicken, grains, fruits and vegetables (NKF, 2016). Sodium intake can be lowered by

choosing products containing less than 140mg of sodium per serving. It is important to read

labels for hidden sources of sodium such as salt, baking soda, baking powder, MSG, and sodium

compounds (AKF, 2016). Some foods to avoid include ice cream, milk, milk shakes, canned

fruits, canned vegetables, commercially baked bread, soft drinks, sauces, pickles, and excessive

amounts of animal meat products (NKF, 2016). Animal organ meats such as kidneys, liver, and

brain should also be avoided along with shellfish and saltwater fish. Many of these foods also

contain high levels of phosphorus, so limiting these sources in the diet will effectively control

both sodium and phosphorus levels in the body. Good, sources of sodium include spinach,

carrots, beetroot, white turnips, and unsalted butter (Grodner et al., 2012). To limit potassium in

the diet, avoid bananas, coconut water, dark leafy green vegetables, dried beans, nuts, potatoes,

tomatoes, raw vegetables, soft drinks, and dry fruit (Grodner et al., 2012). A good way to remove

potassium from vegetables is to peel, cut and soak them in water for an extended period of time.

This process leeches the potassium from the vegetable into the water so that these items may

then be boiled and prepared as desired. Never use a microwave to cook vegetables or fruits as
THERAPEUTIC NUTRITION: INTRODUCTION TO CKD DIET

this process traps potassium inside the food item. Items that are naturally lower in potassium

include apples, papaya, guava, pears, pineapple, and oranges (Grodner et al., 2012).

In short, the CKD diet conforms well to current dietary guidelines because it heavily

emphasizes exchanging certain food items for comparable items rather than eliminating food

groups entirely. For example, to limit potassium it is recommended to consume a pear rather than

a banana. Both are still common fruits that are readily available to most individuals and are very

similar in most of their other nutritional values. This diet also emphasizes food preparation habits

instead of limiting a food altogether. For example, while not the most favorable food choice,

CKD patients may still eat white potatoes as long as they use the soak and cut method previously

mentioned. Recommended daily allowances and other guidelines are still followed with the CKD

diet, foods are just exchanged for more favorable options within the same group. Supplements

may be recommended on an individual basis, but are not recommended as a general component

of this diet. Because of these factors, the CKD diet is relatively easy to use for patients, provided

that they receive the proper education. This diet emphasizes restricting amounts of certain

substances rather than eliminating the substance entirely, which makes it accessible for people of

all health literacy and socioeconomic statuses. Patients must be educated on how to read food

labels, how to prepare food, how to use nutritional reference guides, food journaling, kidney

function, as well as signs and symptoms of kidney failure. Nursing implications for these patients

include daily weight monitoring, edema and peripheral vascular assessments, intake and output

measurements, cardiovascular assessments and ADL proficiency assessments. With proper

education and management, patients with CKD are able to live long and healthy lives.
THERAPEUTIC NUTRITION: INTRODUCTION TO CKD DIET

References

American Kidney Fund. (2016). Kidney-friendly diet for CKD. Retrieved from

http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/kidney-friendly-

diet-for-ckd.html?referrer=https://www.google.com/.

Grodner, M., Roth, S.L., & Walkingshaw, B.C. (2012). Nutrition for Diseases of the Kidneys.

Nutritional Foundations and Clinical Applications (452-469). St. Louis, MO: Mosby.

National Kidney Foundation. (2016). Nutrition and Kidney Disease, Stages 1-4. Retrieved from

https://www.kidney.org/nutrition/Kidney-Disease-Stages-1-4.