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Why a planned diet is a must for chronic kidney disease (CKD) patients?

You have kidney disease that means your kidney is not functioning in its optimal capacity hence it cannot excrete the metabolic waste products, cannot balance electrolytes and fluid in your body. On the other hand you need a high calorie diet because CKD is a cataboli disease. So to maintain your health you need a specific high calorie diet that will optimize the metabolic waste generation, balance the electrolyte and fluid.

A balanced diet for CKD patients depends on the stage of the disease, weather on dialysis or not, presence of diabetes or hypertension, stress level, urine output and your BMI (Height & weight).

Diet for chronic kidney patient not on dialysis –

You have already getting advices like “Do not consume high protein like dal, milk products, fish, egg. Don’t drink too much fluid. Don’t have banana/ mango.” But the question is what can you have? How much of a particular food is safe?

Your daily nutrition is all about meeting the need for calorie, macro (carbohydrate, protein, fat), and micro (vitamins, minerals) nutrients by balancing metabolic waste, electrolytes, and fluid. Let’s get into the details one by one.

1.  How much energy from diet you need?  

As told earlier, CKD is a catabolic disease that increases the demand for energy and if proper energy requirements not met, then rapid weight loss due to loss of body fat & muscle are observed. Generally, CKD patients already suffer from a lack of appetite. On top due to a lack of proper dietary guidance, patients often randomly start restricting food.  Result? More and more weight loss and muscle wasting, build-up of nitrogenous products (azotemia), increased creatinine level, etc. So, what to do?

Being a CKD patient estimation of daily calorie need is essential. A daily deficiency or excess of even 300-500 kcal makes a huge difference in the condition of the patient. Your requirement of daily calorie depends on your body weight & degree of illness.

A sufficient amount of carbohydrates, a measured quantity of protein, and quality fat are a must in your daily diet to fulfill the supply of your energy need.

2.How to pick the right Protein for CKD patient –

Our body is constantly in the make and break mode. Dietary protein is essential for the body’s growth, maintenance, and repair. In CKD, your kidneys are already struggling to function properly. The glomerulus (microscopic filter) filtration rate drops causing less urine output and accumulation of metabolic waste products in the body. Under this situation, a high protein diet will accumulate waste products in blood which will cause damage to glomerular structure by increasing intra glomerular pressure.

Therefore protein-restricted but proper calorie providing diet is advised for advanced CKD patients to prevent malnutrition, maintain the ideal body weight, normal serum albumin and electrolyte values.

3.How much of protein is safe for CKD patient not on dialysis –

If GFR is above 55ml/min you can have 0.8g/Kg of your body weight/ per day

If GFR is between 25-55ml/min you can have 0.6g/Kg of your body weight/ per day

If GFR is below 25ml/min you can have 0.3g/Kg of your body weight/ per day

Use Vegetable source of protein. Patient with CKD and diabetes are generally recommended a diet having protein 0.8 g/kg/day.

Don’t think being a vegetarian you are missing on quality protein. Yes, it’s a fact that animal protein has a high biological value. But it is also evident that a vegetarian diet has its benefits to treat CKD. Plant protein has been found to be beneficial because it reduce protein in urine and improve Lipid profile. You have to take care of Phosphorus & potassium also so it is preferable to use proteins with low phosphorus like Green Pea & Lentil (moong).

4.How to pick the best source of Carbohydrate –

In the CKD diet, protein is restricted for better preservation of kidney function. For maintaining heart health, fat is also advised in moderation. But don’t forget the calorie requirement is often high. Therefore the only way to provide calories is from carbohydrates.

But as you have probably already understood that life is not that simple especially for CKD patients with diabetes.  The inclusion of complex carbs is the only choice for such cases.

Don’t forget phosphorus and potassium are still a matter of concern in case of choosing the carbohydrate source.

How to pick the best grain for supplying adequate carbohydrate with low phosphorus – Semolina, Rice, Buckwheat

Whole grains are comparatively high in phosphorous content. Therefore maida is safe than atta for CKD patients. Similarly instead of steel-cut oats or brown rice or millets, rolled oats, white rice and its products are better choices.

As staple cereal rice, rice products are safe choice for CKD patients.

However stay away from all kinds of ultra processed packaged breakfast cereal, instant noodles, instant pasta, etc. Don’t forget that these foods are loaded with refined sugar, refined cereals along with many types of food additives and preservatives which can be dangerous for a CKD patient.

5.How to choose the best fat sources for CKD?   

Fat metabolism gets altered in CKD patients. The very low-density lipoprotein (VLDL) and Low-density lipoprotein (LDL) are increased whereas high-density lipoprotein level drops. In short, it’s the exact opposite situation that one should ask for better heart health. Therefore moderate intake of good quality fat is something repeatedly advised.  

Unrefined oil, cold-pressed or kacchi ghani oil is the best choice for regular cooking.  Avoid consuming butter, and fried foods.

Nuts and seeds are very good source of good fat. However few are also high in phosphorous, and if salted then also high in salt/ sodium. Avoid almond, cashew, pistachio as they are high in phosphorus.

Avoid consuming any type of ultra processed and packaged foods as they contain refined oil, hydrogenated or partially hydrogenated fat, trans fat etc along with many artificial additives and preservatives.

6.Why and how to control Fluid/ Water?

The major function of the kidney is to balance the fluid in our body. When the kidney fails to perform. Fluid starts accumulating in the body which is called fluid overload. This can cause high blood pressure, swelling of the ankle and slowly the swelling spreads out to the other body parts. If not treated on time then eventually settle in the lungs causing a life-threatening condition called pulmonary edema.

If you restrict fluid intake too much then the kidney will not get adequate substrate to remove the waste products causing an increase in urea, creatinine in the blood.

Therefore fluid balance is a must for CKD patient. Based on urine volume and blood pressure reading the fluid intake should be decided for the next day.

7.How to control the thirst?

Most of the CKD patients from hot humid climates often complain of excess thirst. CKD patients with diabetes suffers even worst.  Try these home remedies to feel better –

• Limit consuming sodium containing foods and spicy food
• Try drinking cold beverages instead of a hot one
• Sip on your drink, try to keep the fluid in your mouth for longer
• Try licking ice
• Use small cup

8.How to pick vegetables and fruits in the CKD?

Vegetables and fruits are essential to meet the supply of micronutrients (vitamins and minerals). The vitamin and most of the mineral requirements of a CKD patient are just like any normal adult. However as mentioned earlier you must restrict your dietary supply of sodium, potassium, phosphorous. I have already explained how you can restrict sodium and phosphorous in detail above.

Potassium is needed for controlling your nerve and muscle functions. The kidney helps to keep the potassium level in control. But once kidney function lacks potassium starts getting accumulated in the body. This hampers the normal activity of your heart.  So limit your potassium intake.

The biggest supply of dietary potassium comes from vegetables and fruits. Potassium is heat sensitive. Therefore thorough cooking helps to reduce the potassium content of vegetables. Since you can’t cook the fruits, one should be very careful on choosing the right fruit. Beetroot, Pink raddish, Methi, Bottle Gourd, Cucumber, parwal, tinda, ridge gourd are low potassium fruits & vegetables.

9.Cooking tips to reduce the potassium content of food –

• Boil the vegetables with excess water for 1 minute and discard the water. This blanching technique will immediately reduce the potassium content of the food.
• Beside this boiling, pressure cooking methods work best to minimise the potassium content

10.Attention :Renal diet is one of the most challenging diet. You may need a qualified renal nutritionist for personalized diet plan.

11.Keep in Mind: Adequate calorie, restricted protein, phosphorous, sodium and potassium diet is what you need at this time. Eat mindfully. Eat well.

Adopting a healthy lifestyle

Control blood sugar and blood pressure is mandatory

Try to stay active throughout the day

Pay attention to your sleep quality (Deep sleep for 6-8 hrs is non-negotiable)

Manage your stress

 All the best.