DESCRIPTION
1
>90
Near normal to mild kidney damage
2
60–89
Mild kidney damage
3a
45–59
Mild to moderate kidney damage
3b
30–44
Moderate to severe kidney damage
4
15–29
Severe kidney damage
5
<15
Kidney Failure
Stage 1 (GFR >90 mL/min/1.73m2)
This stage is typically considered normal kidney function. At this point, you want to make sure that your blood sugar and blood pressure are well controlled. You will want to work on your diet and make adjustments in your lifestyle as needed, such as quit smoking, maintain a healthy weight, and exercise regularly.
Stage 2 (GFR 60–89 mL/min/1.73m2)
There is mild kidney damage, but your kidneys are still relatively healthy and able to do their job fairly well. You most likely won’t even know you are at this stage as most don’t show any symptoms yet. Your healthcare practitioner may want to check your urine and monitor your GFR periodically to see how the kidney disease is progressing. At this stage, make sure that your diet is nourishing and well-balanced, and that you quit smoking, exercise regularly, take your medications as prescribed, and have regular checkups with your doctor. If you have diabetes or hypertension, keep your blood sugar and blood pressure well controlled.
Stage 3a (GFR 45–59 mL/min/1.73m2)
At this stage, you have mild to moderate kidney damage. Most people at this stage still don’t show any signs or symptoms. Although if you do, you may experience fluid retention (edema) and changes in your urine. Making healthy lifestyle changes such as eating a well-balanced nutritious diet, habitually exercising, and maintaining a healthy weight are important components to help manage the disease. If you are diabetic or have hypertension, be sure to maintain your blood sugar and blood pressure in the appropriate ranges.
Stage 3b (GFR 30–44 mL/min/1.73m2)
Your kidney disease has progressed, and the damage is moderate to severe. You should be working with a nephrologist to develop a more specialized treatment plan. At this point in the disease, you want to make sure you are eating a diet with appropriate protein content, limiting sodium intake, and cutting back on excess sugars and saturated fats. Also, if you haven’t already, you should be keeping your blood sugar and blood pressure under control, quit smoking, and maintain a healthy lifestyle that includes regular exercise of at least 150 minutes per week.
At stages 3a and 3b, you should definitely talk to your doctor about seeing a dietitian or search for one on your own. Diet and proper nutrition are a crucial part of delaying the progression of your kidney disease.
Stage 4 (GFR 15–29 mL/min/1.73m2)
At this stage, your kidneys are severely damaged and working at less than 30 percent capacity. You are most likely showing symptoms of CKD such as fluid retention, tiredness, foamy urine, back pain, nausea and vomiting, changes in taste, and loss of appetite. Though the disease is at a later stage, you can still work at your diet and lifestyle to slow its progression. If you aren’t already seeing a nephrologist, you definitely want to ask your primary healthcare provider to refer you to one. During this stage, you and your doctor may want to discuss treatment options and you should be working with a dietitian if you aren’t already. Diet and maintaining a healthy lifestyle are critical at this point to slow down the progression of your CKD. Be sure you are communicating with your doctor, taking your medications as prescribed, and are always prepared for your appointments. At this stage, your doctor is likely monitoring your labs and urine more frequently. Be proactive, participate in your care, and ask questions if needed.
Stage 5 (GFR <15 mL/min/1.73m2)
This stage is known as end-stage or kidney failure. Your kidneys are working at less than 15 percent of their capacity, meaning that they have lost nearly all their functional abilities. If you haven’t already been experiencing symptoms, you most likely are having them at this stage. Common symptoms that occur at this point are loss of appetite, changes in weight due to fluid retention, fatigue, headaches or difficulty concentrating, itching, decreased urine output, and tingling in your hands and feet. Toxins are building up in your body and causing you to feel ill.
Once your nephrons are damaged, they usually don’t recover completely, but don’t panic. Although there is no cure for kidney disease, there are definitely things you can do to take control of the disease and delay its progression. You can still live a happy and quality life by making appropriate changes in your diet and lifestyle.
What to Expect on the Renal Diet
Every person is different, and everyone has different nutrients they will need to monitor with CKD. You may be at the same stage of CKD as someone but have completely different diet needs depending on your body and your overall condition.
The CKD diet requires you, your healthcare practitioner, and hopefully also a dietitian to monitor your labs and progress to ensure you are following an appropriate diet. While it may be overwhelming to think about all the different components, the diet is manageable if you have the proper tools and guidance. The fact that you are reading this book is a great sign that you are on the right path. You may feel overwhelmed or think that this diet is going to be terrible, but I promise you there are plenty of tasty recipes that can be created on a renal diet.
The renal diet includes a variety of whole grains, appropriate proteins, plenty of fruits and vegetables, and flavorful and fun seasoning and spices. There are certain nutrients that people with CKD may need to watch out for; these may include, but are not limited to, protein, potassium, phosphorus, and sodium. While these nutrients are important to monitor depending on your needs, it’s also good to note that there are many foods you can incorporate into your diet that are tasty as well as nutritious and good for your body.
Protein
Protein is considered the building block of life. It is part of our muscle, skin, hair, and nails. Our bodies need protein to grow and develop, help repair tissues, fight infections, and heal from injuries. Though protein is important, those with CKD need to be mindful of protein intake. When we eat protein, our body metabolizes it and uses it but some of it also becomes waste products. Healthy kidneys are able to filter these waste products and excrete them in our urine. However, those with CKD are not able to remove the wastes as effectively, and the waste ends up building up in our blood. When you have too much protein in your body, it puts extra stress onto the kidneys and makes it even harder to remove the waste products. When you have CKD, your protein needs will be different and likely less than usual.
There are two different types of protein—animal proteins and plant proteins. Animal proteins (beef, chicken, fish, pork, dairy, eggs) are considered high-biological value because they contain a sufficient number of amino acids, which are the components of protein that our body needs. Though they are considered high-quality proteins, animal proteins create more waste products in our bodies than plant proteins and our kidneys are not able to filter them as well. Plant proteins don’t create as much waste product when our body metabolizes them and therefore put less strain on our kidneys. Newer research is showing that following a more plant-based diet has been beneficial for those with CKD. Examples of plant proteins are nuts, nut butters, seeds, tofu, grains, beans, lentils, peas, soy, and tempeh.
PROTEIN CONTENT IN COMMON FOODS
EGGS, MEAT, POULTRY, SEAFOOD*
NUTS AND SEEDS**
LEGUMES AND VEGETABLES***
CEREAL, BREADS, AND GRAINS
DAIRY, SOY, NONDAIRY MILK BEVERAGES
• Beef
• Chicken
• Clams
• Egg (1 large)
• Fish
• Lamb
• Lobster (1.5 oz)
• Pork
• Salmon
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�� Scallops (1.5 oz)
• Shrimp
• Tuna
• Turkey
• Almonds
• Brazil nuts (4g)
• Cashews (5g)
• Chia seeds (5g)
• Flaxseed
• Hazelnuts (4g)
• Macadamia nuts (2g)
• Peanuts (7g)
• Peanut butter (1 tbsp = 7g)
• Pecans (3g)
• Pistachios
• Pumpkin seeds (9g)
• Soy nuts (12g)
• Sunflower seeds
• Walnuts (4g)
• Adzuki beans (9g)
• Asparagus (2g)
• Black beans (8g)
• Black-eyed peas (7g)
• Brussels sprouts (2g)
• Chickpeas (7g)
• Edamame (9g)
• Fava beans (7g)
• Green peas (4g)
• Lentils (9g)
• Lima beans (6g)
• Pinto beans (11g)
• Red kidney beans (8g)
• Spinach (3g)
• Bagel (1 whole = 10g)
• Biscuit (1 whole = 4g)
• Brown rice (1 cup = 5g)
• Corn tortilla (1g)
• Flour tortilla (4g)
• Hamburger bun (1 bun = 4g)
• Macaroni (2 cups = 7g)
• Pancakes (1 (6-inch) = 5g)
• Popcorn (1 oz = 3g)
• Quinoa (4g)
• Spaghetti noodles (1 cup = 8g)
• Waffles (1 (7-inch) = 6g)
• White bread (1 slice = 3g)
• White rice (1 cup = 4g)
• Whole-wheat bread (1 slice = 4g)
• Almond milk (1 cup = 1g)
• Cheese (blue cheese, Cheddar, Gouda, Gruyère, mozzarella, Colby, Swiss) (1 oz = about 7g)
• Cottage cheese (1 oz = 4g)
• Feta cheese (1 oz = 4g)
• Greek yogurt (6 oz = 18g)
• Milk (whole, low-fat, nonfat) (1 cup = 8g)
• Oat milk (1 cup = 4g)
• Parmesan cheese (1 oz = 11g)
• Regular yogurt (1 cup = 11g)
• Rice milk (1 cup = 1g)
• Soy milk (1 cup = 7g)
• String cheese (1 piece = 6g)
*One serving = 1 ounce and provides about 7 grams of protein unless otherwise indicated.
**One serving = 1 ounce and provides about 6 grams of protein unless otherwise indicated.
***One serving = ½ cup cooked unless otherwise indicated. Protein content varies.
Sodium
Sodium is an essential part of our lives and is needed by our bodies to function properly. Sodium helps us regulate blood pressure and maintain fluid balance. Although we need sodium, too much of it is harmful to the kidneys. If you have CKD, your kidneys can’t get rid of the extra sodium or fluid. When these things build up, your blood pressure increases, and you may experience swelling and have difficulty breathing. Too much sodium and fluids in your body can also damage other organs.
Sodium is in almost everything you eat. You need to be especially careful about the amount of sodium you have in your diet. The recommended guidelines for sodium are less than 2,300 mg per day, which is equal to about 1 teaspoon of salt per day.
Avoid eating out whenever possible, since restaurant foods tend to be higher in sodium. Sometimes, something might not taste salty, but it can still be very high in sodium. If you do dine out, ask for sauces and dressings on the side and request no added salt on your food. Check food labels and the serving sizes to make sure you are sticking to your sodium goals. As a general guide, find foods that have 5 percent or less DV of sodium or <140 mg of sodium.
SODIUM CONTENT IN COMMON FOODS
AVOID/LIMIT
CHOOSE
Vegetables
Canned or frozen vegetables that are seasoned or sauced, pickled or fermented vegetables
Fresh or frozen vegetables that are not pre-seasoned or pre-sauced, unsalted or low-sodium canned vegetables
Fruit
Canned in syrup
Fresh or frozen
Breads, Cereals, Starches
Instant hot cereals, quick breads, premade pancake/waffle/bread mixes, salted crackers/chips
Rice, pasta, grain box mixes that are pre-seasoned or come with a seasoning packet
Instant noodles
Make your own breads at home or buy from the bakery section—choose items that have a lower sodium content
Plain rice, pasta, noodles, grains
Dairy
Processed cheeses, cheese spreads, buttermilk, instant pudding mix
Low-sodium cheese, milk, yogurt
Meat, Fish, Poultry
Cured meats, deli lunch meats, canned meats, bacon, sausages, corned beef, hot dogs, Spam
Fresh meat, fish, poultry, low- or no-sodium deli meats (can usually be found at the deli counter)
Snack Foods
Salted chips, crackers, popcorn, pretzels, pumpkin or sunflower seeds
Unsalted chips, crackers, popcorn, pretzels, seeds
Herbs and Seasonings
Salts (table/kosher/sea/Himalayan/flavored), MSG
No-salt seasonings (Mrs. Dash, Chef Paul Prudhomme) lemon, basil, oregano, parsley, turmeric, onion powder, garlic powder, cayenne pepper, black pepper, etc.
Sauces and Marinades
Salad dressings, barbecue sauce, ketchup, soy sauce, steak sauce, teriyaki sauce
No-salt-added sauces, marinades, and salad dressings (try making your own at home), lemon juice, mustard, Siete hot sauce, vinegar
Canned and Frozen Packaged Foods
Avoid all types of regular canned foods and frozen packaged meals
Low or no-salt-added canned goods; make big batches of recipes at home and freeze in appropriate portions for your own frozen meals
Potassium
Potassium is a mineral that helps keep our heartbeat regular and our muscles contracting properly. The kidneys play a role in making sure that we have the right amount of potassium in our bodies. With CKD, you may not be able to maintain proper potassium balance. Having too much or too little potassium can cause serious heart complications. Potassium is measured by a blood test; a normal blood potassium level is between 3.5 and 5.0 mEq/L. Though you may have CKD, you may or may not need to restrict your potassium intake. Your healthcare practitioner will review your labs to determine your potassium needs. Do not restrict unnecessarily, because there are complications that can occur if you don’t have enough potassium in your diet. Foods that are high in potassium are also high in fiber, vitamins, minerals, and other nutrients we need. Potassium is mostly found in fruits, vegetables, legumes, nuts, meats, and dairy products. You may even find potassium in some salt substitutes, so be careful if you need to limit your intake.
POTASSIUM CONTENT IN COMMON FOODS*
LOW POTASSIUM
(<200 mg/serving)
HIGH POTASSIUM
(<200 mg/serving)
Fruits
Vegetables
Other Foods
Fruits
Vegetables
Other Foods
• Apple (1 medium)
• Applesauce
• Blackberries
• Blueberries
• Cherries
• Cranberries
• Grapes
• Grapefruit
• Lemon/lime
• Mandarin oranges
• Alfalfa sprouts
• Asparagus (6 raw medium spears)
• Beans, green or wax
• Broccoli
• Cabbage
• Carrots
• Cauliflower
• Celery
• Cookies without nuts or chocolate
• Noodles
• Pasta
• Pies without chocolate or high-potassium fruits
• Rice
• Apricot, raw (2 medium), d
ried (5 halves)
• Avocado (½ whole)
• Banana (½ whole)
• Cantaloupe
• Coconut (1 cup)
• Dates (5 whole)
• Dried fruits
• Acorn squash
• Artichoke
• Baked beans
• Bamboo shoots
• Beet greens
• Beets
• Black beans
• Broccoli, cooked
• Bok choy
• Bran/bran products
• Chocolate (2 ounces)
• Granola
• Milk (1 cup)
• Molasses (1 tablespoon)
• Nuts and seeds
• Peanut butter (2 tablespoons)
• Salt substitutes
• Yogurt
• Peaches, fresh (1 small), canned (½ cup)
• Pears, fresh (1 small); canned (½ cup)
• Pineapple
• Plums (1 whole)
• Raspberries
• Strawberries
• Tangerine (1 whole)
• Watermelon (limit to 1 cup max)
• Corn (½ ear fresh, ½ cup frozen)
• Cucumber
• Eggplant
• Green peas
• Kale
• Lettuce
• Leeks
• Mustard
• Parsley
• Peppers
• Radish
• Rhubarb
• Scallions
• Spaghetti squash
• Spinach, raw
• Water chestnuts, canned
• Yellow squash
• Zucchini
• Grapefruit juice
• Honeydew
• Kiwi (1 medium)
• Mango (1 medium)
• Orange (1 medium)
• Orange juice
• Papaya (½ whole)
• Pomegranate (1 whole)
• Pomegranate juice
• Prunes
• Prune juice
Renal Diet Cookbook for Beginners: 75 Simple Recipes to Help Manage Chronic Kidney Disease Page 2
