NUTRITIONAL NEEDS BY STAGE
CKD STAGE
PROTEIN
SODIUM
PHOSPHORUS
POTASSIUM
Stage 1–2
0.8–1.2 grams of protein per kilogram of ideal body weight (see chart here)
<2,300mg
Maintain a blood phosphorus level that is within the normal range
Maintain a blood potassium level that is within the normal range
Stage 3
0.55–0.6 grams of protein per kilogram of ideal body weight
Protein needs may vary depending on your personal needs/goals—talk to your dietitian and nephrologist about what is right for you
<2,300mg
Sodium needs may vary depending on your personal needs/goals—talk to your dietitian and nephrologist about what is right for you
Maintain a blood phosphorus level that is within the normal range
Based on your labs, you may need to restrict phosphorus to 800–1000 mg/day
Maintain a blood potassium level that is within the normal range
Based on your labs, you may need to adjust your potassium intake—talk to your dietitian and nephrologist about what is right for you
Stage 4
*Stage 5 (non-dialysis)
*Stage 5 (non-dialysis): The nutrition needs at this stage are very specific and must be tailored to the unique individual. A thorough evaluation by your renal dietitian is recommended to create a personal plan of care.
For Diabetes: If you have diabetes and CKD, your protein needs can be slightly higher at 0.8 to 0.9 grams of protein per kilogram of body weight. Diabetics have an increased protein requirement to help with blood sugar control.
Example: For a 5-foot-2-inch-tall woman with stage 3 CKD, the estimated ideal body weight is 50 kilograms. You would estimate your daily protein needs by multiplying 0.55 grams of protein by 50 kilograms: 0.55 grams of protein x 50 kilograms = 27.5 grams of protein per day.
IDEAL BODY WEIGHT
MALE
FEMALE
HEIGHT
IBW (KG)
HEIGHT
IBW (KG)
5 ft
48
4 ft 10
41
5 ft 1
51
4 ft 11
43
5 ft 2
54
5 ft
45
5 ft 3
56
5 ft 1
48
5 ft 4
59
5 ft 2
50
5 ft 5
62
5 ft 3
52
5 ft 6
65
5 ft 4
55
5 ft 7
67
5 ft 5
57
5 ft 8
70
5 ft 6
59
5 ft 9
73
5 ft 7
61
5 ft 10
75
5 ft 8
64
5 ft 11
78
5 ft 9
66
6 ft
81
5 ft 10
68
6 ft 1
84
5 ft 11
70
6 ft 2
86
6 ft
73
6 ft 3
89
6 ft 4
92
The weights listed in this table provide a quick estimate of your lean body mass. Your ideal body weight may be higher or lower than the weight listed in this table. Many factors go into determining an individual’s ideal body weight, and so you should consult your HCP for more specific guidance.
Personalizing Your Nutrition
As I’ve mentioned many times throughout this chapter, every person is unique and may have different nutrition requirements. Be proactive in your care and work closely with your nephrologist and renal dietitian to find out what your specific needs/goals should be to help you manage CKD. Use this chart to keep track of your needs and any special components you need to make note of.
NUTRIENT
MY NEEDS/GOALS
NOTES
Protein
Example: 5-foot 2-inch woman with stage 3 CKD
27.5 grams of protein per day
Limit animal proteins
Sodium
Potassium
Phosphorus
Carbohydrates
Fats
Vitamins/Minerals
Blood Sugar
Blood Pressure
2
Cooking Basics
Cooking doesn’t have to be difficult and once you learn the basics, you will find that cooking can be easy and fun. The recipes in this book are perfect for beginners and don’t require any fancy equipment, extensive skills, or training. With a bit of planning and preparing, you can easily master a variety of different recipes and techniques.
Getting Started
The first step is to read the recipe entirely before you start cooking to prevent making any mistakes while cooking or baking. When reading, take note of what ingredients or equipment you might need. You will also want to take note of the preparation time and recipe yield (does it make enough, or do you need to double or halve it?). I find it helpful to read through a recipe twice: first to check if the recipe meets my needs, and second to prepare all my ingredients and arrange them in order to be more efficient when cooking starts.
The most important tips are to have fun and be confident. Cooking can be an enjoyable and therapeutic activity for you and your family. Don’t be afraid of trying new things and experimenting with different tastes and flavors!
Essential Kitchen Tools
Before beginning any cooking adventure, you need to have the proper equipment so that you can seamlessly prepare your meals and snacks. Kitchen tools don’t have to be fancy; you can find many products at affordable prices in stores or online. Beyond the basics like a can opener, spatula, and whisk, you will need:
Baking sheets: A necessity for baking and roasting. These are used in many savory and sweet recipes.
Blender or food processor: These are great to have on hand to help chop, blend, puree, and mix things together. You can also use them to create different types of flours to make cooking simpler.
Cake pans: Despite its name, a cake pan isn’t just for baking cakes. It can be used to make casseroles and lasagnas as well. I suggest having a square one (9-by-9 inch) and a rectangular one (13-by-9 inch).
Colander: This tool is used for draining pasta and rice; I also use it for washing and draining fruits and vegetables.
Cooking pans or skillets: Cast iron, nonstick, or stainless steel are great options for cookware. You will want to have at least two different sizes, one medium (10-inch) and one large (12-inch). These are used for searing, sautéing, and frying.
Cutting board: This is used for chopping fruits, vegetables, and meats. I prefer color-coded ones so that I avoid any cross contamination with raw meats and fresh fruits and vegetables.
Knife set: A good-quality knife set is important to have in every kitchen. Knife sets can be pricey, but you can get away with just having a chef’s knife. However, I recommend starting out with at least three knives: a chef’s knife, a paring knife, and a serrated knife.
Measuring cups and spoons: These are used to measure out ingredients in recipes, but are also useful for portioning out foods to ensure you are staying within your nutrient goals and not over- or undereating.
Measuring scale: A food scale is needed to measure and portion your food more precisely. These can typically measure in grams and ounces. You’ll notice the recipes include precise measurements for many ingredients, so investing in a scale is paramount for those with CKD.
Mixing bowls: These are important to help you prepare your ingredients. I prefer to buy the nested versions to save space a
nd have a wide variety of sizes to work with.
Peeler: These are easy to use for peeling fruits and vegetables. While I typically encourage clients to keep peels and skins on fruits and veggies for extra fiber and nutrients, some recipes require you to remove them.
Saucepan: A smaller 3-quart saucepan is great for making sauces and when you don’t necessarily need to make large quantities of food.
Stock or soup pot: A 6-quart pot is a good size to have. You can use stock or soup pots to make soups, stews, and stocks, boil pasta or rice, and cook many one-pot meals.
Nice-to-Have Kitchen Tools
Air fryer: An air fryer is similar to a convection oven; it uses hot air on rapid circulation to cook food quickly and make it crispy. It is super easy to clean up as well. An air fryer can cook almost anything, and it prepares food in a way that uses less fat than traditional frying methods.
Mandoline: This easy to use and affordable tool is great to have to make chopping, slicing, and grating easier. It also can help with making food more eye-catching, since you can slice things uniformly for better presentation.
Multifunction cooker: This tool can act as a pressure cooker, sauté pan, steamer, slow cooker, and an air fryer. This is useful for smaller kitchens, because you can just have one appliance on your counter versus five different ones.
Pressure cooker or slow cooker: Pressure cookers can cook food quickly, usually in less than half the time it would take on the stove or in the oven. Slow cookers cook foods slowly on lower heat and are great for busy days as well. You can toss all your ingredients in, leave the cooker to do its thing, and your meal can be ready when you return.
But What Should I Eat?
As I mentioned before, there is no one-size-fits-all approach to nutrition with CKD. Every person will have different needs and restrictions. Depending on your specific needs, you may want to keep those charts from chapter 1 handy to ensure that you are staying within your nutrient goals. While the renal diet may seem complicated, knowing what you can and can’t eat is crucial for your success.
Foods to Enjoy
Fruits and vegetables: Eating a variety of colorful fruits and vegetables will provide you with a balanced number of vitamins, minerals, and antioxidants. Unless you need to restrict potassium, all fruits and vegetables, fresh and frozen, can be part of a healthy diet.
Whole grains: Whole-grain foods are high in nutrients, packed with fiber, and can help combat many health conditions such as CKD, diabetes, and heart disease. Try to make half of your grain intake whole grains, which include amaranth; barley; brown and wild rice; buckwheat; oatmeal; popcorn; quinoa; and whole-grain breads, tortillas, and crackers.
Plant-based proteins: These types of proteins are easier on your kidneys and provide you with essential nutrients and fiber and include beans and legumes, nuts and seeds, soy, tempeh, and tofu. Dried, canned, or fresh are all great options but be mindful of sodium content and try to choose those that are low-sodium or no-salt-added.
Other: Coffee, tea, water, and unsweetened beverages; eggs; olive and avocado oils and vinegar; and spices and seasonings are also included in a healthy renal diet.
Foods to Limit or Avoid
The following foods should be avoided or at least limited to being consumed less than once a week.
Animal proteins: Though these types of proteins are considered high nutritional value, they are more taxing on your kidneys to metabolize and produce more wastes. It is best to limit your intake of animal proteins like beef, pork, poultry, and lamb, to less than once per week to protect your kidneys. For fish and seafood, limit intake to two times or less per week.
Highly processed, convenience foods: These types of foods are often packed with added sodium, sugars, and additives that can be hard on the kidneys.
• Food with saturated fats (bacon fat, margarine)
• High-sodium processed meats (bacon, bologna, pastrami, corned beef, hot dogs)
• Pickles, olives, and relish
• Premade seasonings, sauces, dressings, and marinades
• Salty processed chips and snacks
• Sodium-rich canned foods (sauces, marinades, soups)
Foods with added sugars: It is recommended that adults limit their added sugar intake to less than 10 percent of total calorie intake. Added sugar is not to be confused with sugar that naturally occurs in foods such as fruits. Added sugars are those that are put in foods during processing. Eating too much added sugar can increase your risk of heart disease and cause weight gain. Avoid dessert foods like ice cream, cookies, and candies, and juices and sodas (including diet sodas) on a renal diet.
Reading Nutrition Labels
Reading food labels is crucial to your success on the renal-friendly diet, because they give you key information that you need to keep track of your nutrient intake.
A Serving Size: Pay attention to how much is in a serving. The nutrition facts listed is per serving. Most people will eat more than 1 serving so it is important to know how much you are really consuming.
B Calories: The number of calories is listed per serving.
C Sodium: Most people with CKD will want to control their intake of sodium. Try to find products with less than 5 percent DV of sodium, less than 140 mg, or a sodium amount that is less than the number of calories.
D Carbohydrates: If you are diabetic and need to control your carbohydrate intake, pay close attention to the total carbohydrates listed on the label. Most people will only look at the total sugars, but all carbohydrates break down into sugar in your body.
E Protein: The CKD stage you are at will determine what your protein goals are. Be mindful of this number if you are on a low-protein diet.
F Potassium: This nutrient has recently been added as a required listing on the nutrition facts label. If you need to limit your intake, then pay close attention to what is listed.
Phosphorus: This is not required to be on a food label. However, if you need to control your phosphorus intake, then you will want to pay attention to the ingredients list on the food package and look for phosphate additives. Look for words that contain “phos” in them, such as monocalcium phosphate, phosphoric acid, and trisodium phosphate.
Different brands of products will have varying nutrition profiles due to differences in ingredients. When choosing between products, remember to read food labels and compare to choose the best item for you and your dietary needs.
Cooking (and Eating) In the Real World
Now that you have a good understanding of the renal diet, it’s time to learn how to apply these guidelines in the real world. I can give you all the information you want, but it’s how you apply it to your life that will be the key to your success. In the real world, you won’t always be eating at home; there will be times when you have family or social gatherings, work functions, or you simply just want to enjoy a meal dining out. These are all okay, and I encourage you to enjoy these events while still keeping in mind your dietary needs.
Cooking for the Whole Family
Many of the recipes in this book can appeal to all members of the family. What I find is the most difficult for most families to adapt to is the decrease in sodium. The best way to make sure all family members can enjoy the same foods is by offering different ways to customize with a toppings bar. Allow others to add more salt, herbs and seasonings of their choice, scallions, sour cream or Greek yogurt, sauces, etc. to their food.
The protein portions of the recipes are likely lower than what most family members need, but this can be easily remedied by cooking more protein for other members of the family.
Three Strategies for Eating Out
Dining out can still be an enjoyable experience while following a CKD-friendly diet. It’s important for you to fully understand your diet, so that you can make conscious choices when eating out and continue to stick to your diet.
1. If possible, plan ahead. Before heading to or while you are waiting at the restaurant, look up the menu so that you are aware
of what is available and what you can have on your diet. Don’t be afraid to ask questions—you may want to know how something is prepared, what it is cooked in, or what sauces are used.
2. Pay attention to protein portions. The typical restaurant portions for all macronutrients are usually more than the average person needs. Be sure to portion out your food prior to eating to avoid going over your daily allowances. Try sharing a meal with someone else or packing up the extra before digging in.
3. Order a la carte. Sometimes it’s better to order items a la carte instead of as a meal, since these are usually served without extra sauces or seasonings. You can also ask for sauces or dressings on the side and request that no salt be added to your meal.
If you have any questions, be sure to talk to your dietitian. They should be able to help further guide you and individualize your specific dining-out needs.
Handling Slipups
Sometimes you might get carried away by the enjoyment of eating out with family, friends, or colleagues, or maybe you just indulged a little bit too much. One little slipup isn’t going to make everything come crashing down. What’s important is that on most days, you are sticking to your diet. Don’t overwhelm yourself with guilt or worry; instead, just get back on track at the next meal or snack. Remember to give yourself some grace, as this diet can be overwhelming and sometimes you might not be able to stick to it 100 percent.
About the Recipes
The recipes in this book are designed to make the renal diet easy by providing you with quick, simple, and delicious meals that lean on affordable and accessible ingredients. Most of the recipes are appropriate for all stages of CKD. For those with advanced CKD (stage 4 or 5), many of the recipes can be modified or adjusted; however, the nutritional needs of those with advanced CKD are very specific and must be tailored to the individual. Consult with your renal dietitian for a personal plan of care.
Renal Diet Cookbook for Beginners: 75 Simple Recipes to Help Manage Chronic Kidney Disease Page 4
