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Managing Chronic Kidney Disease with Good Nutrition

Good nutrition is a key component in preventing and managing chronic kidney disease (CKD). Making diet changes at the first signs of CKD can prevent further damage and slow the progression of the disease. Hypertension and diabetes are commonly associated with CKD. Controlling hypertension with a low sodium, healthy fat diet can reduce blood pressure which will help reduce stress on the kidneys. Managing diabetes and blood sugars with a balanced, consistent carbohydrate diet will decrease kidney damage. Fortunately, a healthy diet and physical activity can improve hypertension, diabetes, and CKD.  
Managing Chronic Kidney Disease with Good NutritionThere are several nutrition elements to consider when making diet changes for CKD. The first and possibly the most important nutrient to consider is sodium intake. Sodium causes fluid retention in the body and increases blood pressure which then puts extra strain on the kidneys. Sodium is found in all types of salt and used as a food preservative. Choose foods that are low in sodium. When looking at the food label, 200 mg of sodium per serving or less is a good option. Avoid foods that have more than 600 mg per serving. Limit total sodium intake to 1500 mg per day. One teaspoon of salt contains about 2300 mg of sodium. Consider putting the salt shaker away and try sodium free seasonings like Ms. Dash, no salt Tony Chachere's cajun seasoning, different types of peppers and herbs, garlic and onion powders, lemon juice, and other salt free seasonings. Look for low sodium canned good options, unsalted nuts and snack mixes, frozen or fresh vegetables without added salt, and fresh or frozen fruit. Making foods from scratch allows you to control the amount of salt that is added. Regular canned foods, frozen convenience products, broths and soups, boxed foods, snack foods (sweet and savory), cheese, processed and canned meats, and condiments/sauces all tend to be high in sodium. Check the labels on these foods and look for low sodium options. 
Protein is a macronutrient that is necessary for the body to preserve and repair bones, muscle, skin and hair; however, it should be limited in people with CKD to prevent further kidney damage. There are two types of protein - animal and plant-based sources. Reduce meat to 2-3 oz at meals. This would be about the size of a deck of cards. Good sources of animal protein include lean beef, skinless poultry, eggs, fish, lamb, pork loin, and wild game. Limit plant-based proteins to ½ cup or ¼ cup nuts. Plant-based protein sources usually contain carbohydrates which can affect blood sugar and can be high in potassium and phosphorus. Plant-based sources include beans, peas, lentils, nuts, nut butter, tofu and whole grains. 
Micronutrients like potassium and phosphorus levels in the body can be affected by kidney function. Potassium is used to control the muscles and nerves in the body including the heart. If the kidneys are unable to filter enough potassium out of the body, elevated potassium levels can cause the heart to not function properly. Avoid salt substitutes as they usually contain potassium chloride. Focus on fruits and vegetables that are low in potassium - apples, berries, grapes, peaches, pineapple, watermelon, asparagus, green beans, cabbage, carrots, cauliflower, corn, greens, and peppers. Avoid tomatoes, bananas, cantaloupe, orange juice, and dried fruit. Dry rice and pasta are good substitutes for potatoes. Drain and rinse canned vegetables and fruits. 
The kidneys control phosphorus build-up in the body. Elevated levels of phosphorus can cause calcium to leach out of bones which leads to brittle bones and fractures. Phosphorus is added to processed foods. These additives are more harmful to the kidneys than natural sources of phosphorus. Avoid foods with ingredients listed with phos (calcium phosphate, disodium phosphate, phosphoric acid, monopotassium phosphate). This includes dark colas, boxed foods, and many convenience foods.  Limit dairy to one serving per day. Rice milk is the best dairy substitute. 
People with CKD should talk with their doctor about fluid needs since fluid restrictions can be beneficial. Choose sugar-free beverages and avoid alcohol and drinks containing phos ingredients like colas and energy drinks. Focus on having more water than other liquids.
Controlling the intake of these nutrients will allow people suffering from CKD to feel better, control side effects, and delay CKD progression. 
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Libbi Calloway RD, CSOWM, LD
 
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