what diet is best for stage 4 kidney disease

Eating Right for Chronic Kidney Disease

You may need to change what you eat to manage your chronic kidney disease (CKD). Work with a registered dietitian to develop a meal plan that includes foods that you enjoy eating while maintaining your kidney health.

The steps below will help you eat right as you manage your kidney disease. The first three steps (1-3) are important for all people with kidney disease. The last two steps (4-5) may become important as your kidney function goes down.

The first steps to eating right

Step 1: Choose and prepare foods with less salt and sodium

Why? To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.

• Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the supermarket or at restaurants.
• Cook foods from scratch instead of eating prepared foods, fast foods, frozen dinners, and canned foods that are higher in sodium. When you prepare your own food, you control what goes into it.
• Use spices, herbs, and sodium-free seasonings in place of salt.
• Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the food is high in sodium.
• Try lower-sodium versions of frozen dinners and other convenience foods.
• Rinse canned vegetables, beans, meats, and fish with water before eating.

Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly salted.

Step 2: Eat the right amount and the right types of protein

Why? To help protect your kidneys. When your body uses protein, it produces waste. Your kidneys remove this waste. Eating more protein than you need may make your kidneys work harder.

• Eat small portions of protein foods.
• Protein is found in foods from plants and animals. Most people eat both types of protein. Talk to your dietitian about how to choose the right combination of protein foods for you.

Animal-protein foods:

• Chicken
• Fish
• Meat
• Eggs
• Dairy

A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards. A portion of dairy foods is cup of milk or yogurt, or one slice of cheese.

Plant-protein foods:

A portion of cooked beans is about cup, and a portion of nuts is cup. A portion of bread is a single slice, and a portion of cooked rice or cooked noodles is cup.

Step 3: Choose foods that are healthy for your heart

Why? To help keep fat from building up in your blood vessels, heart, and kidneys.

• Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
• Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
• Trim fat from meat and remove skin from poultry before eating.
• Try to limit saturated and trans fats. Read the food label.

Heart-healthy foods:

• Lean cuts of meat, such as loin or round
• Poultry without the skin
• Fish
• Beans
• Vegetables
• Fruits
• Low-fat or fat-free milk, yogurt, and cheese

Learn more about heart-healthy eating.

Limit alcoholDrink alcohol only in moderation: no more than one drink per day if you are a woman, and no more than two if you are a man. Drinking too much alcohol can damage the liver, heart, and brain and cause serious health problems. Ask your health care provider how much alcohol you can drink safely.

The next steps to eating right

As your kidney function goes down, you may need to eat foods with less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan. More information is provided in the NIDDK health topic, Nutrition for Advanced Chronic Kidney Disease.

Step 4: Choose foods and drinks with less phosphorus

Why? To help protect your bones and blood vessels. When you have CKD, phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.

• Many packaged foods have added phosphorus. Look for phosphorusor for words with PHOSon ingredient labels.
• Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.

Foods Lower in Phosphorus Fresh fruits and vegetables Breads, pasta, rice Rice milk (not enriched) Corn and rice cereals Light-colored sodas/pop, such as lemon-lime or homemade iced tea

Foods Higher in Phosphorus Meat, poultry, fish Bran cereals and oatmeal Dairy foods Beans, lentils, nuts Dark-colored sodas/pop, fruit punch, some bottled or canned iced teas that have added phosphorus

Your health care provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood. A phosphate binder is a medicine that acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into your blood. Instead, your body removes the phosphorus through your stool.

Step 5: Choose foods with the right amount of potassium

Why? To help your nerves and muscles work the right way. Problems can occur when blood potassium levels are too high or too low. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Your food and drink choices can help you lower your potassium level, if needed.

• Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt substitutes.
• Drain canned fruits and vegetables before eating.

Foods Lower in Potassium Apples, peaches Carrots, green beans White bread and pasta White rice Rice milk (not enriched) Cooked rice and wheat cereals, grits Apple, grape, or cranberry juice

Foods Higher in Potassium Oranges, bananas, and orange juice Potatoes, tomatoes Brown and wild rice Bran cereals Dairy foods Whole-wheat bread and pasta Beans and nuts

Some medicines also can raise your potassium level. Your health care provider may adjust the medicines you take.

View tips for people with chronic kidney disease:

The 20 Best Foods for People with Kidney Disease

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If you have kidney disease, you may need to follow a special diet, usually low in sodium, phosphorus, and potassium. This may not heal your kidneys, but it can help make them healthier.

When your kidneys arent working properly, waste builds up in the blood, including waste products from food. People with kidney disease can benefit from following a special diet known as a renal diet.

Here, we look at 20 of the best foods for people with kidney disease.

Dietary restrictions vary depending on the level of kidney damage. People with later-stage kidney disease will have different restrictions from those with early kidney disease.

At any stage, the diet will need to boost kidney function while lowering the risk of further damage.

While dietary restrictions vary, people with kidney disease typically need to restrict the following nutrients. The kidneys may have difficulty removing or processing these nutrients, and high levels can cause damage to the body.

Since kidney disease has close links with heart disease, its best to combine these choices with a heart-healthy diet one that contains plenty of fresh, plant-based foods and is low in saturated fats.

Everyones experience of kidney disease varies, so its important to talk with a doctor about your individual dietary needs.

Here are 20 foods that may improve kidney health or prevent it from worsening:

Cauliflower provides many nutrients, including vitamin K, folate, and fiber. It also contains antioxidants and anti-inflammatory compounds.

Try mashed cauliflower in place of potato for a low potassium side dish.

One-half cup or about 62 grams (g) of boiled cauliflower without salt contains:

• sodium: 9.3 milligrams (mg)
• potassium: 88 mg
• phosphorus: 20 mg
• protein: 1 g

Blueberries are rich in nutrients and antioxidants known as anthocyanins, which may protect against heart disease, diabetes, and other diseases.

Theyre also low in sodium, phosphorus, and potassium.

One cup (148 g) of fresh blueberries contains:

• sodium: 1.5 mg
• potassium: 114 mg
• phosphorus: 18 mg
• protein: 1 g

Sea bass is a fish option that provides high quality protein. It also contains healthy fats called omega-3s. Omega-3s may help prevent a range of diseases and boost the health of those living with long-term conditions.

Three ounces (85 g) of cooked sea bass contains:

• sodium: 74 mg
• potassium: 279 mg
• phosphorus: 211 mg
• protein: 20 g

However, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends eating small portions of meat or fish, as high protein levels can make the kidneys work harder.

One portion is 23 ounces of chicken, fish, or meat, or a piece around the size of a deck of cards.

Red grapes are a good source of antioxidants called flavonoids, which may help reduce inflammation and protect against heart disease, diabetes, and other health conditions.

One half-cup (75 g) of red grapes contains:

• sodium: 1.5 mg
• potassium: 144 mg
• phosphorus: 15 mg
• protein: 0.5 g

Egg whites provide a high quality, kidney-friendly source of protein that is low in phosphorus.

Egg whites may be a better choice than whole eggs for people on a renal diet, as egg yolks can be high in phosphorus.

Two large, raw egg whites (66 g) contain:

• sodium: 110 mg
• potassium: 108 mg
• phosphorus: 10 mg
• protein: 7 g

Garlic provides a tasty alternative to salt, adding flavor to dishes while also providing nutritional benefits.

Its a good source of manganese and vitamin B6. It also contains sulfur compounds with anti-inflammatory properties.

Three cloves (9 g) of garlic contain:

• sodium: 1.5 mg
• potassium: 36 mg
• phosphorus: 14 mg
• protein: 0.5 g

Buckwheat is a whole grain thats low in potassium. It also contains B vitamins, magnesium, iron, and fiber.

Its also gluten-free, making it suitable for people with celiac disease or gluten intolerance.

A half cup (85 g) of buckwheat contains:

• sodium: 0.8 mg
• potassium: 391 mg
• phosphorus: 295 mg
• protein: 11 g

Olive oil is a healthy source of vitamin E and mostly unsaturated fat. Its also phosphorus-free, making it a suitable option for people with kidney disease.

Most of the fat in olive oil is oleic acid, which has anti-inflammatory properties.

Whats more, monounsaturated fats are stable at high temperatures, making olive oil a healthy choice for cooking.

One tablespoon (14 g) of olive oil contains:

• sodium: 0.3 mg
• potassium: 0.1 mg
• phosphorus: 0 mg
• protein: 0 g

Bulgur is a whole grain wheat product and a kidney-friendly alternative to other whole grains that are higher in potassium and phosphorus.

Bulgur provides B vitamins, magnesium, and iron, as well as plant-based protein and fiber, which is important for digestive health.

A half-cup (70 g) serving of cooked bulgur contains:

• sodium: 154 mg
• potassium: 48 mg
• phosphorus: 28 mg
• protein: 2 g

Cabbage belongs to the cruciferous vegetable family and provides vitamins, minerals, and antioxidant compounds.

The authors of a 2021 study note that white, green, and red cabbage can help:

• manage blood sugar
• reduce the risk of kidney and liver damage
• prevent oxidative stress and obesity

A cup (70 g) of shredded savoy cabbage contains:

• sodium: 20 mg
• potassium: 161 mg
• phosphorus: 29 mg
• protein: 1.4 g

Skinless chicken breast has less fat and phosphorus than chicken with the skin on.

One cup (140 g) of cooked, skinless chicken breast contains:

• sodium: 104 mg
• potassium: 358 mg
• phosphorus: 319 mg
• protein: 43 g

NIDDK advises people with kidney disease to limit portions of meat and fish to 23 ounces, as high protein levels can make your kidneys work harder.

Bell peppers are high in vitamins A and C and other antioxidants but low in potassium.

These nutrients are important for immune function, which is closely linked with kidney disease.

One medium red pepper (100 g) contains:

• sodium: less than 2.5 mg
• potassium: 213 mg
• phosphorus: 27 mg
• protein: 1 g

Reducing salt can be challenging, but onions are one way of providing sodium-free flavor to renal diet dishes.

Sauting onions with garlic, olive oil, and herbs can add flavor to dishes without compromising your kidney health.

Onions provide vitamin C, manganese, and B vitamins, including folate. They also contain prebiotic fibers that help keep your digestive system healthy by feeding beneficial gut bacteria.

One small onion (70 g) contains:

• sodium: 3 mg
• potassium: 102 mg
• phosphorus: 20 mg
• protein: 0.8 g

Arugula is a flavorful and nutrient-dense green that is low in potassium, making it a good choice for kidney-friendly salads and side dishes.

Arugula provides vitamin K, manganese, and calcium, all of which are important for bone health.

This nutritious green also contains nitrates, which can lower blood pressure an important benefit for those with kidney disease.

One cup (20 g) of raw arugula contains:

• sodium: 5 mg
• potassium: 74 mg
• phosphorus: 10 mg
• protein: 0.5 g

Most nuts are high in phosphorus and are not suitable if youre following a renal diet.

But macadamia nuts are a delicious option for people with kidney problems. Theyre lower in potassium and phosphorus than peanuts or almonds.

They also provide calcium, healthy fats, folate, magnesium, copper, iron, and manganese.

One ounce (28 g) of macadamia nuts contains:

• sodium: 1.4 mg
• potassium: 104 mg
• phosphorus: 53 mg
• protein: 2 g

Radishes are crunchy vegetables that make a nutritious addition to a renal diet. Theyre very low in potassium and phosphorus but contain other important nutrients, such as folate and vitamin A.

Their peppery taste makes a flavorful addition to low sodium dishes.

A half cup (58 g) of sliced radishes contains:

• sodium: 23 mg
• potassium: 135 mg
• phosphorus: 12 mg
• protein: 0.4 g

Turnips are root vegetables that provide fiber, vitamin C, vitamin B6, and manganese.

They can be roasted or boiled and mashed for a healthy side dish that works well for a renal diet. Alternatively, serve raw, grated turnips with a salad or add them to a winter stew.

A half-cup (80 g) of cooked turnip cubes contains:

• sodium: 160 mg
• potassium: 159 mg
• phosphorus: 22 mg
• protein: 1 g

Pineapple can make a sweet treat for people with kidney conditions. Its lower in phosphorus, potassium, and sodium than oranges, bananas, or kiwis.

Pineapple is also a good source of fiber and vitamin A, and it contains bromelain, an enzyme that may help reduce inflammation.

One cup (165 g) of pineapple chunks contains:

• sodium: 2 mg
• potassium: 180 mg
• phosphorus: 13 mg
• protein: 1 g

Cranberries contain phytonutrients called A-type proanthocyanidins. These are antioxidants that may prevent urinary tract and kidney infections by reducing bacteria levels in urine.

Cranberries are also low in potassium, phosphorus, and sodium.

There are close links between urinary tract infections (UTI) and kidney infections, and a UTI can lead to kidney complications.

You can eat cranberries dried, cooked, fresh, or as a juice.

One cup (100 g) of whole, fresh cranberries contains:

• sodium: 2 mg
• potassium: 80 mg
• phosphorus: 11 mg
• protein: 0.5 g

Shiitake mushrooms are a savory ingredient that you can use as a plant-based meat substitute. Theyre suitable for people with kidney disease who follow a plant-based diet and anyone on a renal diet who needs to limit their protein intake.

Theyre an excellent source of B vitamins, copper, manganese, and selenium. They also provide a good amount of plant-based protein and dietary fiber.

Shiitake mushrooms are lower in potassium, sodium, and phosphorus than portabella and white button mushrooms, making them a good choice if youre following a renal diet.

One cup (145 g) of cooked shiitake mushroom pieces without added salt contains:

• sodium: 6 mg
• potassium: 170 mg
• phosphorus: 42 mg
• protein: 2 g

What is the best diet for kidney disease and kidney failure?

It may not be possible to heal your kidneys, but according to the National Institute of Diabetes and Digestive and Kidney Diseases, it may be possible to manage your kidney disease with dietary changes such as:

How can I make my kidneys stronger again?

The National Kidney Foundation recommends the following to help keep your kidneys healthy:

• manage high blood pressure levels
• maintain ideal blood sugar levels
• avoid eating too much protein
• lower your salt intake
• avoid nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin), aspirin, and naproxen (Naprosyn)
• get your annual flu shot

What is the best drink for healthy kidneys?

Water is the best option as it flushes out the kidneys without adding stress due to toxins. Theres also growing evidence that drinking plain water may help prevent kidney disease.

Unsweetened cranberry juice is also a good option, as it contains antioxidants that may help protect the kidneys from infections. You might also try rice milk thats not enriched with potassium or phosphorus.

Limit or avoid alcohol, as this can increase your chances of developing several health problems.

What are 10 foods that are bad for the kidneys?

Foods to avoid if you have kidney disease are mainly those that are high in sodium, phosphorus, or both.

Here are some items to avoid or limit:

• processed foods or premade meals, which tend to have added sodium
• canned foods with added salt opt for salt-free or rinse them before using them
• large portions of protein foods, such as meat or dairy foods
• high fat items and any food thats not heart healthy
• alcohol
• packaged foods with labels that have PHOS on them (standing for phosphorus)
• deli meats
• bran cereals and oatmeal

Learn more about which foods to avoid if you have kidney disease.

People with kidney disease have to manage their intake of phosphorus, salt, and potassium. At certain stages, they may also need to limit their protein intake.

As nutritional needs and restrictions change during the course of the disease, its best to speak with a doctor before making any dietary changes. They will help you work out a diet suitable for you.

Suitable options may include chicken, shiitake mushrooms, cranberries, macadamia nuts, and a wide range of other tasty and nutritious foods.

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