By Gail Kessler, retired dietitian, RKDF Volunteer, rarekidney.org
Nutritional health is important for anyone with kidney disease as it may slow the progression of the disease and delay the need for dialysis or kidney transplant, prevent the necessity for additional medication, and prevent side effects that may seriously harm general health and well being. A consultation with a registered dietitian/nutritionist who specializes in kidney disease is advised. If your physician has not referred you to one, ask for a referral. In the US, Medicare Part B covers medical nutrition therapy for diabetes and kidney disease if your doctor refers you for services. Some, but not all private insurance companies do as well. My husband, Dan, was diagnosed with ADTKD-UMOD in 2004, although he’d had declining kidney function for a few years prior to that. I was a dietitian and although I didn’t specialize in kidney disease I had trained and worked in a hospital that had a dialysis unit and could easily access sources of information. I am no longer a registered dietitian but I feel strongly that a nutritional plan based on each person’s individual needs should be obtained from a registered dietitian/nutritionist. The following information can be found at the National Kidney Foundation website, kidney.org and The National Institute of Diabetes and Kidney Diseases website, niddk.nih.gov
The chronic kidney disease diet does not need to be overly restrictive. The general recommendations are to decrease sodium intake, eat a moderate amount of protein, lower intake of fat, particularly saturated fats and trans fats, and lower intake of phosphorus and potassium. Vitamin and mineral supplements may be necessary but should be prescribed by your nephrologist. I feel strongly that highly processed foods should be avoided. They are often higher in sodium, fat, sugar, and additives. Read the food labels and opt for the foods lower in sodium, fat, and added sugar. Reading these can be tricky so ask your dietitian for help if necessary.
My husband’s diet was moderate in sodium as his blood pressure was under good control until he needed to be on the transplant list. He ate a moderate amount of protein. Protein intake, which usually consisted of chicken, turkey, and fish and low in red meat, was eaten at lunch and supper and serving sizes were three to four ounces. I don’t tolerate eggs so we never ate a lot of eggs. Dairy in the form of milk, cheese, and yogurt was limited because it is high in phosphorus and he had to watch his phosphorus levels. He did not eat a lot of beans, lentils, or nuts as these are high in phosphorus as well. He stopped drinking colas and beer and switched to Diet Mountain Dew and wine. To control his potassium levels he stopped drinking orange juice and switched to 1/2 cup of 100% apple juice or cranberry juice in the morning and stopped eating bananas and oranges. He ate fruits and vegetables that were lower in potassium but still ate whole grains like oatmeal, whole grain bread, and rice. Once in a while his blood phosphorus or potassium levels would be slightly elevated but he could lower them by being a little more restrictive with his diet and never needed medication to help lower his blood levels. He avoided fried foods and he was already avoiding red meat, dairy products, eggs, and processed foods so he was mostly able to avoid saturated fats as well. He took an over the counter multivitamin in order to obtain the increased water soluble vitamins needed for CKD patients but we made sure it didn’t contain excessive potassium or phosphorus and he let his doctor know what he was taking. He was anemic but was never prescribed iron or medication. The doctor monitored his calcium and vitamin D levels and prescribed the appropriate medication when needed.
Besides watching his nutrition Dan walked daily, never smoked, was adherent to his medication, saw his doctors regularly including the dentist, and watched his weight. He was placed on the kidney transplant list in 2020, was never on dialysis, and received a kidney transplant January 4, 2022, three months before his 70th birthday. He’s doing great!
By Gail Kessler, retired dietitian, RKDF Volunteer, rarekidney.org