A Guide to Diet and Chronic Kidney Disease

A Guide to Diet and Chronic Kidney Disease

About this guide
This guide is intended to give an overview of the dietary advice that people with chronic kidney disease may be advised to follow.

The renal dietitian can provide more in-depth information and carry out a dietary assessment, if you or your doctor/nurse think this would be beneficial. Please discuss this with your kidney nurse or doctor who can refer you for a dietetic outpatient appointment.

Possible symptoms of chronic kidney disease
Common features of chronic kidney disease may include poor appetite, taste changes, weight loss, itching and nausea. In some cases it is possible to modify your diet which may help alleviate your symptoms.

It is important to work with your renal team by keeping them up to date with any symptoms you experience.

Why is diet important?
A healthy diet is important for everyone. Making careful food choices is an important part of managing your kidney disease and can help to:

• Control blood pressure
• Maintain safe levels of waste products in the blood
• Reduce symptoms such as nausea
• Prevent weight loss if you have a poor appetite
• Achieve a healthy weight if you are overweight
• Improve blood glucose control
• Control long term issues such as bone and heart disease

Healthy dietary choices that help control your blood pressure, blood glucose levels, and reduce the risk of heart disease may help protect your kidneys.

Does everyone with kidney disease need to follow a ‘kidney diet’?
No, there is no standard ‘kidney diet’. Dietary advice depends on your blood results, appetite, overall nutritional status, medications, your medical plan and stage of kidney disease. Dietary changes may be required depending on your kidney function. You can discuss this with the Renal team or Renal Dietitian.

Salt
Eating less salt is important for everyone, especially if you have high blood pressure or kidney disease. The largest amount of salt in our diets is from the salt that we add at the table, in cooking, and in food manufacturing. Food can sometimes taste bland when you first cut down and it may take weeks for your taste to adjust to less salt.

Tips to reduce your salt intake;

• Use less salt in cooking by trying salt-free flavour boosters, such as pepper, herbs, garlic, ginger, vinegar, and spices.
• Avoid adding salt when cooking food or before eating.
• Reduce the amount of processed foods eaten; they can contain a lot of hidden salt, for example, tinned food, ready meals, processed meats and smoked fish.
• Check food labels when shopping: low salt = 0.3g salt/100g.
• Avoid salty snacks such as crisps, salted nuts, try unsalted varieties or popcorn.
• Avoid ‘salt substitutes’, for example, Lo-Salt. These products can still contain a significant amount of sodium and also contain additional potassium.

Protein
Your body needs protein to build muscle, repair body tissues and fight infections. When your body digests protein it produces a waste substance known as urea. Your kidneys remove urea from your blood. It can be helpful, therefore, to avoid eating large portions of protein to help reduce the amount of urea that your kidneys have to filter. Low protein diets are no longer recommended in the UK. Your dietary protein intake therefore should be similar to that recommended for general healthy eating. At a main meal the meat or pulses portion should be no more than 5oz or 140g. Milk and dairy foods can be taken in moderation.

Phosphate
Our kidneys help control the level of phosphate in our blood. When the kidneys are not working properly a reduced phosphate diet may help to control blood levels. A normal phosphate level with kidney disease is 0.9 -1.5mmol/l. If your blood levels of phosphate are high and you have a good appetite, it may be beneficial to reduce your intake of high phosphate foods.

The following short list gives some basic advice on how you can reduce phosphate in your diet, however the Dietitian can give you more advice regarding this

• Reduce cola, Pepsi or any other dark coloured fizzy
• Reduce milk intake towards 1/2 pints a day
• Avoid processed cheese slices, spreads or triangles such as; Dairylea, primula & Laughing Cow

You can contact the Renal Dietitian for more information regarding this.

Potassium
Our kidneys control the level of potassium in our blood. Normal blood potassium levels are 3.7- 5.5mmol/l. Generally, if you have been advised that your blood potassium levels are normal then it may not be necessary to avoid high potassium foods. However, if your blood levels of potassium are increasing or you have been told that they are high, it may be beneficial to reduce the intake of potassium in your diet. It is important to discuss the need for restricting potassium with your Renal Dietitian or Renal team. The below foods can be higher in potassium so it is important to discuss this with your Dietitian to look at the suitability of these foods in your diet.

Diabetes

Chronic kidney disease can be a long-term complication of Diabetes. Good blood glucose control can help slow the progression of kidney disease. It is therefore important that you have regular check- ups with the diabetes team and follow a healthy eating diet.

You can ask the Dietitian if you want more advice regarding diet & Diabetes.

Fluid

The amount of fluid your body needs depends on the type and stage of kidney disease, other health conditions and medications.

Your doctor or nurse will advise on your recommended fluid intake per day.

The Dietitian can then provide you with more information regarding this.

Vitamin and mineral supplements
If you eat a healthy diet, there is probably no need for a supplement unless advised by your dietitian or doctor. Please note:

Herbal tablets, sports supplements or protein shakes.
Please avoid taking these supplements unless you have discussed with your doctor, nurse or dietitian.

Cook books
Please see the Kidney Care website for links to the Renal Recipe Book, Kidney Friendly Cookbook, Kidney Care Cook Book.

Other books include:

Eating well with Kidney Failure: A practical guide and cook book and expert guidance and delicious recipes: You can buy these books online from National Kidney Foundation (UK) website or the renal dietitians hold a stock of order forms.

Rediscovering Food & Flavours: Shire Pharmaceuticals and Kidney Care UK.
Available through the Kidney Care UK website

Food with thought: Amgen – available from the National Kidney Foundation (UK) website.

Truly Tasty: Over 100 Special Recipes Created by Irelands Top Chefs for Adults Living with Kidney Disease. Editor: Valerie Twomey and published by Atrium.

Useful websites for people following renal dietary advice
The list below details a few of the websites which we feel may be helpful to you. Many of the websites have links to other sites with useful information and recipes.

UK based websites
For information on all aspects of renal failure, the National Kidney Foundation – www.kidney.org.uk

• A site with useful, patient friendly information on diet and recipe books – www.kidneypatientguide.org.uk
• Kidney Kitchen is a website developed by Kidney Care UK devoted to nutrition and diet – www.kidneycareuk.org/about-kidney-health/living-kidney-disease/kidney- kitchen/
• Kidney Research UK has general information on diet and links to leaflets.
  www.kidneyresearchuk.org/kidney-health-information/living-with-kidney- disease/how-can-i-help-myself/healthy-eating-for-kidney-patients/
• Healthy eating advice in chronic kidney disease can be found at: www.nhs.uk/conditions/kidney-disease/living-with/

International websites

• The American kidney Federation has interesting information on diet, including recipes in the section ‘kidney kitchen’. In addition it has other information regarding renal disease – www.kidney.org
• The Australian kidney federation has a useful diet section and links to other websites and information – www.kidney.org.au
• DaVita is a comprehensive resource regarding dialysis and kidneys disease. It has an extensive diet section – www.davita.com
• www.freseniuskidneycare.com – an American website with useful information about kidney disease and has some good recipe idea.

Disclaimer
This dietary guide is for information only and should not be used for the diagnosis or medical treatment of chronic kidney disease.

Acknowledgement: UHCW NHS Trust Dietetics Team

Notes:

Worcestershire Acute Hospitals NHS Trust
Covering the Alexandra Hospital, Redditch, Worcestershire Royal Hospital and Kidderminster Hospital

Tel: 01905 760 136
Email: wah-tr.dietetics@nhs.net

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day

If you are unable to understand this leaflet, please communicate with a member of staff.

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