Nutrition Focus: Stages of Kidney Disease

Macey Thompson
Aug 1
5 min read

Written by Macey Thompson RDN student, Reviewed by Danielle Gersmehl, RD LDN

Navigating kidney disease can be challenging, especially when adhering to a kidney-friendly diet. It is important to understand each stage of kidney disease to know how to manage the disease through nutrition. Kidney disease can be split into five different stages, including kidney failure and kidney transplant. As kidney disease evolves there are different nutrition recommendations. In this blog, we will explain each stage of kidney disease with focus on nutrition.

Healthy Kidneys

Detection: A blood test measures eGFR (glomerular filtration rate). This value indicates if the kidneys are able to filter waste properly. The eGFR values for a healthy kidney are 120 to 90.

Focus: The aim is to follow general health recommendations for physical activity, nutrition, and lifestyle habits. Other chronic conditions, like diabetes, hypertension, and obesity can increase the risk of developing chronic kidney disease.

Nutrition: The nutrition recommendations encourage consumption of whole grains, a variety of fruits and vegetables, healthy fats, lean protein, adequate fluid intake, limited sugar, reduced salt, and limited saturated fats.

Five red kidneys illustrating stages of chronic kidney disease, from normal function to kidney failure, labeled with stages and descriptions. — The image illustrates the progression of chronic kidney disease through five stages, from normal function to kidney failure, highlighting the increasing damage and loss of function at each stage.

Stages 1 & 2

Damage: Mild kidney damage is present at stages 1 and 2.

Detection: For stages 1 and 2 the eGFR values may range from 90 to 60. A urine test can also be conducted to detect if proteins are being excreted in the urine.

Focus: The goal is to prevent any further damage of the kidneys. Disease progression can be managed through lifestyle changes, like physical activity and nutrition.

Nutrition: The nutrition recommendations during this stage are similar to the general recommendations for individuals with health kidneys.

Fluid: Fluid intake is vital for maintaining kidney health and function. It helps the kidneys filter waste, monitor blood pressure, and balance electrolytes.
Sodium: Sodium is a vital electrolyte for the body, but an excess can be difficult for the kidneys to remove. This excess can cause a strain to the kidneys and heart, causing high blood pressure. There are lots of foods that have added sodium to monitor, like condiments, canned foods, seasonings, baked goods, and frozen dinners. The general recommendation is 2,300mg of salt a day.
Whole Grains: Whole grains are more nutrient dense than refined carbs. This means they have more fiber, vitamins, and minerals. This swap can help get more beneficial nutrients to the kidneys. Look for breads that say whole wheat or whole grain.
Vegetables: It is recommended to consume 2 cups of vegetables a day. During the beginning stages of kidney disease this is still important since it can help protect the heart, blood vessels, and digestive system through the vitamins, minerals, and fiber they provide. Non-starchy vegetables are a great option since they are low in carbs and calories, but still provide energy for the body. Try cooking options that don't include frying, like steaming or roasting. Some examples include broccoli, bell pepper, cucumber, and lettuce.
Lean Protein: Lean protein is a general nutrition recommendation since it contains less saturated fat and cholesterol that can build up in blood vessels and damage the heart and kidneys. Some options include fish, soy products, quinoa, eggs, chicken, pork tenderloin, and lean beef.
Sugar: It is recommended to consume sugar in moderation. Sugar is processed by our bodies quickly, leading to blood sugar spikes. Continuous high blood sugar can cause weight gain and diabetes, which are risk factors for chronic kidney disease.

Stages 3, 4, & 5

Damage: The kidneys are not able to filter waste out of the blood adequately. During these stages, it is beneficial to work with a doctor and a dietitian to develop a kidney-friendly diet. Following a kidney diet can help prevent damage and slow the progression of chronic kidney disease.

Detection: For stages 3, 4, and 5, the eGFR values may range from 60 to 15.

Focus: Prior to dialysis, some nutrients may need to be monitored or restricted due to the kidneys inability to filter it properly. Designing a kidney-friendly meal plan can be helpful when navigating these restrictions.

Nutrition: The nutrients to monitor are protein, sodium, and fluid. These nutrients don't need to be completely restricted, but it may be helpful to work with a doctor and dietitian to determine a meal plan that is safe for the individuals kidneys.

Protein: The kidneys have to filter out the waste produced from proteins. During these stages, protein consumption needs to be monitored so the kidneys are not overworked. It is recommended to get protein from lean sources, like eggs, chicken, fish, turkey, quinoa, and beans. Portions sizes of protein may need to be restricted as advised by a doctor and dietitian.
Sodium: Similar to protein, sodium will not be filtered properly by damaged kidneys, so a reduced intake will cause less strain on the kidneys. Choose low sodium options of processed foods and use herbs to flavor meals.
Fluid: Since the kidneys are not able to perform one of their main functions of fluid balance, fluid can be retained in the body causing bloating and discomfort. This includes fluid from all beverages, soups, and ice. It is recommended to work with a doctor and dietitian to determine adequate fluid intake.

Person sitting in a hospital chair receiving dialysis, connected to a machine. The room is blue-toned, creating a calm atmosphere. — Patient receiving treatment through a dialysis machine, seated in a medical chair.

Kidney Failure (Dialysis)

Damage: Kidney failure means the kidneys need support through a dialysis machine. Even with a dialysis machine, the kidneys need support through diet to prevent waste build up in the body.

Detection: For kidney failure, the eGFR values are 15 to 0.

Focus: It is important to work with a doctor and dietitian at a dialysis clinic to develop a plan for dialysis and a meal plan.

Nutrition: Similar to the previous stages, protein, fluid, and sodium may need to be restricted. Too much sodium can cause the body to hold on to fluid. Symptoms like swelling, trouble breathing, high blood pressure, heart failure, and lung infections can be due to fluid retention. There are some other nutrients that need to be monitored once on dialysis, like phosphorus and potassium.

Potassium: Potassium is involved in muscle contraction. It is vital for the body, but and excess can create an imbalance that could lead to issues with heart contraction. Potassium is found in a variety of foods. Some types of foods are high or low potassium, so working with a dietitian is crucial for developing a meal plan.
Phosphorus: Phosphorus is another nutrient that is abundant in several types of food. It is often added to food as a preservative in fast food, processed food, and sodas. Excess phosphorus can cause itchy skin, brittle bones, high blood pressure, and calcium deposits.

Red kidney shapes surrounded by colorful fruits and vegetables, including lemons, apples, and asparagus, on a white background. — Colorful fruits and vegetables surround a representation of kidneys, highlighting the importance of nutrition for maintaining kidney health.

Kidney Transplant

After a kidney transplant, there is less restrictions to the diet since the kidneys can filter foods properly again. Despite this, nutrition still plays an important role. Transplants put a strain on the immune system, so it is necessary to take immunosuppressive medicines and practice food safety. This includes checking meat temperatures with a food thermometer, consuming pasteurized drinks, and washing produce.

Citations

Any stage of chronic kidney disease requires support from a dietitian to ensure that any further kidney damage or damage to other organs is being prevented. Click this link to book a consultation with a registered dietitian today!