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Eating Right for Your Kidneys

Jun 21, 2017
Image of Dr. Bosnic
  Sejal Bosnic, RD, DMC Sinai-Grace Hospital

If you or a loved one has had kidney failure or are on dialysis, foods that are typically good for your body may no longer be your allies in health.  When kidneys can’t do their job of getting rid of waste products through urine a doctor may prescribe a special diet that limits fluids, potassium, phosphorus, and salt.  While it may sound daunting at first glance, this so-called “Renal Diet” still offers many flavorful and popular food choices.  

To simplify the Renal Diet, here are a few guidelines to avoid excessive Potassium, Salt and Phosphorus while still eating pleasurable and healthy meals:

Potassium

Potassium is a mineral found in many of the foods you eat. It plays a role in keeping your heartbeat regular and your muscles working right. It is the job of healthy kidneys to keep the right amount of potassium in your body. If your potassium levels are too high, it can cause an irregular heartbeat or even a heart attack. When your kidneys are not healthy, you need to limit certain foods such as nuts, tomatoes and chocolate that are high in potassium.  You may feel some weakness, numbness and tingling if your potassium is at a high level. 

All fruits and vegetables have some potassium so serving sizes are important to monitor because a large quantity of a low-potassium food can turn into a high-potassium food. If you are on dialysis or have kidney disease, it’s best to choose foods lower in potassium, or ask your dietitian how to leach the potassium out of your favorite vegetables like potatoes through a soaking-and-boiling method.


Examples of Low-Potassium Foods for a Renal Diet

VEGETABLES:

choose ½ cup
  • Cabbage, Carrots,Cauliflower, Celery,Cucumber, Eggplant, Green Beans, Kale, Lettuce, Mushrooms (white, raw), Onions, Peppers (all types and colors), Radishes, Yellow squash, Zucchini squash

Limit or avoid these vegetables:

  • Acorn Squash, Baked or refried beans, Butternut squash, Beets, Black beans, Broccoli, Brussel sprouts, Carrots (raw), Greens, except kale, Lentils, Mushrooms (cooked, white), Okra, Potatoes (white and sweet), Spinach (cooked), Tomatoes/tomato products

FRUITS/JUICES:

choose ½ cup or 1 small fruit or 4 ounces of juice daily from these fruit options

  •  Apples, Berries, Cherries, Fruit cocktail, drained, Grapefruit (1/2 of whole fruit), Grapes, Peach (fresh=1 small, or canned= ½ cup), Pear (fresh=1 small, or canned= ½ cup), Pineapple, Plums, Tangerine, Watermelon (limit to 1 cup)

Limit or avoid these fruits:

  • Oranges and orange juice, Kiwis, Nectarines, Prunes and prune juice, Raisins and dried fruit, Bananas, Melons (cantaloupe and honeydew)
Always avoid star fruit (carambola), which has 121 mg of potassium.

OTHER FOODS:

Choose ½ cup unless otherwise specified

  • Rice, Noodles, Pasta, Bread (not whole grain), Cake (angel or yellow), Coffee (limit to 8 oz. a day), Pies (without chocolate or high-potassium fruit), Cookies (without nuts or chocolate), Tea (limit to 16 oz. a day) 

Phosphorus and Dairy Foods

Phosphorus is a mineral that is good for you but when the kidneys cannot eliminate the excess, this mineral can contribute to low calcium levels and lead to bone fractures. Most dairy foods are very high in phosphorus. People with kidney disease should limit their daily intake of milk, yogurt, and cheese to ½ cup milk, or ½ cup yogurt or 1-ounce cheese. If you do eat high-phosphorus foods, ask your doctor for a phosphate binder to be taken with your meals.

Recommended dairy foods that are lower in phosphorus include:  margarine, cream cheese, heavy cream, ricotta and brie cheese, non-dairy whipped topping, or sherbet.

Salt (SODIUM CHLORIDE)

Even though we often think of salt as a spice, salt is really a mineral called sodium chloride that occurs naturally in many foods. It is highest in processed foods or pre-packaged foods, and in table salt. Sodium attracts and holds water in your body and causes water weight gain. If your kidneys are not working well, you may have swelling in your legs, arms, and hands. In some people, too much sodium can also increase blood pressure. Excess salt will also put an undue stress on other organs.

Like the minerals of potassium and phosphorus, a kidney that’s unhealthy can’t remove excess sodium from the body.  “Pre-packaged  and processed lunch meats like bacon, salami, sausages and hot dogs all have a lot of sodium, “ notes Sejal Bosnic, RD, a dietitian at DMC Sinai-Grace who counsels patients on dialysis. “If salt or sodium is listed as one of the first five ingredients, it’s not a good choice,” Bosnic advises.  She also recommends that people who have kidney disease buy fresh meats and cook them at home to avoid the extra salt.

Limit your Fluids

A person whose kidneys aren’t functioning can no longer excrete fluids. “There’s only a certain amount of fluid a person on dialysis can handle because they’re not urinating and there’s no place for fluid to go,” explains Bosnic. “Patients need to limit their fluid intake to six cups a day, or as recommended by their nephrologist,” she added, noting that a “fluid” is anything liquid at room temperature, including water, soda pop, juice, ice cream, soup, jello, and ice.

Add Extra Protein 

People on hemodialysis have higher protein needs due to losses incurred during dialysis so they need to increase their protein intake to about 60 grams of protein for women and 65 for men.  Depending on the size of the person, eat 8-10 ounces of a high protein food daily such as beef, eggs or egg substitutes, fish, pork, and poultry. There are other high-protein foods—like nuts, seeds, dried beans, peas, and lentils—but they are generally not recommended in a renal diet because they are high in both potassium and phosphorus. If you are vegetarian, a dietitian can create a special diet plan for you.  

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