Renal Diet FAQs

Since protein requirements can be specific to your medications, other medical conditions or your overall nutritional status, it is best to speak with a renal dietitian about the amount of protein that will help you optimize your health. In general, if you have stage 1-4 kidney disease you should aim for 0.8 grams protein per kg of body weight. This amounts to approximately 1-2 servings of low phosphorus Meat and Alternatives, each about the size of a deck of cards each day. If you are on dialysis, some protein is lost during the filtration process so you should aim for 1.1-1.3 grams of protein per kg per day. This amounts to 2-3 servings of low phosphorus Meat & Alternatives, again each about the size of a deck of cards.

Being physically active does not increase your protein needs unless intense training for several hours a day is part of your routine. Additional protein requirements are recommended for pregnant and lactating women.

Yes, artificial sweeteners approved for use in Canada are safe to use by chronic kidney disease patients.

Health Canada regulates all sweeteners that are used and sold in Canada. Sweeteners are only approved when scientific evidence confirms that they are safe.

The following shows the different types of sweeteners that have been approved for use in Canada:

Aspartame is marketed under the brand names of Equal™ and Nutrasweet™. It’s used in soft drinks, yogurt, candy and as a table-top sweetener. It contains phenylalanine, so people with phenylketonuria (PKU) must avoid aspartame.

Sucralose is marketed under the brand name Splenda™. It is widely used in soft drinks, candy, baked goods and frozen desserts and ice cream products. It is also used for home cooking and baking.

Acesulfame potassium is not used as a table top sweetener. It’s used only by food manufacturers as an ingredient for sweetening soft drinks and candy.

Sugar alcohols (sorbitol, mannitol, maltitol, xylitol) can’t be bought as table sweeteners but are used by food manufacturers in foods and beverages such as candy, frozen desserts and ice cream products. Sugar alcohols are not “true” artificial sweeteners – they do provide small amounts of calories which may affect blood glucose (sugar) levels. Large amounts (more than 10 grams/day) can cause diarrhea, cramps, gas and bloating.

Saccharin is marketed as the table top sweetener Hermesetas®. It can only be bought at pharmacies in Canada. If you are pregnant, check with your doctor before using saccharin.

Stevia leaf and extract of stevia leaves are approved for use as ingredients in certain natural health products. Purified stevia extract, also known as “steviol glycoside” is approved as a table top sweetener and food additive in some foods such as candy, gum, baking mixes and snacks.

Cyclamate is marketed as the table top sweeteners Sucaryl®, Sugar Twin® and Sweet ‘N Low®. It is not permitted as a food additive in Canada.

For pregnant and breastfeeding women
If you are pregnant or breastfeeding approved sweeteners, including aspartame, acesulfame potassium, sucralose and sugar alcohols are considered safe. However, make sure artificially-sweetened foods are not replacing nutrient-rich foods you need for a healthy pregnancy.

For infants and children
It is recommended that infants and children avoid sweeteners.

Vitamins are compounds found in the foods we eat and have many purposes in the human body. Eating a variety of foods is the best way to get all of your vitamins. People with chronic kidney disease (CKD) may not get enough of some vitamins because of diet restrictions, poor appetite or vitamin losses during dialysis treatments. In general CKD patients, especially those on dialysis, may need extra water-soluble vitamins like the B vitamins. Some vitamins and minerals must be limited or avoided because levels can build up in the body as the kidneys stop working. In general these are the fat-soluble vitamins like A, E and K and minerals such as potassium and phosphorus. These shouldn’t be supplemented unless ordered by your doctor. A daily vitamin supplement specifically designed for kidney patients is often recommended. If your doctor has not prescribed a vitamin supplement, ask if you would benefit from one. Only use the vitamin supplement approved by your health care team.

A fluid restriction is a recommendation that comes from your doctor or heath care team. Restricting fluid unnecessarily may cause problems so be sure to ask your doctor.

Congratulations on your transplant! Each transplant is different and as you progress, your blood work will greatly assist your doctor and renal dietitian to guide you on what foods to include in your diet. Your protein requirements are usually higher after a transplant in order to promote wound healing and also because of higher doses of steroid medications used to suppress your immune system. Your blood sugars may also be higher because of the steroid medications, especially if you have diabetes. Your doctor or a diabetes educator can help you manage your blood sugars. The higher dose of steroid medications will also increase your calcium requirements so you should focus on including calcium rich foods to keep your bones strong. In general, you should continue to follow a low sodium diet unless otherwise directed by your health care team.

Quite often, a higher intake of whole grains, bran, nuts & seeds, beans and lentils are recommended to ensure you are getting adequate minerals like phosphorous and magnesium. Lastly, preventing unwanted weight gain post-transplant as a result of increased appetite, increased palatability of food and less dietary restrictions is important. Ask your doctor for a referral to a renal dietitian if you would like advice on what foods to include in your diet for optimal health.

Moderate alcohol use may be okay, but it’s best to check with your doctor to find out if it’s safe for you. Drinking too much alcohol can contribute to high blood pressure, high blood triglyceride levels, blood thinning, pancreas and/or liver damage, and it may interact with your medications. In addition, alcohol may make blood pressure or blood sugar more difficult to control, and can lead to weight gain.

If you are drinking alcohol, drink no more than 1-2 standard drinks a day and no more than 14 drinks per week for men and 10 for women.

Standard drinks are:
355 ml (12 oz) can of 5% beer
146 ml (5 oz) glass of 10-12% wine or
44 ml (1.5 oz) of 40% hard liquor or spirit.

Special considerations for alcohol and kidney disease:

• Alcohol contributes added fluid and many with CKD, especially those on dialysis, are advised to limit their fluid intake.
• Certain alcoholic beverages are higher in potassium or phosphorus than others:
  • Red wine contains more potassium than white wine.
  • Beer is a significant source of potassium and phosphorus.
  • Spirits such as vodka, rum and gin contain nearly no potassium or phosphorus.
  • Mixes served with hard alcohol may be high in potassium and/or phosphorus (for example orange juice is high in potassium and colas are often high in potassium and/or phosphorus).

Loss of appetite is a common problem when the kidneys fail to clean waste out of the blood. Getting enough protein and calories is important for staying healthy and preventing muscle loss.

If your appetite is poor:

• Eat small frequent meals and high calorie snacks throughout the day (eat every 2-3 hours).
• Eat your biggest meal when your appetite is best. If you’re not hungry in the evening, have your main meal at breakfast or lunch.
• Carry snacks with you if you are going to be away from home during the day, at treatment, appointments or work. Examples include crackers and cheese, a small muffin or half a sandwich.
• Schedule meals and snacks – set an alarm as a reminder to eat if you don’t get hungry.
• Experiment with different foods, for instance try cold foods instead of a hot meal.
• Make a list of easy or favourite meals and look at it when you’re not sure what to eat.
• Try taking a walk or getting some fresh air, this may help you feel hungry.
• Ask your dietitian about trying a kidney-friendly liquid supplement.
• Make every mouthful count. Add extra protein and calories:
  • Add margarine to rice, noodles, crackers, vegetables and bread.
  • Use honey, jam, margarine or cream cheese on toast, bread and crackers.
  • Mix cooked ground beef, chicken or turkey into soups, pasta or rice.
  • Add cheese to vegetables, salads or casseroles.
  • Add hard-boiled egg or tuna to your salad.
  • Spread peanut butter on crackers, bread or fruit.
  • Add tofu to soups, stews or stir-fry’s.
  • Eat no salt added cottage cheese with fruit.
  • Use “good” fats liberally. Try dipping bread in olive oil.
  • Sauté foods in canola or olive oil.
  • Add low salt dressings to salads and vegetables.
  • Drink beverages that contain calories.
  • Use whipped topping on fruits and desserts.
  • Avoid “light” or “diet” foods

Have you ever wondered why some products list potassium in the Nutrition Facts table, and other products do not?  Potassium is not always listed in the Nutrition Facts table since it isn’t one of the 13 core nutrients that are mandatory.  Labels that list potassium might do so because the manufacturer reduced sodium in the product by adding potassium salts, or because the manufacturer is making a claim about the product being a good source of potassium, or because the manufacturer voluntarily decided to include this information.  Just because one product lists potassium and a similar product doesn’t, this does not mean the similar product contains zero potassium. Almost all foods contain potassium.  For example, one brand of apple juice may list 200 mg potassium in ¾ cup of juice, whereas another brand of apple juice may not list potassium in the Nutrition Facts table at all.  Likely both brands of apple juice contain about 200 mg potassium in ¾ cup, but the labelling laws do not require that potassium content be listed.

If a Nutrition Facts table provides potassium content, what do the numbers mean?  The following guidelines may be useful when deciding if a food has a lot or a little potassium:  (always check with your renal dietitian for individual guidelines)

• Very low potassium: below 40 mg per serving (1 %)
• Low potassium: below 100 mg per serving (3%)
• Medium potassium: 100-250 mg per serving (3-7%)
• High potassium: 250-500 mg per serving (7-14%)
• Very high potassium: above 500 mg per serving (>14%)

Animal protein foods such as beef, lamb, pork, poultry and fish are very rich in protein.  Eating these protein-rich foods make it easier to meet your dietary protein needs.

For those who eat meat but can only tolerate small amounts, eat small quantities of protein more often and incorporate meats into mixed ingredients dishes such as in soups, salads, pastas, sandwiches, etc.  People who dislike red meat and/or poultry may enjoy fish.  Fish is an excellent source of protein.  The consumption of egg and low phosphorus cheese (e.g. softer cheeses such as brie, camembert, goat, cottage cheese) can also help meet protein needs.  It is important to speak to your dietitian to know how much meat, egg and cheese is appropriate for you.

Some people may choose to NOT eat meat for various reasons (e.g. religious reasons, preferences, taste aversions). For those who avoid all meats, you may be able to consume additional milk products, tofu, or legumes to meet your protein needs. Often, however, additional milk products and legumes cause an undesirable rise in blood phosphorus levels.  Speak to your dietitian about your blood levels and food intake.

When ordinary foods are not sufficient to meet protein needs, it may be necessary to use protein supplements.  Supplements may include protein powders that are mixed into other foods or high protein nutrition beverages. Talk to your dietitian before using protein supplements and ask about kidney-friendly high protein beverages that may help you meet your protein needs.

There are many ways to help delay the progression of kidney disease, especially if you are diagnosed in the early stages. Here are some tips that can help you protect your kidneys:

• Eat a healthy diet: we generally recommend you follow a well balanced diet that limits sodium in order to help control blood pressure. A good way to limit sodium is to avoid processed foods (such as fast foods, canned foods, packaged foods and frozen entrees). We also recommend you avoid excess protein (see FAQ ‘how much protein do I need each day?’). In addition, replacing some animal protein with vegetable protein may help slow the progression of CKD. Avoiding phosphate additives from processed foods (like colas, processed cheeses and seasoned meats) may also help protect your kidneys.
• Monitor blood pressure: Studies have shown that good blood pressure control can help slow the progression of kidney disease.
• Stay active: Make physical activity a regular habit. 30 minutes of moderate intensity physical activity per day is recommended.
• Maintain a healthy weight: being overweight increases your risk of developing diabetes and high blood pressure which are major risk factors for kidney disease.
• Stay hydrated: Drink water instead of calorie-rich beverages.
• If you consume alcohol, drink in moderation: limit alcohol to 2 standard drinks per day for men, 1 per day for women (see FAQ ‘how much alcohol is safe for kidney patients).
• If you have diabetes: maintain good blood glucose control.
• Be a non-smoker: Smoking is a risk factor for faster progression of kidney disease.
• Take medications as prescribed by your doctor.
• Have regular checkups with your doctor.
• Maintain a positive ‘stay well’ attitude and do things that help you relax and reduce stress.

Remember it is never too late to make positive changes to your lifestyle. Eating well and keeping active can improve long term health and help you maintain good kidney function.

The recipes are recommended for all stages of kidney disease and are low in sodium, potassium, and phosphorus.

Similar to certain vitamins, some herbal supplements can be harmful to people with kidney disease. Speak with your doctor, dietitian or renal pharmacist if you are taking any herbal preparations as they can guide you on which ones may be of concern.