Why do I need to change how I eat in kidney disease stages 3, 4 and 5 (not on dialysis)?

In kidney disease stages 3, 4 and 5, there is damage to your kidneys that prevents them from working as well as they should to filter waste and extra fluid out of your blood. Since your kidneys are not working as well as they did during the earlier stages of kidney disease, your doctor and dietitian may recommend that you follow a specific kidney-friendly food and fluid plan. Making changes to the way you eat and the amount of fluids you consume may help you prevent further damage to your kidneys and slow down the progression to kidney failure.

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How can I eat healthy in
kidney disease stages 3, 4 and 5 (not on dialysis)?

You will likely need to limit:

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Protein

In these stages, you will need to limit the amount of protein you eat.

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Sodium (salt)

Too much sodium can make your body retain fluid, which can raise your blood pressure. When you have high blood pressure, your kidneys must work harder to filter your blood.

Fluid

In these stages, you may need to limit your total fluid intake. Anything that is liquid at room temperature counts as fluid, not just water!

Protein

Your body needs protein to build muscle, heal and stay healthy, but the amount of protein you should eat depends on your stage of kidney disease. In kidney disease stages 3, 4 and 5 (not on dialysis), you should eat less protein to prevent your kidneys from having to work even harder to filter more protein waste, which could wear them out faster.

Ask your doctor and dietitian how much protein you should eat each day.

The daily amount of protein you need is based on your weight and activity level. For the general population:

  • About 56 grams of protein each day will easily provide the average protein needs for a man who weighs 155 pounds
  • About 46 grams of protein each day will easily provide the average protein needs for a woman who weighs 130 pounds

Lean protein serving size suggestions:

  • ½ cup beans (7 grams of protein)
  • 1 large egg (6 grams of protein)
  • 3 ounces chicken, which is about the size of your palm (27 grams of protein)
  • 3 ounces fish, which is about the size of your palm (20 grams of protein)

Tips to limit protein:

  • Eat a smaller serving of protein at meals
  • Fill more of your plate with fresh or frozen non-starchy vegetables (you may need to start choosing low-potassium vegetables to prevent raising your potassium to dangerous levels-discuss this with your doctor or dietitian)
  • Use a small plate (9-10 inches in diameter) to make your portion size look larger

Get your protein from lean protein sources:

  • Eggs
  • Chicken
  • Fish
  • Turkey
  • Quinoa
  • Beans
  • Soy products (tofu, edamame, tempeh, soy milk, etc.)

Limit or avoid protein from these sources:

  • Red meat (beef, bison, lamb, pork, venison, etc.)
  • Organ meats (liver, etc.)

Sodium(salt)

You can find the amount of sodium-one of two electrolytes in salt-in foods by checking the nutrition label. Sodium plays many important roles in the way our bodies function, but too much sodium can be harmful for people with kidney disease. When your kidneys are not working as well as they should, they may not be able to remove extra sodium from your body.

Having too much sodium in your body can make your body retain (hold onto) fluid, which makes your heart and kidneys work harder. Over time, this can raise your blood pressure and cause your kidney disease to get worse.

The amount of sodium found naturally in foods is enough to keep a healthy level in your body, but sodium is often added to many processed foods, foods we eat in restaurants and even the food we cook ourselves. This can lead to eating too much salt and cause too much sodium to build up in your body.

 

The recommended amount of sodium to consume can depend on your stage of kidney disease and your kidney function. In general, a healthy amount of sodium is 2,300mg or less of sodium per day. This is equal to about 1 teaspoon of salt a day. Ask your doctor and dietitian how much sodium you should consume each day in kidney disease stages 3, 4 and 5 (not on dialysis).

Tips to avoid added sodium:

  • Avoid salt substitutes that say "NuSalt" or "No-Salt" - these are made with potassium and could raise your potassium to a dangerous level
  • Choose canned and jarred foods that say "no salt added" on the package
  • Choose no salt added snacks (unsalted or no-salt pretzels, etc.)
  • Prepare and cook your meals from scratch using one of our kidney-friendly recipes, so you can control the amount of salt in your food
  • Use fresh or dried herbs and spices to add extra flavor to your dishes, instead of salt
  • Drink water instead of sports drinks or soda
  • When eating out, ask your server for your food to be prepared without any added salt

These foods and drinks usually have added sodium (unless marked as low-salt or low-sodium):

  • Canned and jarred foods (tomatoes, beans, corn, pickles, etc.)
  • Frozen dinners and snacks
  • Fast food and food from restaurants
  • Soda and sports drinks
  • Bakery items (bread, bagels, pies, cakes, etc.)
  • Packaged snacks (chips, pretzels, nuts, etc.)
  • Condiments (ketchup, salad dressings, hot sauce, soy sauce, etc.)
  • Seasonings and spices with salt (garlic salt, celery salt, seasoned salt, taco seasoning, seafood seasoning, etc.)

Fluid

Controlling the balance of fluid in your body is one of your kidney's main jobs. In kidney disease stages 3, 4 and 5 (not on dialysis), your kidneys are not working well, which means they cannot filter extra fluid out of your body. You will likely need to limit the amount of fluid you consume, so your kidneys do not have to work as hard.

It is important to limit fluids to prevent fluid retention, which is when too much fluid builds up in your body. Fluid retention can make you feel bloated and uncomfortable, and make your blood pressure go up, which can weaken your heart and make your kidney disease worse.

Ask your doctor and dietitian how much fluid you should have each day.

Remember, fluid is more than just the water you drink! Everything that turns to liquid at room temperature counts toward your daily fluid intake.

Examples of fluids include:

  • All beverages (water, soda, coffee, tea, milk,
    non-dairy milk, sports drinks, protein drinks, etc.)
  • Ice
  • Soups and stews
  • Ice cream, sherbet, sorbet, popsicles
  • Jell-O®, other gelatin products and gelatin
    substitutes (pectin, arrowroot powder, etc.)
  • Pudding

Tell your doctor right away if you have any of these signs of possible fluid retention:

  • Swelling in your feet or ankles
  • Trouble breathing or shortness of breath when:

    1. Walking a short distance (1-3 blocks)
    2. Lying flat on your back

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