5 Diet Guidelines for Stage 5 CKD Non-Dialysis Patients

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

A stage 5 chronic kidney disease (CKD) or end stage renal disease (ESRD) diagnosis means that your kidneys are working at less than 15 percent and can no longer clean your blood adequately. To prevent dangerous amounts of toxin buildup in your body, you’ll need dialysis or a kidney transplant. These toxins include protein waste products, potassium, phosphorus, sodium and fluid. When waste accumulates in the bloodstream a condition called uremia occurs, causing symptoms such as:

  • poor appetite
  • nausea
  • vomiting
  • decreased taste and smell
  • a bad taste in the mouth
  • fatigue
  • difficulty sleeping
  • itching
  • restless legs

The diet for stage 5 CKD takes into consideration lab results, nutritional status, and plans for transplant, dialysis or no treatment. For most people in stage 5, eating becomes a challenge because of uremia. Preventing malnutrition is a top priority because people who are undernourished are at higher risk for hospitalization and even death before starting dialysis or undergoing surgery for a kidney transplant.

The following five diet guidelines can help you manage your nutrition and diet in stage 5 CKD prior to dialysis or transplant.

1. Know the right amount of protein and strive to eat that amount each day.

Limiting protein helps reduce waste buildup in the blood and can help control uremia. However, a low-protein diet coupled with loss of appetite also puts you at high risk for malnutrition. Many people in stage 5 naturally decrease their protein and calorie intake, due to decreased appetite, as the glomerular filtration rate (GFR, a measurement of kidney function) declines.

The recommended amount of protein to eat in stage 5 is 0.6 to 0.75 grams of protein per kilogram body weight. A nutrition assessment by a registered dietitian will determine the right amount of protein for your individualized meal plan. On your lab test, an albumin result below 4.0 mg/dL is an indication you may be depleting your protein stores due to a low protein or calorie intake.

2. Eat enough calories to maintain your weight, even if you are overweight.

Inadequate calorie intake may occur in stage 5 CKD due to appetite troubles, gastrointestinal problems, aversion to certain animal proteins, chronic inflammation, medications, depression and other medical conditions such as diabetes or heart disease. Even if you are overweight, a low calorie intake and weight loss is not recommended in stage 5. Aim for adequate calories to prevent weight loss and to help preserve your body’s muscle stores. Ask your doctor or dietitian about a nutritional supplement for a CKD non-dialysis diet if you are experiencing poor appetite and weight loss.

3. Monitor potassium levels that may increase due to low urine output or from medications.

Potassium builds up in the body when kidney function declines. If urine output is less than one liter per day (about 32 ounces), and potassium level exceeds 5.0, a low-potassium diet is prescribed. A low-potassium diet is usually 2,000 to 3,000 mg per day depending on your lab results and urine output. Avoid the highest potassium foods and track your potassium level by getting regular blood tests.

High-potassium foods to limit or avoid

Avocado

Bananas

Cantaloupe and honeydew melon

Dried fruit

Legumes

Milk and yogurt

Nuts and seeds

Oranges and orange juice

Potatoes

Pumpkin and winter squash

Salt substitutes and low sodium foods that contain potassium additives

Tomato products (juices, sauces, paste)

Your doctor or dietitian will provide additional information on potassium and your kidney diet prescription. See “Potassium and Chronic Kidney Disease” for more on foods to limit and which ones to keep when you’re prescribed a low-potassium diet.

4. Phosphorus levels are likely to occur naturally if you are limiting high-protein foods.

Phosphorus-calcium imbalance and bone changes can occur as early as stage 3 CKD, but high phosphorus levels may not occur until stage 5. If you are following a low-protein diet, you naturally decrease phosphorus intake, because protein and phosphorus go together. Additional sources of phosphorus are from phosphate additives in processed foods. Read ingredient labels to avoid additives with “phos” in it.

Foods naturally high in phosphorus

Cheese

Chocolate

Ice cream

Legumes

Milk and yogurt

Nuts and seeds

For an extensive food list with high- and low-phosphorus foods, read “Phosphorus and Chronic Kidney Disease” and "Hidden Phosphorus in Your Diet and How to Control It."

5. Control fluid retention and blood pressure with lower sodium and fluid intake and prescribed medications.

Fluid restriction and the degree of sodium restriction needed vary greatly with people in stage 5 CKD, so your requirements will be assessed by your doctor and dietitian. Weigh yourself daily to track weight gains. Fluid weight gains occur quickly, and are associated with swelling and shortness of breath. A high-sodium diet can make you retain more fluid and can affect blood pressure. Ask your doctor or dietitian about the amount of sodium you need each day. For tips to manage sodium intake, read “Sodium and Chronic Kidney Disease,” and to help manage fluid check out “Fluid Control for People on Dialysis.”

Managing stage 5 CKD non-dialysis with diet

Attention to diet and nutrition are extremely important for people in stage 5 CKD who aren’t on dialysis. Awareness of protein, calories, potassium, phosphorus, sodium and fluid, along with an individualized assessment of your needs, can minimize uremia symptoms and prevent malnutrition prior to starting dialysis or having a kidney transplant.

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