Diet and Nutrition Goals for People with Stage 3 Chronic Kidney Disease

In stage 3 chronic kidney disease (CKD), the kidneys still function sufficiently to remove fluid, potassium and a moderate amount of waste. Adhering to kidney diet goals includes managing:

Which nutrients do I focus on for stage 3 kidney disease?

Calories

Adequate calories can either prevent weight loss if you’re at a desirable weight or provide extra calories if you are underweight. Making changes in your diet may cause weight loss, so weigh yourself and keep track to see if you need additional calories. If you’re overweight or obese, you may find that diet changes help you lose weight. Your dietitian will determine a desirable weight and monitor your progress.

Fats and cholesterol

If you have cardiovascular disease or your blood cholesterol is high, unhealthy fats—such as saturated fats and trans-fats—should be replaced by poly- and monounsaturated fats from vegetable oil, canola oil and olive oil. A limit on high cholesterol foods is recommended.

Fluid

Fluid is not restricted in stage 3 CKD unless you experience fluid retention. Sudden weight gain, shortness of breath, swelling in the feet, hands and face and high blood pressure are signs of fluid retention. These symptoms may indicate a decline in kidney function and decreased urine output.

Phosphorus

Phosphorus may be limited because reduced kidney function causes phosphorus to build up in your blood. A diet with no more than 800 mg phosphorus can help. First, avoid foods with phosphate additives rather than adjust foods with natural phosphates, such as:

Cheese

Chocolate

Ice cream

Legumes

Milk

Nuts

Seeds

Yogurt

If PTH is higher than expected, a special active vitamin D pill may be prescribed to help lower it. Some patients may have low calcium levels and thus require a calcium supplement. Your doctor also may prescribe a nutritional vitamin D supplement if you’re low in vitamin D.

Potassium

Usually, potassium is not restricted in stage 3 CKD unless lab tests show potassium is too high. Your doctor may make medication changes or prescribe a low-potassium diet. Reduce an elevated potassium level by avoiding some high-potassium foods and potassium chloride (found in salt substitute and many low-sodium processed foods), and limiting your daily servings of fruit, vegetables and milk. Here are examples of high-potassium food :

Avocado

Bananas

Cantaloupe

Honeydew

Legumes

Milk

Nuts

Potatoes

Nuts

Potatoes

Seeds

Tomato products (juices, sauces, paste)

Yogurt

Your dietitian will assess your usual intake and provide instructions on ways to control your potassium.

Protein

The recommendation for protein intake in stage 3 is 0.8 g/kg body weight, the same recommendation for a healthy 150-pound adult. However, a healthy 150-pound American adult often eats more protein. As you incorporate high-protein recipes and meals into your diet, you will find changing your protein intake is not difficult.

On a lower protein diet, at least half of your protein comes from high-quality protein foods that contain all the essential amino acids (protein building blocks your body needs), such as egg whites, fish, poultry, meat, soy and small of amounts of dairy.

Additionally, nuts, seeds, legumes, grains and vegetables contain protein but may be missing some of the essential amino acids. For vegetarian and vegan diets, there’s concern that higher amounts of phosphorus and potassium will be consumed and that there are inadequate amounts of essential amino acids. With the right meal plan, you can continue a vegetarian or vegan diet and stay well nourished. Vegetarians may find it easier than meat eaters to limit protein in their diet.

To estimate your daily protein goal based on a 0.8 g/kg, divide your weight in pounds by 2.2, then multiply the answer by 0.8.

Sodium

Limiting salt and high-sodium foods reduces hypertension, assists blood pressure medications to work more effectively and treats fluid retention. The sodium recommendation for stage 3 CKD is 1,000 to 4,000 mg/day based on blood pressure, fluid balance and the presence of other diseases that may affect sodium requirements. A place to start could be 1,500 to 2,000 mg/day or the amount recommended by your doctor or dietitian.

Sticking with your diet and nutrition goals

When you have stage 3 CKD, it’s important to know what your diet and nutrition goals are. Adhering to your doctor or dietitian’s kidney diet prescription could help slow the progression of the kidney disease and improve your quality of life.

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