Carbohydrates and the Kidney Diet

Food	Serving size	Food	Serving size
Bagel, plain	1 small or 1/2 regular	Cereals, cooked	1/2 cup
Bread (French, Italian, pumpernickel, rye, sourdough, whole wheat )	1 slice	Cereals, puffed	1 1/2 cups
English muffin	1/2	Cereals, unsweetened	3/4 cup
Hot dog or hamburger bun (white or wheat bread)	1/2 (1 ounce)	Cereals, sugar-coated	1/2 cup
Pita bread, plain, 6” across	1/2	Couscous, prepared	1/3 cup
Roll, plain, small	1 (1 ounce)	Granola	1/4 cup
Buckwheat, bulgur	1/2 cup	Pearled barley	1/3 cup
Tabouleh, prepared	1/2 cup	Grits, cooked	1/2 cup
Taco shell, 5” across	2	Pasta, cooked	1/3 cup
Tortilla, flour or corn, 6” across	1	Rice, white or wild, cooked	1/3 cup
Waffle, 4” across	1	Polenta, cooked	1/3 cup

Food	Serving size	Food	Serving size
Cassava	1/2 cup	Parsnips	1/2 cup
Corn (higher in phosphorus)	1/2 cup	Green peas (higher in phosphorus)	1/2 cup

Crackers and snacks (Each serving contains approximately 15 grams of carbohydrate)

Fruits (Each serving contains approximately 15 grams of carbohydrate)

Dairy and dairy substitute products (Each serving contains approximately 6-12 grams of carbohydrate)

*Ask your dietitian about including these due to high potassium, phosphorus and calcium amounts.

Sweets and desserts (Each serving contains approximately 15 grams of carbohydrate)

Diabetes and carbohydrates

If you have diabetes, understanding which foods contain carbohydrates and how much you can eat is important for blood sugar control. Blood sugar levels should run between 80-120 mg/dL before eating, and below 180 mg/dL two hours after eating. Taking diabetes medication prescribed by your doctor is not enough to manage blood sugar levels. Controlling diabetes includes:

• Following a healthy diet (as instructed by your dietitian)
• Eating at consistent meal and snack times and not skipping meals
• Following recommended serving sizes and reading food labels
• Balancing carbohydrate intake throughout the day
• Checking blood sugar levels often

Carbohydrate foods to avoid or eat only occasionally

Not all carbohydrates fit into a kidney diet because they contain high amounts of phosphorus, potassium, sodium or fluid, such as:

Some of the above foods may be worked into a healthy kidney diet depending on your lab results for potassium and phosphorus. Work with your dietitian to individualize your meal plan when including these foods.

Carbohydrates and hemodialysis

If you do in-center hemodialysis or home hemodialysis (HHD), you may have different carbohydrate needs for your dialysis diet. Your individual need for foods containing carbohydrate is typically half of your diet. This means 40-60% of your total daily calorie intake should come from carbohydrate foods. For example, if you need 2,000 calories to meet your daily needs, then 800-1,200 calories should come from carbohydrate foods. This equals 200-275 grams of carbohydrate a day.

Carbohydrates and peritoneal dialysis

For people on peritoneal dialysis (PD), the need for carbohydrates is less than for people on hemodialysis. In PD, a dialysate containing dextrose — a form of sugar — is used to pull waste and fluid out of the blood. Because dextrose is a carbohydrate like glucose, your body absorbs these calories, decreasing your need to consume carbohydrates in food. These excess calories can affect weight control and blood sugar management. This means only 35-40% of your total daily calories should come from carbohydrate foods while on PD, because 15% of your calorie needs will be absorbed from the dialysate. The rest of your calories should come from protein foods and fat. For example, if you need 2,000 calories per day, 700-800 calories should come from carbohydrate foods. This equals 175-200 grams of carbohydrate a day. Approximately 300 calories are provided from the dialysate throughout the day.

The percentage of dextrose in your dialysate and the type of PD you choose — continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) — may affect how many calories your body absorbs. This table shows how many calories you may absorb per liter:

Consider which type of dextrose you use for treatment and how many bags you use each day. You may gain weight if you use too much of the more concentrated solution. Your dietitian and health care team can assist you in maintaining weight and blood sugar control and optimizing the appropriate treatment for you.

Summary

Carbohydrates are important when you’re on the kidney diet. Carbohydrate foods can give you the energy you need to go about your daily activities. Whether you have early stage kidney disease, are on a particular type of dialysis treatment or have diabetes will determine how many carbohydrates you should have per day. Work with your dietitian on deciding which carbohydrates are best for your kidney diet.