Best Diet for Kidney Disease

What diet is best for kidney disease? According to the American Society for Nutrition, “The renal diet is commonly recommended for those with late stages of chronic kidney disease and end-stage kidney disease.” Many people with these kidney conditions are undergoing renal replacement therapy, also called hemodialysis, but additionally require dietary changes in order to avoid potentially serious complications.

Renal diet - Dr. Axe

What do you eat on a renal diet? Among kidney expects, this is actually a point a controversy, since there are a number of renal diet restrictions that are now being questioned. While the renal diet has been used for many years to reduce complications among people with kidney disease, the diet is restrictive and not without criticism.

There’s growing concern that renal diet restrictions limit intake of important micronutrients (vitamins and minerals), polyphenols, and dietary fiber, since many foods that need to be reduced/avoided are good sources of these essential nutrients. For example, a traditional renal diet involves avoidance or limitations of food group including fruits, vegetables, whole grains, legumes, beans and nuts — and recent research shows this can increase the risk for other health problems tied overall low nutrient intake.

Some practitioners now feel that the “kidney disease diet” is not only too restrictive, hard to prescribe and difficult for patients to follow, but also counterproductive. Therefore, alternative diets, such as the Mediterranean diet or DASH diet, are now recommended as better approaches for managing kidney disease.

What Is a Renal Diet?

Unfortunately there is no permanent treatment/cure for kidney failure, only strategies to keep someone with kidney disease as stable and healthy as possible. One of these strategies is following a kidney disease diet that limits intake of certain nutrients, in order to cut down on the amount of waste in their blood. (1) That’s because the kidneys are needed to properly balance ratios of water, salt and other minerals (called electrolytes) in the blood — therefore, kidney dysfunction can lead to abnormal mineral levels.

What does a renal diet mean? A renal diet eating plan (also called a kidney disease diet) is one that restricts sodium, potassium and phosphorus intake, since people with kidney disease/kidney issues need to monitor how much of these nutrients they consume. These three micronutrients can accumulate in the blood and contribute to problems like high blood pressure (hypertension), swelling and fluid retention, heart arrhythmias (irregular heartbeats), bone disorders, and vascular calcifications. (2)

Based on recent research findings, some experts worry that prescribing the “traditional renal diet” to patients encourages them to eat “Western-type diets” instead that are high in red meat, packaged products made with lots of preservatives and additives, and foods made with refined grains and sugars.

A newer approach that is now being studied and encouraged for patients with kidney issues is the Mediterranean diet. For example, the European Renal Association-European Dialysis and Transplantation Association now recommends a Mediterranean diet eating pattern rather than a traditional renal diet because it includes more nutrient-dense foods, such as a wider variety of vegetables and legumes, and is more flexible. Certain studies have also found benefits of plant-based diets that limit protein and sodium among people with chronic kidney disease. (3)

Signs and Symptoms of Kidney Issues

What is renal failure (also called kidney failure), and what are some symptoms that someone might be experiencing it? Kidney failure occurs when the kidneys stop working well enough to keep someone alive. This condition is characterized as “sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes and maintain fluid balance.”

Acute kidney injury (also called acute renal kidney failure) is the term commonly used to describe patients whose kidneys suddenly stop functioning as they normally should. Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of normal/healthy kidney function.

Some patients with kidney issues or even kidney disease won’t experience any obvious symptoms. However, if sudden “failure” of the kidneys occurs, this quickly becomes an emergency situation as symptoms tend to progress quickly.

Kidney disease symptoms tend to worsen with time and can begin with: (4)

Nausea, vomiting and loss of appetite
Fatigue and weakness
Sleep problems
Swelling
Changes in how much you urinate
Muscle twitches and cramps
Chest pain
Shortness of breath
High blood pressure (hypertension)

Kidney failure symptoms normally include:

Kidney pain, which feels like throbbing or tenderness below the rib cage or in the back/abdomen (sometimes called “flank pain”)
Producing less urine than usual or sometimes not at all. A warning side of kidney disease, however, may be frequent urination, sometimes with blood or other color changes.
Fluid retention and swelling due to imbalance of electrolytes, especially in the lower extremities, such as the legs, ankles or feet. The face and eyes may also appear puffy and swollen.
Indigestion, nausea, loss of appetite and sometimes vomiting
High blood pressure
Cognitive and mood changes, mostly due to shifting electrolyte levels and dehydration. These can include confusion, trouble sleeping, anxiety, fatigue, trouble concentrating, weakness and brain fog.

What increases someone’s risk for kidney issues? Risk factors for experiencing kidney disease/kidney failure include:

Having a history of diabetes, anemia, high blood pressure, heart disease or heart failure.
Consuming an unhealthy diet
Being very overweight or obese.
Being an older adult.
Having a history of prostate disease (an enlarged prostate), liver damage or liver disease.
Experiencing trauma or an injury to the kidneys that causes sudden blood loss.
Having low immune function due to another illness.
Being treated in a hospital or intensive care unit, such as having surgery or undergoing an organ/bone marrow transplant.
Taking medications that can sometimes lead to kidney problems, such as antibiotics, painkillers, blood pressure drugs or ACE inhibitors.
In rare cases, kidney disease can be caused by a kidney infection, or pyelonephritis, a type of urinary tract infection that can be triggered by bacteria or a virus. It often begins in the urethra or bladder and then travels to one or more kidneys. If a kidney infection develops, symptoms can include: fever, back and side pain, frequent urination, nausea, and blood in the urine.

Stats/Facts on Renal Failure

In the U.S., about 13 percent of the adult population has some sort of kidney disease, and this number is expected to rise with the growing elderly population. (5) Chronic kidney disease is a major risk factor for kidney failure.
Experts report that there are five primary complications associated with chronic kidney diseases: anemia, hyperlipidemia, poor nutrition, cardiovascular disease risk factors and osteodystrophy (abnormal growth of bone mass associated with disturbances in calcium and phosphorus metabolism). (6)
Dialysis is one treatment option for those with kidney failure, which is needed when a patient has only 10 percent to 15 percent of normal kidney function left. The United States Renal Data System estimates that 382,000 patients with end stage kidney disease are currently receiving some form of dialysis. Many dialysis patients have food restrictions related to other health problems, such as diabetes or anemia.
Acute kidney failure is a serious condition; if a patient ends up in intensive care due to acute kidney failure studies show that chance of mortality is between 50 percent to 80 percent. (7)
Kidney stones are a prevalent health problem. It’s estimated that one in 10 people will deal with a painful kidney stone at one point in their lives. (8) Kidney stone symptoms include pain in the back or side part of the body, nausea or vomiting, fever, blood in urine and/or frequent urination and sweating. The main causes of kidney stones include: eating a poor diet (especially one that’s high in oxalates), taking synthetic calcium supplements, genetic factors, food allergies or sensitivities, electrolyte imbalances, obesity and medication or drug use.

Renal Diet Foods List

If you intend to follow a healthy renal diet plan, the first step to take is to stock your kitchen with the right foods. You’ll also need to educate yourself on renal diet restrictions and be careful to avoid foods that contribute too much sodium, potassium and phosphorus to your diet.

In recent years, advice about the best diet for people with kidney disease has started shifting. A 2017 study published in the Clinical Journal of the American Society of Nephrology found that “healthy dietary patterns,” as opposed to a traditional renal diet, were associated with lower mortality in people with kidney disease. Healthy eating patterns referred to diets that included fruits and vegetables, fish, legumes, whole grains and high-fiber foods, while also limiting red meat, sodium and refined sugar intake.

This finding is noteworthy because it goes against the traditional renal diet guidelines that were recommended in the past. (9) Recent findings from the DIET-HD multi-national cohort study that included over 8,000 hemodialysis patients also showed that a high adherence to the Mediterranean or DASH-type diet was not associated with reduced cardiovascular mortality or all-cause mortality, and actually helped reduce mortality risk. (10)

Based on the latest research, here are renal diet foods to eat: (11)

A variety of vegetables, including leafy greens, raw veggies and cooked veggies (aim for variety). Beets/beet juice, greens like spinach, tomatoes, purple potatoes, seaweeds and celery are some of the best choices. However be aware that depending on the severity of your condition, your doctor might advise that you avoid veggies and fruits that are very high in potassium (for example, avocado, cantaloupe, honeydew, bananas, oranges, fruit juices, tomatoes, beans, etc.)
A variety of fruits, especially those high in antioxidants like cranberries, black cherries and blueberries. These dark “superfruits” are nutrient-dense and may help fight kidney infections. Drinking cranberry-lingonberry juice concentrate is another option. Consuming lemon/lime juice is also helpful for its cleansing effects.
100% whole grains, although fortified grains may contribute too many minerals to your diet
Organic milk and dairy products, including yogurt, kefir and aged cheeses
Grass-fed, quality meats, poultry, and fish. Protein powder, such as collagen powder or protein powder made from bone broth, are also good options.
Eggs
Nuts, seeds, and legumes (4–5 servings per week)
Healthy fats and oils, including coconut oil, olive oil, grass-fed butter and ghee
Foods to shown to help lower blood pressure, including: pomegranate juice, greens, coriander, beetroot juice, dark chocolate, flax seed, sesame oil and hibiscus tea
Fresh herbs and spices, including: oregano, turmeric, ginger, cinnamon, parsley, rosemary, etc.
Also be sure to drink enough water and hydrating fluids, including herbal tea, sparkling water or fruit-infused water

And here are renal diet foods and ingredients to avoid: (12)

Kosher salt, sea salt and other flavored salts such as garlic salt, onion salt or “seasoned” salt
Processed meats including cold cuts, ham, bacon, sausage, hot dogs, lunch meats, and chicken tenders or nuggets. Many refrigerated or frozen meats that are packaged “in a solution” are also high in sodium, such as chicken breasts, pork chops, pork tenderloin, steaks or burgers.
Most canned soups and frozen meals, which have high sodium levels.
Packaged instant rices.
Many condiments, including mustards, relish and soy sauce.
Refined oils like soybean, safflower or sunflower oil.
Beer and soda (especially Mountain Dew®, root beers, Dr. Pepper®, Hawaiian Punch®, Fruitworks®, Cool® iced tea, and Aquafina® tangerine pineapple).
A traditional renal diet limited intake of high-potassium foods, although there’s now some controversy over whether this is necessary and beneficial. Potassium is found mainly in fruits, vegetables, dairy products/milk and meats. It’s best to discuss with your doctor if you can still tolerate potassium-rich foods including: cantaloupe, honeydew, bananas, oranges, fruit juices, tomatoes, beans, pumpkin, winter squash, potatoes, bran cereal, and greens like collards, spinach, kale and Swiss chard. These are very healthy foods normally, so if possible, you want to keep them in your diet.
Can you eat potatoes on a renal diet? Potatoes and sweet potatoes contain a good amount of potassium, but can usually be eaten in amounts, especially if you peel them and cook them thoroughly.
Your doctor may recommend avoiding certain foods that are high in oxalic acid (spinach, rhubarb, tomatoes, collards, eggplant, beets, celery, summer squash, sweet potatoes, peanuts, almonds, blueberries, blackberries, strawberries, parsley and cocoa).
To avoid consuming too much phosphorus and potassium, limit intake of milk/dairy products to one cup per day.
To avoid getting too much phosphorus, limit dried beans, greens, broccoli, mushrooms and Brussels sprouts to one cup per day. High phosphorus foods that you should consume in small amounts only include: lima, black, red, white, kidney and garbanzo beans, most grains, chocolate, dried vegetables and fruits, and sodas.
Avoid having more than one cup of bran, wheat cereals, oatmeal or granola daily, which tend to be fortified.

Although this approach alone isn’t enough to manage kidney disease, doing a “kidney cleanse” is beneficial if you’ve ever suffered with any type of kidney infection, any type of fluid retention, urinary tract infections or kidney stone symptoms. In order to help nourish the kidneys, you consume herbs, fruits and vegetables that have anti-inflammatory effects. In addition to eating the foods recommended above, three herbs that can benefit the kidneys include: stinging nettle, burdock and rehmannia.

Stinging nettle is really high in vitamin C and may help flush extra fluids through the kidneys.
Burdock root/burdock root tea acts as a diuretic and stimulates the kidneys to get rid of excess fluid, mainly water and sodium.
Rehmannia is a Traditional Chinese Medicine herb that’s believed to help cleanse the kidneys.
However, if you have chronic kidney disease or serious issues with fluid retention, you should ask your doctor about trying these supplements before starting to use them.

Renal Diet Protocol and Eating Plan

Here is an overview of the renal diet guidelines:

Limit or monitor your intake of foods with sodium, potassium and phosphorus. Try to cook at home more and avoid eating out/eating convenience foods, which are typically high in sodium/salt. Do not use salt when cooking food or add extra salt to meals.
Avoid high-sodium foods (many packaged foods) by carefully reading labels. Skip any food that has more than 300 milligrams sodium per serving. A good rule of thumb is to “avoid foods that have salt in the first 4 or 5 items in the ingredient list.” (13) Instead, look for lower salt or “no salt added” options or trying making your favorite meals at home.
To help manage blood sugar levels, eat “balanced meals” that include a source of protein, healthy fat and complex carb.
To avoid getting too much of one mineral, eat a wide variety of fruits and vegetables. This provides you with nutrients without overloading how much potassium you’re consuming.
To make meals taste better without adding salt, add herbs and spices — like black pepper, red pepper flakes, cumin, chili powder, garlic and onion (both granulated), dried oregano, smoked paprika, fresh cilantro, fresh basil, fresh scallions, fresh lemon and lime zest, and rosemary.
Limit milk to 1 cup per day, or 1 serving of yogurt/1 ounce of cheese.
Stick with whole foods, since packaged foods commonly contain phosphate additives.
Talk to your doctor about whether you need to limit protein intake, since this depends on the specific patient. In the early stages of chronic kidney disease, you may need to limit the amount of protein you eat. If you need to start dialysis treatments, you may have to eat more protein than before. (14)
You should also speak with your doctor about how much fluids you should be consuming, since some patients need to decrease fluid intake and other need to increase it.

Here is an example of a renal diet menu:

Breakfasts: whole grain pancakes topped with ¼ cup walnuts and 1 cup fruit, plus 8 ounces of milk or plain yogurt; 2 eggs with cooked greens and 1 piece of toast or 1 cup homemade hash brown potatoes; smoothie made with collagen protein, berries, spinach and yogurt/milk; 8 ounces plain yogurt, ½ cup blueberries, 2 tablespoons sliced almonds, ¼ cup granola.
Lunches: Salad with fish/chicken and dressed with olive oil and vinegar; 4 ounces tuna or salmon salad served with sweet potato and veggies.
Dinners: 4 ounces of fish or chicken salad with cooked veggies and 1/2 cup rice or quinoa; stew/soup made with meat and veggies and a side salad.
Snacks: fruit, yogurt, handful of nuts, protein smoothie or yogurt.

Recipes

The healthy renal diet recipes below are appropriate for people with kidney disease because they are free of foods that promote inflammation and other issues. Ideas for renal diet recipes include:

Risks and Side Effects

Remember that a number of factors influence the best type of kidney diet that someone can follow, including: the stage of their renal disease, type of treatment
they are on, and presence of other medical conditions.

Even though a healthy diet that is similar to the DASH diet or Mediterranean diet has been slow the progression of kidney disease and other diseases like heart disease too, some patients will still need to follow a special diet that is more restrictive. To be safe, always speak with your doctor before changing your diet, especially if you have chronic kidney disease. The DASH diet and Mediterranean diet are not intended for people on dialysis, who should work with a dietician to make sure they are managing their nutrient intake carefully.

Final Thoughts

The renal diet (kidney disease diet) is intended to help prevent complications in people with chronic kidney disease or kidney failure.
Kidney failure occurs when the kidneys aren’t able to filter the blood, leaving behind wastes and excess fluid. Risk factors include a history of kidney problems, being obese, eating an unhealthy diet, or having diabetes, heart disease, anemia and bone metabolism problems.
A traditional renal diet limited foods like vegetables, fruits, whole grains, beans and legumes in order to control mineral intake. The goal of the diet is to limit consumption of sodium, potassium and phosphorus, since the kidneys are needed to function properly to balance levels of these nutrients.
In recent years, experts have started recommending a different type of kidney diet, such as the Mediterranean diet or DASH diet. When following these healthy diets, renal diet recipes include a wider variety of veggies, fruits, whole grains, dairy products, nuts, beans and healthy fats.