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Chronic Kidney Disease

Good nutrition for those with Chronic Kidney Disease (CKD) is important.  However nutrition needs may vary at different stages of the disease.
 
CKD is classifield as Stage 1-5 (as determined by eGCF-estimated glomerular filtation rate - a measure of kidney function) with 5 being the most advanced.  If you are unsure as to the stage of CKD, then discuss this with your doctor.
 

CKD1-3

There is no renal specific dietary guidelines for CKD 1-3 so referral to a specialist renal dietitian is unncessary.  The main focus is to try and reduce the risk of cardiovascular disease.  A health eating diet and a body mass index within the normal range is recommended.
 
 
As devised by the Food Standards Agency, the eight tips for eating well include:
  1. Base your meals on starchy foods
  2. Eat lots of fruit and vegetables
  3. Eat more fish
  4. Cut down on saturated fat and sugar
  5. Try to eat less salt - no more than 6g/day
  6. Get active and try and be a healthy weight
  7. Drink plenty of water
  8. Don't skip breakfast
 
The eat well plate has been developed to show the types and proportions of food that we need to eat a healthy and balanced diet. 
 
 
If more depth dietary advice is needed (e.g. cholesterol lowering, weight management, diabetes) a referral should be made by your GP through the usual channels to a primary care dietitian, who is best placed to advise on these areas.  Occasionally hyperkalaemia (high levels of potassium in the blood) may occur, particularly in those treated with ACE inhibiytors (a blood pressure medication), and dietary advice about reducing potassium intake will be indicated.  Some first line advice is available at the link below.  However this should be followed up by referral to a dietitian in primary care.
 
 

CKD 4 & 5

 
Patients with this level of kidney disease are usually referred to, or discussed with, a specialist Renal Centre.  More specialist dietary support may be necessary for the management of hyperphosphataemia (high levels of phosphate in the blood), hyperkalaemia and poor appetite/under-nutrition problems.  Renal dietitians are best placed to manage these more complex diets as they are able to advide on suitable food choices while still ensuring an adequate nutritional intake.
 
HYPERPHOSPHATAEMIA
The kidneys control the amount of phosphate in the blood.  As the kidney function deteriorates, phosphate builds up and is associated with increased risk of death, renal bone disease and vascular and soft tissue calcification (hardening of the blood vessels and other body tissues).  It is therefore important that hyperphosphataemia is managed appropriately.  This can be done by reducing dietary phosphate intake.  Phosphate binder medications to reduce absorption of phosphate from the diet may also be ncessary.
 
Information about reducing dietary phosphate should be advised by a dietitian who is able to adapt the advice to individual needs as over-restriction of phosphate containing foods may lead to inadequate protein/calcium intakes.  Some basic information about phosphate rich foods can be found at the following link but referral to a dietitian is recommended for more details advice.
 
 
HYPERKALAEMIA
Potassium levels may rise as KCF progresses due to a reduction in the amount of potassium that can be lost in the urine.  This can trigger abnormal heart rhythms, which can be harmful.  Reducing dietary potassium intake can reduce potassium levels.  The following link will show some of the main sources of dietary potassium.  However to ensure the information is appropriate to the individual, referral to a dietitian is recommended.
 
 
 
POOR APPETITE/UNDESIRED WEIGHT LOSS
AS CKD progresses, waste products accumulate in the blood.  These can sometimes cause a reduced appetite.  Some people describe taste changes (a metallic taste) and others find they feel nauseous or actually vomit.  All of this can casue a reduction in food intake and therefore affect nutritional status - some people will lose weight.
 
Referral to a dietitian is recommended if any of the above problems are present.  The dietitian will be able to try and improve the quality of the food you are able to eat and/or recommend nutritional supplements to improve your nutritional intake.
 

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Related Links

 
  • Weight management groups 

ADULTS

  1. DHAL
  2. LEAP - link to poster giving more information

 

FAMILIES

  1. FLIC