Nutrition for Later Chronic 

Kidney Disease in Adults 

National Kidney and Urologic Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

U.S. Department 

of Health and 

Human Services 

As kidney disease progresses, nutritional 

needs change as well. If you have reduced 

kidney function, your doctor may recommend that you change your diet to protect 

your kidneys. 

You can prevent or delay health problems 

from chronic kidney disease (CKD) by eating the right foods and avoiding foods high 

in phosphorus, potassium, and sodium. 

Eating too much protein can also burden 

the kidneys and speed the progression of 

CKD. Protein foods like meat and dairy 

products break down into nitrogen and 

creatinine, waste products that healthy 

kidneys remove from the blood. But diseased kidneys can’t stop waste products 

from building up in the blood and causing 

health problems. 

With reduced kidney function, you may 

need to start paying attention to the protein, phosphorus, sodium, and potassium 

content of the foods you eat. Learning 

about your food will help you understand 

what changes you need to make. 

Calories 

Calories are units of energy provided by 

food. Work with your dietitian to determine how many calories you need each 

day to maintain a healthy weight. 

As CKD progresses, you may find that 

foods do not taste the same, and you may 

lose your appetite. Your dietitian can help 

you find healthy ways to add calories to 

your diet if you are losing too much weight. 

Protein 

Protein is an essential part of any diet. Proteins help build and maintain muscle, bone, 

skin, connective tissue, internal organs, and 

blood. They help fight disease and heal 

wounds. But proteins also break down into 

waste products that must be cleaned from 

the blood by the kidneys. Eating more protein than your body needs may put an extra 

burden on the kidneys and cause kidney 

function to decline faster. 

Doctors have long recommended that 

patients with CKD eat moderate or reduced 

amounts of protein. Some worried, however, that restricting protein would lead 

to malnutrition in many patients. In the 

1990s, a major clinical trial measured the 

benefits and dangers of protein restriction 

for kidney patients. The Modification of 

Diet in Renal Disease (MDRD) Study 

assigned groups of CKD patients to diets 

with different levels of daily protein intake. 

The study found that patients who succeeded in reducing their daily protein intake by 

0.2 grams for each kilogram of body weight 

for 1 year had healthier levels of bicarbonate, phosphorus, and urea nitrogen in their 

blood. 

For example, a man who weighs 154 

pounds (70 kilograms) and who normally 

eats 56 grams of protein a day would have 

to reduce his protein intake to 42 grams a 

day. To cut back on protein, he might eat 

oatmeal at breakfast (6 grams of protein) 

instead of a bacon, egg, and cheese sandwich (18 grams of protein). 
Medical Nutrition Therapy 

Figuring out what to eat can be tricky at 

first. You may need to cut down on foods 

you’ve always considered healthy, like 

fruits and vegetables. First, you need to 

learn how certain foods affect your kidneys and how reduced kidney function 

changes the way your body uses food. 

Then learn about the nutritional content 

of foods so you can recognize foods that 

are acceptable and foods that contain the 

substances you need to limit or avoid, like 

sodium, phosphorus, and potassium. 

Working with a dietitian can help you 

understand how foods affect your health. 

Ask the dietitian to review your lab 

reports for problems that you can address 

by changing your diet. For example, your 

lab report might show a high level of 

phosphorus in your blood. Your dietitian 

can show you how to lower your phosphorus level by avoiding high-phosphate 

foods like dairy products, nuts and peanut 

butter, beer, cola, canned iced teas and 

lemonade, and certain vegetables. 

Together, you can plan meals that fit your 

habits and your preferences but also provide the nutrition you need and avoid or 

restrict the foods that can cause problems. 

Ask your doctor to refer you to a dietitian 

who specializes in nutrition for people 

with chronic kidney disease. The dietitian’s fee may be covered by your health 

insurance. Check with your insurance 

provider. You may need a referral from 

your doctor. If you qualify for Medicare, 

you can receive a benefit for medical 

nutrition therapy (MNT) from a registered dietitian or nutrition professional 

when your doctor provides a referral 

indicating that you have diabetes or 

kidney disease. Medicare covers 80 percent of the Medicare-approved amount 

for MNT after you have paid the $100 

deductible for Part B services. 

One way to locate a qualified dietitian 

is to consult the American Dietetic Association website at www.eatright.org, which 

features a “Find a Nutrition Professional” 

page. Users can enter their address or 

ZIP code and a list of dietitians in that 

area will appear. Click on “Renal nutrition” in the specialty field. 

2 Nutrition for Later Chronic Kidney Disease in Adults 
The typical American diet contains more 

than enough protein. Most people can get 

the protein they need by eating two 3­

ounce servings of meat or meat substitute 

each day. Learning about portion sizes 

can help you limit your protein intake. 

What’s the Right Size? 

A 3-ounce serving of meat is about the 

size of a deck of cards or the palm of 

your hand. You can moderate your 

protein intake by limiting meat in your 

diet to two 3-ounce servings each day. 

Talk with your dietitian about the amount 

of protein and the sources of protein in 

your diet. Animal sources such as egg 

whites, cheese, chicken, fish, and red meats 

contain more of the essential amino acids 

your body needs. A well-balanced vegetarian meal plan can also provide these 

nutrients. Your dietitian can suggest ways 

to make small adjustments in your eating 

habits that can result in significant protein 

reduction. For example, you can make 

sandwiches using thinner slices of meat 

and filling out the sandwich with lettuce, 

pickles, cucumber slices, apple slices, and 

other garnishes. 

Protein Content of Foods 


High-Protein 

Foods 

Ground beef 

Halibut 

Salmon 

Tuna 

Chicken breast 

Chili con carne 

Lower Protein 

Alternatives 

Egg substitutes 

Shrimp 

Tofu 

Imitation crab meat 

Chicken drumstick 

Beef stew 

Source: United States Department of Agriculture 

(USDA) National Nutrient Database for Standard 

Reference, Release 17–1 (www.nal.usda.gov/fnic/ 

foodcomp/Data/SR17/wtrank/sr17a203.pdf; accessed 

June 2, 2005) 

Sources of Fats 


Bad Fats 

Saturated fats 

• Red meat 

• Poultry 

• Whole milk 

• Butter 

• Lard 

Trans-fatty acids 

• Commercial baked 

goods 

• French fries 

• Doughnuts 

Hydrogenated 

vegetable oils 

Good Fats 

Monounsaturated fats 

• Corn oil 

• Safflower oil 

• Olive oil 

• Peanut oil 

• Canola oil 

3 Nutrition for Later Chronic Kidney Disease in Adults 

Fat 

Fat provides energy, helps produce 

hormone-like substances that regulate 

blood pressure and other heart functions, 

and carries fat-soluble vitamins. You need 

fat in your diet, but some fats are healthier 

than others. Saturated fats and trans-fatty 

acids can raise your blood cholesterol levels 

and cause clogging of blood vessels. 

Talk with your dietitian about healthy and 

unhealthy sources of fat. Saturated fats are 

found in animal products like red meat, 

poultry, whole milk, and butter. These 

fats are usually solid at room temperature. 

Trans-fatty acids are often found in commercial baked goods like cookies and cakes 

and in fried foods like doughnuts and 

french fries. 

Your dietitian can suggest healthy ways to 

get fat into your diet, especially if you need 

more calories. Vegetable oils like corn or 
safflower oil are healthier than animal fats 

like butter or lard. Avoid hydrogenated 

vegetable oils because they are high in 

trans-fatty acids. Monounsaturated fats— 

olive, peanut, and canola oils—are healthy 

alternatives to animal fats. 

Sodium 

Sodium is found in ordinary table salt and 

many salty seasonings like soy sauce and 

teriyaki sauce. Canned foods, some frozen 

foods, and most processed meats have large 

amounts of table salt. Snack foods like 

chips and crackers are also high in salt. 

Too much sodium in your diet can be 

harmful because it causes your blood to 

hold fluid. The extra fluid raises your 

blood pressure and puts a strain on your 

heart and kidneys. 

Talk with your dietitian about ways to 

reduce the amount of sodium in your diet. 

Look for the sodium content on the nutrition labels of the foods you buy. Choose 

“sodium-free” or “low-sodium” food products. Aim to keep your daily sodium intake 

less than 1,500 milligrams. 

Try alternative seasonings like lemon juice, 

salt-free seasoning mixes, or hot pepper 

sauce. But avoid salt substitutes that use 

potassium. 

Sodium Content of Foods 

High-Sodium 

Foods 

Salt 

Canned vegetables 

Hot dogs 

Packaged rice with 

sauce 

Packaged noodles 

with sauce 

Frozen vegetables 

with sauce 

Canned soup 

Tomato sauce 

Snack foods 

Lower-Sodium 

Alternatives 

Salt-free herb seasonings 

Frozen vegetables 

Plain rice 

Plain noodles 

Unsalted pretzels 

Unsalted popcorn 

Source: United States Department of Agriculture 

foodcomp/Data/SR17/wtrank/sr17a307.pdf; accessed 

June 3, 2005) 

(USDA) National Nutrient Database for Standard 

Reference, Release 17–1 (www.nal.usda.gov/fnic/ 

Potassium 

Potassium is found in many fruits and 

vegetables, such as bananas, potatoes, 

avocados, and melons. Check your blood 

tests to make sure that your potassium level 

stays in the normal range. If it begins to 

climb, talk with your dietitian about ways 

to limit the amount of potassium you eat. 

You may need to avoid some fruits and 

vegetables. You can reduce the potassium 

content of potatoes by soaking them in 

water for several hours before cooking. 

4 Nutrition for Later Chronic Kidney Disease in Adults 
Source: United States Department of Agriculture 

foodcomp/Data/SR17/wtrank/sr17a306.pdf; accessed 

June 3, 2005) 

Oranges and 

orange juice 

Melons 

Apricots 

Banana 

Kiwi 

Sweet potatoes 

Cooked spinach 

Beans (baked, 

kidney, lima, pinto) 

Apples and apple juice 

Cranberry juice 

Canned fruit 

Strawberries, blueberries, 

raspberries 

Plums 

Cabbage 

Cauliflower 

Mustard greens 

Broccoli 

Potassium Content of Foods 

(USDA) National Nutrient Database for Standard 

Reference, Release 17–1 (www.nal.usda.gov/fnic/ 

High-Potassium 

Foods 

Lower-Potassium 

Aternatives 

Potatoes 

Tomatoes 

Pineapple 

Phosphorus 

Phosphorus is a mineral found in many 

foods. Too much phosphorus in your blood 

pulls calcium from your bones. Losing calcium will make your bones weak and likely 

to break. Too much phosphorus may also 

make your skin itch. Foods like milk and 

cheese, dried beans, peas, colas, canned 

iced teas and lemonade, nuts, and peanut 

butter are high in phosphorus. Talk with 

your dietitian about how much phosphorus 

you should have in your diet. 

As your kidney disease progresses, you may 

need to take a phosphate binder like sevelamer hydrochloride (Renagel), calcium 

acetate (PhosLo), or calcium carbonate 

(Tums) to control the phosphorus in your 

blood. These medications act like sponges 

to soak up, or bind, phosphorus while it is 

in the stomach. Because it is bound, the 

phosphorus does not get into the blood. 

Instead, it is passed out of the body in the 

stool. 

Fluids 

As your kidney disease progresses, you 

may need to limit how much you drink 

because your kidneys can’t remove the 

extra fluid, so it builds up in your body and 

strains the heart. Tell your doctor if you 

notice you are making either less urine or 

more urine or if you have any swelling 

around your eyes or in your legs, arms, 

or abdomen. 

Source: United States Department of Agriculture 

foodcomp/Data/SR17/wtrank/sr17a305.pdf; accessed 

June 3, 2005) 

Alternatives 

Dairy foods (milk, 

cheese, yogurt) 

Beans (baked, kidney, 

lima, pinto) 

Nuts and peanut 

butter 

dogs, canned meat) 

Cola 

Canned iced teas and 

lemonade 

Bran cereals 

Egg yolks 

Liquid non-dairy 

creamer 

Sherbet 

Rice and corn cereals 

Green beans 

lemonade mixes 

Phosphorus Content of Foods 

(USDA) National Nutrient Database for Standard 

Reference, Release 17–1 (www.nal.usda.gov/fnic/ 

High-Phosphorus 

Foods 

Lower-Phosphorus 

Processed meats (hot 

Pasta rice 

Popcorn 

Lemon-lime soda 

Root beer 

Powdered iced tea and 

5 Nutrition for Later Chronic Kidney Disease in Adults 
Keep Track of Test Results 

If you have CKD, your doctor will order 

regular blood tests. Many patients find that 

keeping track of their test results helps 

them see how their treatment is working. 

Ask your doctor for copies of your lab 

reports and ask to have them explained. 

Note any results that are out of the normal 

range. When you learn how to read your 

reports, you will see how the foods you eat 

affect your kidneys. Talk with your doctor 

or your dietitian about what you can do to 

make healthier food choices. Remember 

that you are the most important member 

of your health care team. 

Hope Through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

has many research programs aimed at 

slowing the progression of chronic kidney 

disease. For example, the NIDDK is sponsoring the Chronic Renal Insufficiency 

Cohort study to determine the risk factors 

for rapid decline in kidney function and 

development of cardiovascular disease. 

This study of about 3,000 patients with 

chronic renal insufficiency, another way 

of describing CKD, will reflect the racial, 

ethnic, and gender composition of the 

people in the United States who have permanent kidney failure. The data collected 

and specimens obtained from people in this 

study will serve as a national resource for 

investigating CKD as well as cardiovascular 

disease. Establishing this group of patients 

and following them into the future will also 

provide an opportunity to examine genetic, 

environmental, behavioral, nutritional, 

quality-of-life, and health resource use 

factors in this population. The main part 

of the study will consist of monitoring 

patients and following up at regular clinic 

visits with kidney function measurements, 

cardiovascular studies, and laboratory tests. 

In addition, participants will answer questionnaires to assess various demographic, 

nutritional, and quality-of-life factors. 

The U.S. Government does not endorse or favor 

any specific commercial product or company. 

Trade, proprietary, or company names appearing 

in this document are used only because they are 

considered necessary in the context of the 

information provided. If a product is not 

mentioned, the omission does not mean or 

imply that the product is unsatisfactory. 

6 Nutrition for Later Chronic Kidney Disease in Adults 
Additional Reading 

The following fact sheets and brochures, as 

well as other information, are available on 

request from the organizations listed. Most 

of them can also be found online at the web 

address given. 

Dining Out With Confidence: A Guide for 

Patients with Kidney Disease 

Nutrition and Chronic Kidney Disease 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 212–889–2210 

Email: info@kidney.org 

Internet: www.kidney.org 

Facts About the DASH Eating Plan 

National Heart, Lung, and Blood Institute 

Information Center 

P.O. Box 30105 

Bethesda, MD 20824–0105 

Phone: 301–592–8573 

TTY: 240–629–3255 

Fax: 301–592–8563 

Internet: www.nhlbi.nih.gov 

A Healthy Food Guide for People with 

Chronic Kidney Disease 

American Dietetic Association 

120 South Riverside Plaza 

Suite 2000 

Chicago, IL 60606–6995 

Phone: 1–800–366–1655 

Email: knowledge@eatright.org 

Internet: www.eatright.org 

Kidney Beginnings: A Patient’s Guide to 

Living with Reduced Kidney Function 

American Association of Kidney Patients 

3505 East Frontage Road 

Suite 315 

Tampa, FL 33607 

Phone: 1–800–749–2257 or 813–636–8100 

Email: info@aakp.org 

Internet: www.aakp.org 

For More Information 

American Kidney Fund 

6110 Executive Boulevard 

Suite 1010 

Rockville, MD 20852 

Phone: 1–800–638–8299 or 301–881–3052 

Email: helpline@akfinc.org 

Internet: www.kidneyfund.org 

Food and Nutrition Information Center 

National Agricultural Library/USDA 

10301 Baltimore Avenue, Room 304 

Beltsville, MD 20705–2351 

Phone: 301–504–5719 

Email: fnic@nal.usda.gov 

Internet: www.nal.usda.gov/fnic 

Life Options Rehabilitation Resource 

Center 

c/o Medical Education Institute, Inc. 

414 D’Onofrio Drive 

Suite 200 

Madison, WI 53719 

Phone: 1–800–468–7777 

Email: lifeoptions@MEIresearch.org 

Internet: www.lifeoptions.org 

National Kidney Disease Education 

Program 

3 Kidney Information Way 

Bethesda, MD 20892 

Phone: 1–866–4–KIDNEY (454–3639) 

Email: nkdep@info.niddk.gov 

Internet: www.nkdep.nih.gov 

The information in this fact sheet should not 

be used in the nutritional counseling of infants, 

children, and adolescents with chronic kidney 

disease. Families of pediatric patients with 

CKD should seek age-appropriate nutritional 

counseling from a pediatric renal dietitian. 

7 Nutrition for Later Chronic Kidney Disease in Adults 
About the Nutrition for 

Chronic Kidney Disease Series 

The NIDDK Nutrition for Chronic Kidney 

Disease Series includes three fact sheets: 

•	 Nutrition for Early Chronic Kidney 

Disease in Adults 

•	 Nutrition for Later Chronic Kidney 

Disease in Adults 

•	 Nutrition in Children with Chronic
 

Kidney Disease
 

For free single printed copies of this 

series, please contact the National Kidney and Urologic Diseases Information 

Clearinghouse. 

National Kidney and 

Urologic Diseases 

Information Clearinghouse 

3 Information Way
 

Bethesda, MD 20892–3580
 

Phone: 1–800–891–5390
 

Fax: 703–738–4929
 

Email: nkudic@info.niddk.nih.gov
 

Internet: www.kidney.niddk.nih.gov
 

The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is a 

service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK). 

The NIDDK is part of the National Institutes 

of Health under the U.S. Department of Health 

and Human Services. Established in 1987, the 

Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to 

their families, health care professionals, and the 

public. The NKUDIC answers inquiries, develops and distributes publications, and works 

closely with professional and patient organizations and Government agencies to coordinate 

resources about kidney and urologic diseases. 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. This fact sheet was 

reviewed by Lisa Murphy-Gutekunst, MSEd, 

RD, CSR, Cleve-Hill Dialysis, Buffalo, NY; and 

Marcy Bushman, MPH, RD, LDN, Sigma-Tau 

Pharmaceuticals. 

This publication is not copyrighted. The 

Clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.kidney.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 06–5572 

January 2006