“Excuse Me, But Which Aisle Has the Kidney‐Friendly Foods?” (2007)

Ayoung mother with diabetes; a small-town history teacher with high blood pressure; a defense attorney with celiac disease; a nut-allergic teenager … all go to the supermarket. Each can easily find foods-sometimes even entire shelves-designed or labeled to help them manage their conditions. However, when a 70-year-old grandmother with chronic kidney disease (CKD) goes to the market, she is out of luck. She faces continued hurdles in determining what she should and should not buy in each and every aisle, in each and every food category. These daily obstacles need to be—and can be—overcome. Why is this so vital to us and our CKD population? Several studies have shown that serum phosphorus level correlate directly with increased risk of morbidity and mortality in people with CKD.1-4 K/DOQI guidelines and the work of scientists and leading healthcare clinicians have reinforced the need for our patients to control dietary intake of phosphorus in order to minimize that increased risk.5-7 Now, new long-term data from Framingham Offspring Study participants suggest that elevated serum phosphorous, even in persons without CKD or cardiovascular disease, is associated with an increased risk of cardiovascular disease.8 All of us who treat and support patients with impaired kidney function have been told directly by our patients that they have the hardest time controlling their phosphorus. We need not let this situation continue. All of us who treat and support patients with impaired kidney function have been told directly by our patients that they have the hardest time controlling their phosphorus. We need not let this situation continue. We can increase their dietary satisfaction and enjoyment every day; we can help with their diet and make their efforts to comply far easier. It starts with a simple idea: the “Kidney-Friendly Shelf,” a collection of foods nutritionally appropriate for kidney health and for people with kidney disease gathered in one place in the supermarket. We know that having a convenient welcoming location will be of great value to people with CKD, giving them easy access to products that are kidney friendly and that have the same great taste with less phosphorus and lower sodium and potassium. With so much available evidence that these foods are a medical necessity for people with CKD, we all need to let supermarkets know that the Kidney-Friendly Shelf offers serious value for them, too. Maintaining a Kidney-Friendly Shelf means little or no additional expenses for supermarkets, it provides customers with healthful and clear-cut choices in one specialty location and promotes sales, and it will increase inhouse pharmacy revenues by attracting new and retaining existing pharmacy customers. The foundation of the Kidney-Friendly Shelf should be existing supermarket shelfstable packaged products along with new foods designed specifically for nutrition and kidney health such as DairyDelicious brand low phosphorus milk and very low phosphorus, low sodium cheddar cheese sauce. As technology and innovation expand, it is hoped this will be just the beginning of products designed to improve the lives of people with CKD. Table I is a product list that includes examples of more than 80 shelf-stable products (brand independent) that might be included on the Kidney-Friendly Shelf. This list is changeable, may be adapted for regional tastes, and should be adjusted for modification in product formulation. Wegmans in the Northeast, and Meijer in the Midwest, among others, already have separate gluten-free shelves in many of their stores. Further, ShopRite has developed a system of color-coding shelf labels to indicate items appropriateness for different conditions. One in nine adults has CKD-11% of the adult population.12 That is more than 10 times the number of people with gluten intolerance and more than the number of those currently diagnosed with diabetes. 13,14 Supermarkets have already determined that it is good business to promote products and brands that address these specific conditions and their (smaller) populations. By establishing a Kidney- Friendly Shelf, they have an immediate opportunity both to provide an important service to their customers and to increase their business. They will be positioned to enjoy that ideal of commerce: Do well by doing good. Food merchandisers and manufacturers will not know about the needs of people with CKD and the Kidney-Friendly Shelf if the nephrology community at large does not educate them. A quick talk with a store manager bringing along the Kidney-Friendly Shelf product list is a start; a brief letter to a chain's headquarters will help. I hope this editorial is a successful call to action to join in an effort to place shopping for kidney health and nutrition on par with food shopping for diabetes, food allergies, and cardiovascular health.