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Cleveland Clinic. (2017). Renal Diet | Cleveland Clinic. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/15641-renal-diet-basics

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1. High-Sodium Foods:

Processed foods

Pickles

Processed meats

2. High-Potassium Foods:

Bananas

Oranges

Tomatoes

Potatoes

Dried fruits

3. High-Phosphorus Foods:

Dairy products

Nuts and seeds

Colas and dark sodas

Processed and fast foods

4. High-Protein Foods:

Red meat

Poultry

Dairy products

Eggs

5. Fluid-Rich Foods:

Watermelon

Cucumber

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1. Sodium:

Minimize salt intake, both in cooking and at the table.

2. Potassium:

Monitor and limit intake from high-potassium foods.

3. Phosphorus:

Restrict intake from high-phosphorus foods.

4. Protein:

Adjust protein intake based on individual needs and kidney function

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1. Low-Potassium Fruits:

Apples

strawberries

blueberries

Peaches

2. Low-Potassium Vegetables:

Cabbage

Green beans

Cauliflower

3. Low-Phosphorus Foods:

Rice

Pasta

Bread

4. Lean Proteins:

Fish

Poultry

Egg whites

5. Healthy Fats:

Olive oil

Avocados

Nuts

Make sure these are being eaten in moderation

6. Limited Dairy or Alternatives:

Choose lower-phosphorus dairy options

7. Herbs and Spices:

Use herbs and spices to add flavor

8. Grains:

Grains with lower phosphorus

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NephCure Kidney International ®. (2018). Nephcure.org. https://nephcure.org/livingwithkidneydisease/diet-and-nutrition/renal-diet/

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List THREE foods you should avoid with the renal diet, and then explain why this is.

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List THREE foods you should avoid with the renal diet, and then explain why this is.

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by

Polycystic Kidney Disease International, London NW1 0SE, UK

1. Introduction

'What can I do to manage my kidney disease to enable me to live well?' Every person affected by chronic kidney disease (CKD) and their family members/care givers wants the answer to this.

What does 'living well' mean to patients? This question was explored in an article published concurrently in many journals worldwide to raise awareness for World Kidney Day (WKD) in 2021. Kalantar-Zadeh et al. [ 1] described 'life participation' as one key to living well. Life participation, defined by the Standardised Outcomes in Nephrology Group (SONG) [ 2] is 'the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities', and should be considered a critically important patient-reported outcome (PRO) across all treatment stages of CKD. Other critically important PROs identified by SONG include fatigue, mortality, pain, and depression. Moreover, SONG has reported in other publications [ 3, 4] that patients (and caregivers) consistently gave a higher priority to these PROs than healthcare professionals.

Pharmaceutical, clinical, and surgical interventions such as dialysis and transplantation can, of course, deliver beneficial outcomes for patients. For example, fatigue caused by anaemia can be treated by iron or erythropoiesis-stimulating agents (ESA) therapies, pain by a variety of approved pharmaceutical and non-pharmaceutical treatments, depression by drugs or (cognitive behavioural therapy) CBT, and end-stage kidney disease (ESKD) by kidney replacement therapy (KRT). In addition to those listed above, a range of other 'unpleasant symptoms' has been reported by Kalantar-Zadeh et al. [ 5]. These include 'gastrointestinal, neurological, cardiopulmonary, sexual dysfunction, and sleep disorders'. However, patients across all CKD stages continue to report multiple symptoms that often remain challenging to treat. Many PROs are not routinely monitored or measured, owing to a lack of tools or incentives to collect the data.

Self-reported symptoms such as these are not unique to CKD. Yet CKD patients tell patient charities and foundations that the focus of their renal appointments is 'bloods, urine, blood pressure and kidney function' and the treatment of those complications. Little time is provided to discuss other symptoms and concerns of those with CKD and, where feasible, recommend other treatments that might help, such as lifestyle interventions.

2. Guidelines for Lifestyle Interventions in CKD Are Lacking

The lack of approved guidelines for lifestyle interventions in CKD is historic and due to a lack of evidence. The last international guideline for the 'Evaluation and Management of Chronic Kidney Disease' published by KDIGO in 2012 [ 6] contains 14 references to 'lifestyle'; only 1 is graded and is considered 'low quality evidence'. Diet is mentioned more frequently and getting 'expert dietary advice and information' is 'moderately' graded but no specific dietary intervention gets any grade. There are four references to 'psychological care', but none are graded.

By comparison, the international 'Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care' [ 7] give high priority to lifestyle changes, especially diet and exercise. NICE has published comprehensive guidance [ 8] for Multiple Sclerosis in Adults: Management with detailed sections on fatigue, mobility, pain, and cognition (symptoms frequently mentioned by CKD patients).

It is not surprising that patients look beyond the clinic for lifestyle interventions and complementary or alternative ways to treat their symptoms that they think will improve their quality of life. The proposed update to the KDIGO CKD 2012 guidelines will address more of these unmet patient needs. However, it is unlikely that any recommendations will be graded highly given the paucity of high-quality clinical trials in these interventions.

3. Dietary Guidance Is a Top Priority with CKD Patients

Dietary advice for managing CKD is one of the most highly searched terms on the internet. An enjoyable and nutritious diet is fundamental to living well as a human being. In the many online patient forums, diet is mentioned daily yet patient information is not consistently offered or easily accessed, and is frequently confusing, outdated, or low quality. Some information still does not account for cultural food differences or consider the social environment in which food is grown, bought, cooked, and consumed. Low health literacy is also a barrier to understanding how best to eat well for kidney health.

Early-stage CKD patients, even in high-income countries, are unfortunately rarely referred to dietitians. When patients turn to their renal multidisciplinary team (MDT) or the internet for help, they think their 'chronic' kidney disease is at a later stage than it may be and get confused by end-stage kidney disease diets. It is also noticeable that, despite growing evidence of the potential benefits of plant-based diets in early CKD, dietary information does not reflect this.

Patients at CKD5 or on dialysis will receive advice from dietitians but this advice tends to be about restricting or forbidding something, for example, foods with high potassium and phosphate, accompanied by stern instructions to comply. Lack of nutritional labelling on foods adds to the confusion and challenges of a major change to their habitual eating patterns. Patients can feel overwhelmed and anxious from this dietary burden (on them and their families) which has a negative impact on their quality of life. The requirement to reduce dietary phosphate is especially burdensome and is worsened by having to swallow significant numbers of phosphate binders with every meal or snack eaten. Studies have invariably shown substantial nonadherence with phosphate binders. Perversely, while clinical practice guidelines suggest that reducing high phosphate levels in the blood is essential, the effect of lowering blood phosphate levels on important patient-centred outcomes has never been tested. Meanwhile, a large percentage of the cost of dialysis treatment is the price of phosphate binders.

4. Exercise and Other Lifestyle Guidance

Another lifestyle intervention sought by CKD patients is exercise advice. Again, there is minimal quality evidence that shows a clinical benefit in CKD from a particular exercise. In 2018, the WHO published [ 9] a 'Global action plan on physical activity 2018-2030′. On its website [ 10] is a list of the key facts about physical exercise. Surely, there is sufficient evidence from the WHO (and other reputable sources) to recommend a range of physical activities suitable for early-stage CKD patients at least. As the WHO says: 'Physical activity has significant health benefits for hearts, bodies and minds'. Exercise, therefore, seems to be another fundamental aspect of living well. Of course, patients on dialysis or transplanted, or suffering from fatigue and bone disorders from CKD, will need tailored exercise advice. However, there must be transferrable and trustworthy evidence from other conditions that can be applied, such as in treating hernias (often caused by peritoneal dialysis (PD) or transplant) or osteoporosis (to help with mineral bone disease, especially in older women), or from surgical prehab/rehab programmes (for post fistula, catheter, or transplant surgery). Why is this information not provided to CKD patients?

Similarly, there must be appropriate lifestyle interventions from other conditions such as the treatment of mental health issues in cancer or intractable pain in visceral disorders (such as bowel disease) that can be adapted to CKD patients.

5. Drug Development Regulation Will Focus Attention on PROs

Hope for increased focus on lifestyle interventions may be found in the regulatory environment. The US Food and Drug Administration (FDA) is promoting publicly available standardised core sets of Clinical Outcome Assessments (COAs) to be used in drug development [ 11]. A COA is a 'measure that describes or reflects how a patient feels, functions, or survives'. All interventions must show a clinically meaningful benefit to how long a patient lives and how a patient feels or functions in daily life. Types of COAs include PROMs, Observer-reported outcome (ObsRO) measures, Clinician-reported outcome (ClinRO) measures, and Performance outcome (PerfO) measures.

The PRO can be measured from reports directly from the patient about their health status and should therefore cover the range of 'unpleasant' symptoms described above. The major challenge with PROs in CKD is the lack of Patient Reported Outcome Measures (PROMs) and well-defined and reliable tools to measure symptoms as diverse as pain, fatigue, and life participation. As these tools become necessary for a COA to satisfy regulators, this should encourage the kidney community to address this challenge.

Fortunately, SONG [ 12] in collaboration with the international kidney community is currently undertaking a wide range of initiatives to develop tools across all its core outcomes sets, encompassing core clinical outcomes and PROs. The results of this collective endeavour should stimulate increased interest in and funding of research into delivering the positive outcomes that patients need.

6. More Innovative Research Is Needed

The gold standard RCT evidence to support lifestyle intervention guidelines may be unattainable, but different types of clinical trials, such as pragmatic, could be acceptable alternatives. Biomarkers or surrogate biomarkers may also be feasible. Traditionally in CKD research, the primary outcomes are biomarkers of kidney dysfunction such as serum creatinine, urine output, and urine albumin. However, these may not be appropriate when looking at lifestyle interventions in all kidney disorders, especially in the early stages. For example, kidney function is conserved in earlier stages of autosomal dominant polycystic kidney disease (ADPKD) whilst patients may already be experiencing many of the unpleasant symptoms of CKD and may also be undiagnosed.

New biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and fibroblast growth factor-23 (FGF-23) are showing promise [ 13]. In ADPKD, total kidney volume (TKV) is accepted by both the FDA [ 14] and the European Medicines Agency (EMA) [ 15] as a prognostic biomarker for use in clinical trial enrolment; efforts continue to qualify TKV as a more sensitive predictor of disease progression in early stages of ADPKD. Effects of exercise and lifestyle interventions on oxidative stress have been studied [ 16], but the study was small and of short duration. In patients with mineral bone disorder (CKD-MBD) and osteoporosis, biomarkers such as bone-specific alkaline phosphatase (bALP) and serum intact PTH (iPTH) could be considered to assess bone turnover [ 17].

7. Implementation of Guidelines into Care Pathways

Research, clinical trials, and guidelines are the first steps to ensuring that there is quality evidence to support individualised lifestyle interventions for CKD patients. The next crucial step is to implement all guidelines equitably to patients through holistic integrated multidisciplinary care pathways. Further major challenges are anticipated at this stage. Commissioning and reimbursement vary across and within countries and are often impossible for lifestyle interventions that have no supporting evidence showing the 'hard' clinical outcomes that commissioners and payers demand. Additionally, in the pathway development and implementation, it will be vital to include information about advice and support 'beyond the clinic' such as links to local/national patient and peer support groups, local community or healthcare services offering exercise/diet help, social prescribing, wellbeing, and counselling-which is often lacking in many CKD pathways. Patient and patient group involvement should be integral to pathways. Figure 1 summarises the issues and enablers of lifestyle interventions described above.

8. Conclusions

'Living Well with Kidney Disease' was the 2021 global WKD theme, but it ought to be a daily mission for everyone involved in the care of chronic kidney disease (CKD) patients. For WKD 2022, many organisations called for collective action from governments to add CKD to their health agendas and create and implement a systemic approach to improving the health of all kidney patients worldwide. In addition to requests for more research and reduced inequity of access to life-saving therapies such as KRT, it is time to issue a specific international call to action or joint position statement to focus on lifestyle interventions to help minimise the lifelong consequences and health burden of living with CKD.

Funding

This research received no external funding.

Institutional Review Board Statement

Informed Consent Statement

Data Availability Statement

Conflicts of Interest

The author declares no conflict of interest.

References

1. Ju, A.; Josephson, M.A.; Butt, Z.; Jowsey-Gregoire, S.; Tan, J.; Taylor, Q.; Fowler, K.; Dobbels, F.; Caskey, F.; Jha, V.; et al. Establishing a Core Outcome Measure for Life Participation: A Standardized Outcomes in Nephrology-kidney Transplantation Consensus Workshop Report. Transplantation 2019, 103, 1199-1205. [Google Scholar] [CrossRef] [PubMed] [Green Version]

2. Tong, A.; Manns, B.; Hemmelgarn, B.; Wheeler, D.C.; Evangelidis, N.; Tugwell, P.; Crowe, S.; Van Biesen, W.; Winkelmayer, W.C.; O'Donoghue, D.; et al. Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop. Am. J. Kidney Dis. 2017, 69, 97-107. [Google Scholar] [CrossRef] [PubMed] [Green Version]

3. Kidney Diseases: Improving global Outcomes (KDIGO). The 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD). Kidney Int. Suppl. 2013, 3, 1-150. Available online: https://www.sciencedirect.com/journal/kidney-international-supplements/vol/3/issue/1 (accessed on 11 March 2022).

4. IDF Clinical Practice Recommendations for Managing Type 2 Diabetes in Primary Care. Available online: https://www.idf.org/e-library/guidelines/128-idf-clinical-practice-recommendations-for-managing-type-2-diabetes-in-primary-care.html (accessed on 15 March 2022).

5. Multiple Sclerosis in Adults: Management. Available online: https://www.nice.org.uk/guidance/cg186 (accessed on 18 March 2022).

6. Global Action Plan on Physical Activity 2018-2030: More Active People for a Healthier World. Available online: https://www.who.int/publications/i/item/9789241514187 (accessed on 11 March 2022).

7. Physical Activity. Available online: https://www.who.int/news-room/fact-sheets/detail/physical-activity (accessed on 11 March 2022).

8. Clinical Outcome Assessment (COA): Frequently Asked Questions. Available online: https://www.fda.gov/about-fda/clinical-outcome-assessment-coa-frequently-asked-questions (accessed on 11 March 2022).

9. Standardised Outcomes in Nephrology (SONG). Available online: https://songinitiative.org/ (accessed on 11 March 2022).

10. Available online: https://www.fda.gov/media/93105/download (accessed on 3 April 2022).

11. Available online: https://www.ema.europa.eu/en/documents/regulatory-procedural-guideline/qualification-opinion-total-kidney-volume-tkv-prognostic-biomarker-use-clinical-trials-evaluating_en.pdf (accessed on 3 April 2022).

12. David, M.S.; Kassia, S.B.; Erin, J.H.; David, R.B.; David, W.J.; Nicole, M.I.; Glenda, C.G.; Jeff, S.C. Effects of exercise and lifestyle intervention on oxidative stress in chronic kidney disease. Redox Rep. 2017, 22, 127-136. [Google Scholar] [CrossRef]

Figure 1. Conceptual framework of issues and enablers of lifestyle interventions in kidney disease.

AMA Style

Harris T. Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease. Kidney and Dialysis. 2022; 2(2):204-208. https://doi.org/10.3390/kidneydial2020021

Chicago/Turabian Style

Harris, Tess. 2022. "Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease" Kidney and Dialysis 2, no. 2: 204-208. https://doi.org/10.3390/kidneydial2020021

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Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease

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Lifestyle interventions can play an important role in improving patients' health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is 'life participation', defined as 'the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities'.

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People w ith compromised kidney function must adhere to a renal or kidney diet to cut down on the amount of waste in their blood. Wastes in the blood come from food and liquids that are consumed. When kidney function is compromised, the kidneys not filter or remove waste properly. If waste is left in the blood, it can negatively affect a patient's electrolyte levels. Following a kidney diet may also help promote kidney function and slow the progression of complete kidney failure.

A renal diet is one that is low in sodium, phosphorous, and protein. A renal diet also emphasizes the importance of consuming high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium. Every person's body is different, and therefore, it is crucial that each patient works with a renal dietitian work to come up with a diet that is tailored to the patient's needs.

Below are some substances that are crucial to monitor to promote a renal diet:
What is Sodium and its role in the body?

Sodium is a mineral found in most natural foods. Most people think of salt and sodium as interchangeable. Salt, however, is actually a compound of sodium and chloride. Foods we eat may contain salt or they may contain sodium in other forms. Processed foods often contain higher levels of sodium due to added salt.

Sodium is one of the body's three major electrolytes (potassium and chloride are the other two). Electrolytes control the fluids going in and out of the body's tissues and cells. Sodium contributes to:

Regulating blood pressure and blood volume

Regulating nerve function and muscle contraction

Regulating the acid-base balance of blood

Balancing how much fluid the body keeps or eliminates

Why should kidney patients monitor sodium intake?

Too much sodium can be harmful for people with kidney disease because their kidneys cannot adequately eliminate excess sodium and fluid from the body. As sodium and fluid build up in the tissues and bloodstream, they may cause:

Increased thirst

Edema: swelling in the legs, hands, and face

High blood pressure

Heart failure: excess fluid in the bloodstream can overwork your heart, making it enlarged and weak

Shortness of breath: fluid can build up in the lungs, making it difficult to breathe

How can patients monitor their sodium intake?

Always read food labels. Sodium content is always listed.

Pay close attention to serving sizes.

Use fresh, rather than packaged meats.

Choose fresh fruits and vegetables or no-salt-added canned and frozen produce.

Avoid processed foods.

Compare brands and use items that are lowest in sodium.

Use spices that do not list "salt" in their title (choose garlic powder instead of garlic salt.)

Cook at home and do NOT add salt.

Limit total sodium content to 400 mg per meal and 150 mg per snack.

Printable Low Sodium Diet Guidelines (PDF)

What is Potassium and its role in the body?

Potassium is a mineral found in many of the foods we eat and is also found naturally in the body. Potassium plays a role in keeping the heartbeat regular and the muscles working correctly. Potassium is also necessary for maintaining fluid and electrolyte balance in the bloodstream. The kidneys help to keep the right amount of potassium in your body and they expel excess amounts into the urine.

Why should kidney patients monitor their potassium intake?

When the kidneys fail, they can no longer remove excess potassium, so potassium levels build up in the body. High potassium in the blood is called hyperkalemia which can cause:

Muscle weakness

An irregular heart beat

Slow pulse

Heart attacks

Death

How can patients monitor their potassium intake?

When the kidneys no longer regulate potassium, a patient must monitor the amount of potassium that enters the body.

Tips to help keep the levels of potassium in your blood safe, make sure to:

Talk with a renal dietitian about creating an eating plan.

Limit foods that are high in potassium.

Limit milk and dairy products to 8 oz per day.

Choose fresh fruits and vegetables.

Avoid salt substitutes & seasonings with potassium.

Read labels on packaged foods & avoid potassium chloride.

Pay close attention to serving size.

Keep a food journal.

Printable Low Potassium Diet Guidelines (PDF)

Phosphorus

What is Phosphorus and its role in the body?

Phosphorus is a mineral that is critical in bone maintenance and development. Phosphorus also assists in the development of connective tissue and organs and aids in muscle movement. When food containing phosphorus is consumed and digested, the small intestines absorb the phosphorus so that it can be stored in the bones.

Why should kidney patients monitor Phosphorus intake?

Normal working kidneys can remove extra phosphorus in your blood. When kidney function is compromised, the kidneys no longer remove excess phosphorus. High phosphorus levels can pull calcium out of your bones, making them weak. This also leads to dangerous calcium deposits in the blood vessels, lungs, eyes, and heart.

How can patients monitor their Phosphorus intake?

Phosphorus can be found in many foods. Therefore, patients with compromised kidney function should work with a renal dietitian to help manage phosphorus levels.

Tips to help keep phosphorus at safe levels:

Know what foods are lower in phosphorus.

Pay close attention to serving size

Eat smaller portions of foods that are high in protein at meals and for snacks.

Eat fresh fruits and vegetables.

Ask your physician about using phosphate binders at meal time.

Avoid packaged foods that contain added phosphorus. Look for phosphorus, or for words with "PHOS" on ingredient labels.

Keep a food journal

Printable Low Phosphorus Diet Guidelines (PDF)

Protein is not a problem for healthy kidneys. Normally, protein is ingested and waste products are created, which in turn are filtered by the nephrons of the kidney. Then, with the help of additional renal proteins, the waste turns into urine. In contrast, damaged kidneys fail to remove protein waste and it accumulates in the blood.

The proper consumption of protein is tricky for Chronic Kidney Disease patients as the amount differs with each stage of disease. Protein is essential for tissue maintenance and other bodily roles, so it is important to eat the recommended amount for the specific stage of disease according to your nephrologist or renal dietician.

Fluid control is important for patients in the later stages of Chronic Kidney Disease because normal fluid consumption may cause fluid build up in the body which could become dangerous. People on dialysis often have decreased urine output, so increased fluid in the body can put unnecessary pressure on the person's heart and lungs.

A patient's fluid allowance is calculated on an individual basis, depending on urine output and dialysis settings. It is vital to follow your nephrologist's/nutritionist's fluid intake guidelines.

To control fluid intake, patients should:

Not drink more than what your doctor orders

Count all foods that will melt at room temperature (Jell-O®, popsicles, etc.)

Be cognizant of the amount of fluids used in cooking

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Renal Diet - NephCure Kidney International ®

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People with compromised kidney function must adhere to a renal or kidney diet to cut down on the amount of waste in their blood. Wastes in the blood come from food and liquids that are consumed. When kidney function is compromised, the kidneys not filter or remove waste properly.

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National Institute of Diabetes and Digestive and Kidney Diseases

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You are more likely to develop kidney disease if you have

diabetes

high blood pressure

heart disease

a family history of kidney failure

What can I do to keep my kidneys healthy?

You can protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure. The steps described below may help keep your whole body healthy, including your kidneys.

During your next medical visit, you may want to ask your health care provider about your kidney health. Early kidney disease may not have any symptoms, so getting tested may be the only way to know your kidneys are healthy. Your health care provider will help decide how often you should be tested.

See a provider right away if you develop a urinary tract infection (UTI), which can cause kidney damage if left untreated.

Make healthy food choices

Choose foods that are healthy for your heart and your entire body: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Eat healthy meals, and cut back on salt and added sugars. Aim for less than 2,300 milligrams of sodium each day. Try to have less than 10 percent of your daily calories come from added sugars.

Choose foods that are healthy for your body.

Tips for making healthy food choices

Cook with a mix of spices instead of salt.

Choose veggie toppings such as spinach, broccoli, and peppers for your pizza.

Try baking or broiling meat, chicken, and fish instead of frying.

Serve foods without gravy or added fats.

Try to choose foods with little or no added sugar.

Gradually work your way down from whole milk to 2 percent milk until you're drinking and cooking with fat-free (skim) or low-fat milk and milk products.

Eat foods made from whole grains-such as whole wheat, brown rice, oats, and whole-grain corn-every day. Use whole-grain bread for toast and sandwiches; substitute brown rice for white rice for home-cooked meals and when dining out.

Read food labels. Choose foods low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a slice of cake. Peel and eat an orange instead of drinking orange juice.

Try keeping a written record of what you eat for a week. It can help you see when you tend to overeat or eat foods high in fat or calories.

Research has shown that the DASH eating plan may help you lower your blood pressure. If you have diabetes, high blood pressure, or heart disease, you may want to locate and work with a dietitian to create a meal plan that meets your needs.

Make physical activity part of your routine

Be active for 30 minutes or more on most days. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you. Add more activity to your life with these tips to help you get active.

Aim for a healthy weight

The NIH Body Weight Planner is an online tool to help you tailor your calorie and physical activity plans to achieve and stay at a healthy weight.

If you are overweight or have obesity, work with your health care provider or dietitian to create a realistic weight-loss plan. View more weight control and physical activity resources to help you get and stay motivated.

Get enough sleep

Aim for 7 to 8 hours of sleep each night. If you have trouble sleeping, take steps to improve your sleep habits.

Stop smoking

If you smoke or use other tobacco products, stop. Ask for help so you don't have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov.

Drinking too much alcohol can increase your blood pressure and add extra calories, which can lead to weight gain. If you drink alcohol, limit yourself to one drink per day if you are a woman and two drinks per day if you are a man. One drink is:

12 ounces of beer

5 ounces of wine

1.5 ounces of liquor

Explore stress-reducing activities

Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Physical activity can help reduce stress, as can mind and body practices such as meditation, yoga, or tai chi.

Manage diabetes, high blood pressure, and heart disease

If you have diabetes, high blood pressure, or heart disease, the best way to protect your kidneys from damage is to

Keep blood glucose numbers close to your goal. Checking your blood glucose, or blood sugar, level is an important way to manage your diabetes. Your health care team may want you to test your blood glucose one or more times a day.

Keep your blood pressure numbers close to your goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Read more about high blood pressure.

Take all your medicines as prescribed. Talk with your health care provider about certain blood pressure medicines, called ACE inhibitors and ARBs, which may protect your kidneys. The names of these medicines end in -pril or -sartan.

Be careful about the daily use of over-the-counter pain medications. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can damage your kidneys. Learn more about over-the-counter medicines and your kidneys.

To help prevent heart attacks and stroke, keep your cholesterol levels in the target range. There are two kinds of cholesterol in your blood: LDL and HDL. LDL or "bad" cholesterol can build up and clog your blood vessels, which can cause a heart attack or stroke. HDL or "good" cholesterol helps remove the "bad" cholesterol from your blood vessels. A cholesterol test also may measure another type of blood fat called triglycerides.

Ask your health care provider questions

Ask your health care provider the following key questions about your kidney health during your next medical visit. The sooner you know you have kidney disease, the sooner you can get treatment to help protect your kidneys.
Key questions for your health care provider:

What is my glomerular filtration rate (GFR)?

What is my urine albumin result?

What is my blood pressure?

What is my blood glucose (for people with diabetes)?

How often should I get my kidneys checked?

Other important questions:

What should I do to keep my kidneys healthy?

Do I need to be taking different medicines?

Should I be more physically active?

What kind of physical activity can I do?

What can I eat?

Am I at a healthy weight?

Do I need to talk with a dietitian to get help with meal planning?

Should I be taking ACE inhibitors or ARBs for my kidneys?

What happens if I have kidney disease?

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ckd risk factors;preventing ckd;ckd prevention;ckd;high blood pressure;chronic kidney disease;family history of kidney failure;diabetes;ckd and heart disease

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Preventing Chronic Kidney Disease - NIDDK

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Overview of chronic kidney disease (CKD) prevention, including risk factors and steps to keep kidneys healthy, like preventing high blood pressure and diabetes.

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List two interventions to promote health that minimizes effects of disease state.

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List two interventions to promote health that minimizes effects of disease state.

# data[].attributes.body
1. Water:

Ensure an adequate intake of water, stay hydrated, and make sure to be in fluid restrictions.

2. Vitamin D:

Consume foods rich in vitamin D or consider supplementation

3. Calcium:

Include moderate amounts of calcium-rich foods like low-phosphorus dairy or fortified alternatives.

4. Fiber:

Choose high-fiber foods to support digestive health.

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1. Signs of muscle weakness

2. Pain of pressure in the stomach

3. Hemorrhages

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1. Keep your BP below 140/90 mm Hg (or the target your doctor establishes for you).

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2. Meet with a dietician to create a kidney-healthy eating plan.

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What range should your BP be maintained at?

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What range should your BP be maintained at?

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Your kidneys, each just the size of a computer mouse, filter all the blood in your body every 30 minutes. They work hard to remove wastes, toxins, and excess fluid. They also help control blood pressure, stimulate production of red blood cells, keep your bones healthy, and regulate blood chemicals that are essential to life.

Kidneys that function properly are critical for maintaining good health, however, more than one in seven American adults are estimated to have chronic kidney disease (CKD).

About Chronic Kidney Disease

CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.

Some other health consequences of CKD include:

Anemia or low number of red blood cells

Increased occurrence of infections

Low calcium levels, high potassium levels, and high phosphorus levels in the blood

Loss of appetite or eating less

Depression or lower quality of life

CKD has varying levels of seriousness. It usually gets worse over time though treatment has been shown to slow progression. If left untreated, CKD can progress to kidney failure and early cardiovascular disease. When the kidneys stop working, dialysis or kidney transplant is needed for survival. Kidney failure treated with dialysis or kidney transplant is called end-stage renal disease (ESRD). Learn more about ESRD.

Not all patients with kidney disease progress to kidney failure. To help prevent CKD and lower the risk for kidney failure, control risk factors for CKD, get tested yearly, make lifestyle changes, take medicine as needed, and see your health care team regularly.

Kidney diseases are the ninth leading cause of death in the United States.

About 37 million US adults are estimated to have CKD and most are undiagnosed.

40%of people with severely reduced kidney function are not aware of having CKD.

Every 24 hours, 350 people begin dialysis treatment for kidney failure.

In the United States, diabetes and high blood pressure are the leading causes of kidney failure, representing about 3 out of 4 new cases.

In 2018, treating Medicare beneficiaries with CKD cost over $81.8 billion, and treating people with ESRD cost an additional $36.6 billion.

Risk Factors

Talk to your doctor about getting tested if you have any of these risk factors:

Symptoms

People with CKD may not feel ill or notice any symptoms. The only way to find out for sure if you have CKD is through specific blood and urine tests. These tests include measurement of both the creatinine level in the blood and protein in the urine.
Quick Facts: CKD Snapshot

Kidney diseases are the ninth leading cause of death in the United States.

Early CKD has no signs or symptoms.

Specific blood and urine tests are needed to check for CKD.

CKD tends to get worse over time.

CKD can be treated (the earlier treatment starts the better).

CKD can progress to kidney failure.

Kidney-Friendly Tips

Keep your blood pressure below 140/90 mm Hg (or the target your doctor establishes for you).

If you have diabetes, stay in your target blood sugar range as much as possible.

Get active-physical activity helps control blood pressure and blood sugar levels.

Lose weight if you're overweight.

Get tested for CKD regularly if you're at risk.

If you have CKD, meet with a dietician to create a kidney-healthy eating plan. The plan may need to change as you get older or if your health status changes.

Take medications as instructed, and ask your doctor about blood pressure medicines called angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, which may protect your kidneys in addition to lowering blood pressure.

If you smoke, quit. Smoking can worsen kidney disease and interfere with medication that lowers blood pressure.

Include a kidney doctor (nephrologist) on your health care team.

Costs

Overall Medicare costs for people with CKD were over $81.8 billion in 2018, or $23,700 per person.

Total Medicare spending (excluding prescription drugs) for patients with ESRD or kidney failure reached $36.6 billion in 2018, or $80,000 per person, accounting for about 7% of the Medicare paid claims costs.

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Your kidneys, each just the size of a computer mouse, filter all the blood in your body every 30 minutes. They work hard to remove wastes, toxins, and excess fluid. They also help control blood pressure, stimulate production of red blood cells, keep your bones healthy, and regulate blood chemicals that are essential to life.

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A renal diet is put into practice to help keep levels of fluids, electrolytes, and minerals balanced in the body in individuals usually with kidney failure.

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CONSISTENCY AND MAKING GREAT CHOICES IS THE KEY TO A GREAT RENAL DIET!

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If you have kidney disease, you should: 

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If you have kidney disease, you should: 

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1. Choose fresh foods and cook from scratch as much as you can.

2. Avoid Unhealthy food, this includes fast food and packaged food.

3. Limit the amount of salt intake.

Doing these things helps reduce the loss of the kidney and its functions. It also slows the progression of the disease. Lastly, reducing the intake of certain foods prevents other health complications from happening.

Incorporating all of this into your renal diet, especially managing the amount of salt that is put into the body, helps prevent things such as:

Increased thirst

Edema

High blood pressure

Heart failure

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Renal Diet: Purpose, Benefits, & Foods | UPMC Kidney Disease Center

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If you have kidney disease, you may need to change how you eat.

Making simple tweaks - like eating more fresh fruit and vegetables and less processed foods - can have an impact.

A renal diet can help slow kidney damage and improve your overall health.

What Is a Renal Diet?

The kidneys filter waste from the blood and help keep the right balance of certain nutrients in the body. Kidney disease can prevent them from doing as good of a job keeping this balance.

That's why doctors often suggest arenal diet.

A renal diet won't cure kidney disease, but it can:

Help reduce the risk of losing kidney function.

Slow down disease progression.

Keep you from having other health complications.

A renal diet is often low in sodium, phosphorus and sometimes potassium and protein.

Sodium and potassium are minerals that:

Help maintain fluid balance in the bloodstream and cells.

Keep our nerves and muscles functioning.

Phosphorus is a mineral that helps form bones and teeth and plays other important roles in the body.

Amino acids are the building blocks that make protein. They're essential for building body structures like muscle and maintaining many key body functions.

Your body needs all of these nutrients. But if you have kidney damage, you may not be able to maintain the correct balance or amounts.

Sodium, phosphorus, potassium, and protein byproducts can build up in the blood. This can cause your body to retain too much fluid and lead to imbalances in body function, and kidney damage getting worse.

What Are the Benefits and Risks of Renal Diets?

Sticking to a renal diet can help you manage your kidney disease and related complications.

Renal diet benefits

A renal diet can help slow kidney damage so you can have a healthier life and feel better.

Renal diet risks

A renal diet doesn't have any risks. Because it's also heart-healthy, it can improve both your kidney and complete health.

Some people may feel overwhelmed by the renal diet and end up being overly restrictive with their food intake. If you feel this way, work with your doctor or dietitian to discuss food and drink choices that work for you.

Who Should Follow a Renal Diet?

Anyone with kidney disease should think about a renal diet.

Your doctor may want you to meet with a registered dietician to discuss renal diet considerations and learn recipes.

If you have advanced kidney disease or other health conditions, your doctor or dietitian may have different guidelines for your renal diet.

For instance, people with early kidney disease versus those on dialysis may need to restrict their protein intake. They may also need more potassium.

Top Healthy Foods for People with Kidney Disease

You can enjoy many healthy foods when you follow a renal diet:

Veggies - cabbage, red bell peppers, cauliflower, and onions.

Fruits - apples, cranberries, blueberries, raspberries, strawberries, cherries, and red grapes.

Proteins - lean meat, skinless poultry, eggs, and fish.

Seasonings and oils - fresh or dried herbs, spices, garlic, and olive oil.

Whole grains - barley, buckwheat, bulgur, wild rice, and unsalted popcorn.

Renal diet tips

There are tips to keep in mind if you or a loved one is on a renal diet.

If you have kidney disease, you should:

Choose fresh foods and cook from scratch as much as you can.

Avoid fast food and packaged foods. They're high in sodium.

Use spices and fresh or dried herbs instead of salt to flavor food.

Rinse canned beans and vegetables before cooking to help remove excess salt.

Keep protein serving sizes small. A serving size of protein is 2 to 3 ounces of chicken, fish, or meat.

Limit alcohol to one drink a day for women and two for men.

How much water should I drink on a renal diet?

You will likely need to track how much water you drink in the later stages of kidney disease.

Drinking too much water may cause fluid to build up in your body because you have decreased urine output. Increased fluid in the body puts excess pressure on your heart and lungs.

Your doctor will tell you how much fluid you should take in each day.

Besides water and other drinks, you need to factor in the fluids used in cooking. Foods that melt at room temperature (such as popsicles or gelatin) also count toward your fluid intake.

If I follow a renal diet, what should I know about sodium?

With kidney disease, your kidneys can't remove excess sodium from the body.

This causes fluid build-up in the tissues and bloodstream, and symptoms such as:

Increased thirst.

Swelling.

High blood pressure.

Shortness of breath.

Heart failure.

You should try to limit sodium you consume with meals and snacks.

To help cut back:

Read food labels.

Watch your serving sizes.

Choose fresh over packaged foods.

Cook from scratch to control how much salt goes into your food.

What should I know about phosphorus with a renal diet?

Phosphorus is crucial to form and maintain bones. But if your kidneys aren't working right, they don't remove excess phosphorus from the blood.

Many foods have added phosphorus, or phosphate additives, that the body absorbs well. This can cause problems for a lot of people.

Always read the ingredients list on food labels and look for words with the letters "PHOS."

Foods that often contain phosphate additives include:

Colas and other bottled beverages.

Processed meat products.

Baked goods.

Canned fish.

Fast food.

Other foods that are naturally high in phosphorus include:

Your doctor or dietitian can help you manage your phosphorus levels based on your needs.

If I follow a renal diet, what should I know about potassium?

Potassium is an important mineral that helps to maintain fluid and electrolyte balance. It also helps our heart, nerves, and muscles function.

Getting enough potassium is vital in the early stages of kidney disease.

As kidney disease progresses, the kidneys may have a hard time removing excess potassium in the body. This can result in potassium ranges in the blood rising above the recommended range, a condition known as hyperkalemia. If you are at risk for hyperkalemia, your doctor may recommend that you limit your potassium intake.

Foods that are high in potassium include:

Salt substitutes made with potassium.

Dried fruits.

Bananas.

Potatoes.

Pumpkin.

Tomato sauce and juice.

You can also remove some of the potassium in certain fruits and vegetables. Just peel and soak them in water before cooking.

If I follow a renal diet, what should I know about protein?

We all need protein in our diet. But if you have kidney disease, it's easy to overdo it.

Damaged kidneys have to work harder to remove protein waste from the blood. This causes more stress on organs that don't function well, to begin with.

If you're not on dialysis, your doctor will limit the amount of protein you eat.

If you've started dialysis, you will likely need to eat more protein. Dialysis does the work of your kidneys and removes protein waste from the blood. You may need extra protein to keep your body functioning properly and prevent muscle loss.

The type of protein you eat is vital. Protein comes from both plants and animals, and most people eat both types.

Good protein sources for someone with kidney disease include:

Beans and lentils (in small amounts, as they also contain phosphorus).

Eggs.

Fish or seafood.

Lean beef (like sirloin or tenderloin).

Skinless poultry.

Tofu.

Your doctor or dietitian is the best resource to figure out the best renal diet for you.

Portion sizes and foods to avoid will vary from person to person. Your exact renal diet will also depend on your size, age, and the stage of your disease.

Contact the UPMC Kidney Disease Center

To learn more about treatment for kidney disease at UPMC:

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Renal Diet: Purpose, Benefits, & Foods | UPMC Kidney Disease Center

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If you live with kidney disease, you should follow a renal diet. Eating the right foods in the right amounts can help slow the progression of kidney disease.

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1. Limit fluids

2. Reduce high blood pressure

3. Consume high quality proteins

4. Incorporate exercise

5. Make healthy lifestyle choices

6. Avoid alcohol consumption

7. Avoid/quit smoking

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In your own words, explain what a renal diet is used for. 

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In your own words, explain what a renal diet is used for. 