FAQ's on CKD
What to eat

Should I be on a low protein diet?

Protein helps your body to form muscle and tissue. But when your kidneys are not working well, the byproducts of protein breakdown can accumulate in your blood. This can make your kidneys work harder.

Some studies of low protein diets show that they can slow the progression to kidney failure. But other studies show that the diets do not help. Due to these mixed results and the need to maintain good nutrition; doctors differ about the need to limit  dietary protein intake for people with chronic kidney disease (CKD). The answer is often moderate protein restriction.

Many people with CKD find that they don't want to eat as much protein as they used to, because food doesn't taste the same. You may even need to make a special effort to eat enough protein and calories, because CKD can reduce your appetite.

In all cases, it's crucial to avoid malnutrition. A blood test for albumin, a form of protein, is a good way to tell iif you are in a good nutritional shape. Your albumin level should be 3.0-3.5 g/dl or higher. If you notice weight loss, loss of appetite or other signs of poor nutrition, talk to your doctor.

Dietary Protein Intake for Nondialuzed Patients:
For individuals with chronic renal failure (GFR <25 mL/min) who are not undergoing maintainance dialysis, the institution of a planned low-protein diet providing 0.60 g protein/kg/d should be considered. For individuals who will not accept such a diet or who are unavle to maintain adequate DEI with such a diet, an intake  of  up to 0.75 g protein/kg/d may be prescribed.

In more severe kidney disease (Stages 4 and 5), the guidelines suggest considering 0.6 grams of protein per kilogram each day. Some doctors may advise even lower levels, which require close monitoring. If your diet includes very little protein, your doctor may prescribe supplements of nutrients you would normally get from protein, like ketoacids and/or amino acids.

To figure out how much protein is in the food you're eating, read labels and use nutrition reference tables. After a while, you'll have a good sense of how much protein is in a serving of food, so you won't have to look everything up. A renal dietitian has special expertise helping people with kidney disease put together healthy meal plans. Ask your doctor about a referral to a renal dietitian. Check with your doctor or dietitian before making any changes to the protein level in your diet.

Should I be on a low phosphorus diet?

Ask your doctor- the answer will often be 'yes'. Phosphorus is a mineral found mostly in dairy products and meat or meat  products. eYour body uses it to form strong bones and teeth. But starting in moderate CKD, your kidneys begin to lose the ability to remove extra phosphorus from your body. Because too much phosphorus can harm your bones, it makes sense to eat less phosphorus.

Some experts think 800 to 1,200 mg. of phosphorus per day is a good target. Food labels are not required to list phosphorus, so you will need to talk to a renal dietitian or find a nutrition reference guide and look up foods. You'll soon learn the phosphorus values of the foods you eat most often.

If you are also on a lower protein diet, a low phosphorus diet is easier. Foods high in protein tend to be high in phosphorus, too. Your doctor may want you to limit dairy servings each day and take a calcium supplement. Taken with meals, calcium supplements act as phosphate "binders," because they lock on to extra phosphorus and keep your body from absorbing it.

Should I be on a low potassium diet?

Having the right level of potassium in your body helps all your muscles work smoothly-including your heart. So, to stay as healthy as you can, you need to keep just the right level of potassium in your blood (not too much, not too little). Keeping potassium at the right level all the time is one of the jobs that healthy kidneys do for your body. When kidneys fail, they start to lose this ability.

Your potassium level should be checked regularly with a blood test. If your levels are too high, your doctor will ask you to start a low potassium diet.

Many foods have potassium, but some-like dried fruits, potatoes, oranges, bananas and salt substitutes-are very high in potassium. If you need to limit potassium, your dietitian will help you learn which foods have more and which foods have less potassium.

What can I do about loss of appetite?

Poor appetite is a common symptom of advanced kidney disease. Even if you are not hungry, it is important to eat and keep good nutrition. Well-nourished people with kidney disease stay healthier and live longer. As kidney function drops, you may notice that protein foods lose their appeal, or even taste funny. You need calories and quality protein to feel your best. To get good nutrition try to:
Eat more bland, starchy foods or whatever appeals to you
Eat small portions of protein foods, at a cold temperature
Avoid cooking smells if they bother you
Try a liquid nutritional drink once a day (It is best not to rely on these drinks entirely, as their protein, phosphorus and potassium content are not made for people with kidney disease.)
Graze all day-have several small meals instead of one large one
Watch cooking shows on television to tempt your appetite
Boost the protein content of your meals
Get help from a renal dietitian, if lack of appetite continue

Finally, if you are in Stage 5 CKD and your appetite or nutritional well-being does not improve, this may be a sign that you should start dialysis. Many people find their appetite improves after some time on dialysis.

At which stages of CKD is a protein restriction indicated?

The initiation of protein-restricted diets in patients with chronic kidney disease is indicated with a progressive decline of GFR below the critical value of 50-60 ml/min.

A dietary protein intake of 0.75-0.8 g /kg body weight/day, according to the recommended dietary allowances, seems to be reasonable for patients with chronic kidney disease of Stages 1 and 2. Nevertheless, in respect to and to reduce the decline in the progression, a protein-restricted diet 0.6 or even 0.3-0.4 g protein/kg body weight/day supplemented with Ketoacids (Ketosteril®) can be advised.

As a general rule, the protein intake should be reduced in parallel with the worsening of renal function.

Why protein-restricted diet to be supplemented with Ketoacids?

Protein restriction is needed to prevent/ reduce waste load on the kidneys so that kidney function can be maintained, but as we supply less protein there is less protein formation (muscle, tissue) and one develops malnutrition.

It is essential to avoid malnutrition as it can worsen kidney function and can cause complications. To achieve this one need to supplement low protein diet with Keto acids.

Keto acids are amino acids without nitrogen (i.e. waste), inside the body they bind with the body’s nitrogen and forms proteins (muscles, tissue), so you are less prone to develop malnutrition.