The Five Stages Of Kidney Disease And Their Nutrition Guidelines

By Marika Wamback, BSc. R.D.
Registered Dietitian

Chronic Kidney Disease (CKD) is a broad diagnosis that encompasses the five stages of kidney disease.  Each stage is diagnosed based on a lab test called eGFR.  eGFR measures how well your kidneys filter blood.  Your eGFR results will dictate which level of kidney disease you have.  Kidneys are a vital organ whose function affects other body systems such as your cardiovascular system, bones, blood pH, waste removal, and your overall nutritional status.  If you are a CKD patient, you will be assessed by your renal team to determine your personal plan of care.  Below, the five stages of kidney disease are listed, along with their respective typical dietary recommendations.  These recommendations may be different based on your individual assessment and needs.

General Dietary Recommendations for CKD Stages 1-4

Dietary guidelines recommended during stages 1-4 are to help preserve your kidney function, protect your cardiovascular health, and maintain your nutritional status.  The following dietary recommendations may be encouraged.

  • 0.8 gm protein/kg/day 
  • 1500 mg sodium/day
  • 30-35 kcal/kg/day 

CKD Stages 1-4 Classifications and Their Respective Potential Dietary Recommendations:

STAGE 1: eGFR of 90 ml/min.  Filtration is good, but you have physical evidence of kidney damage.  Protein in the urine may be evident.

STAGE 2: eGFR between 60 to 89 ml/min.  Filtration is good but you may have physical evidence of kidney damage.  Protein in the urine may be evident.

STAGE 3: Stage 3a) eGFR between 45 and 59 ml/min.  Stage 3b) eGFR between 30 to 44 ml/min.  Symptoms may include reduced urine output, swelling, back pain, high blood pressure, anemia, and bone pain. The following dietary restrictions may be implemented at this stage:

  • 800-1000 mg phosphorus/day 
  • 2000 mg potassium/day 

STAGE 4: eGFR of 15 to 29 ml/min.  Indicative that there is moderate to significant kidney damage.  This is the last stage of kidney disease before renal failure.  Symptoms can include swelling, reduced voiding, high blood pressure, anemia, bone disease, and build up of wastes.  If you have stage 4 kidney disease, it is recommended that you talk with your renal team to discuss dialysis options and transplant.

If phosphorus or potassium restrictions have not yet been implemented in your renal diet, they may be at this stage.  The restrictions are the same as stage 3.

Phosphorus and Potassium Restrictions

Below are common foods you may be encouraged to avoid or limit in your diet.

High Phosphorus Foods

  • Dairy and any foods made with dairy (e.g.-ice cream, cream or milk based sauces, cheese sauce)
  • Mushrooms
  • Nuts, seeds, legumes
  • Chocolate
  • Highly processed foods like deli meats, sausage, bacon, fast foods, etc.
  • Whole wheat items such as whole wheat bread, brown rice, and brown pasta
  • Dark colored regular colas or diet colas
  • Some pre-made iced-teas (check the labels for hidden phosphates)
  • Limiting protein to 0.8 grams/kg daily helps limit phosphorus in the diet, as phosphorus is found in animal and vegetable based protein foods.  
  • Read the ingredient list to see if phosphorus has been added to foods in the form of phosphates, such as sodium phosphate, calcium phosphate, and phosphoric acid.

High Potassium Foods

  • Most tropical fruits such as oranges, grapefruit, mangoes, avocados, bananas, and kiwi
  • Dried fruit such as raisins, prunes, and apricots
  • Cantaloupe 
  • Honeydew
  • Tomatoes and tomato products
  • Nuts
  • Potatoes (unless leached and boiled)
  • Dairy and foods made with dairy (e.g.-ice cream, cream or milk based sauces, cheese sauce)
  • Salt substitutes that contain potassium
  • Cooked leafy greens such as spinach
  • Chocolate

CKD Stage 5 and Its Respective Potential Dietary Recommendations

CKD stage 5 is also known as End Stage Renal Disease or ESRD.   This is diagnosed with an eGFR of less than 15.  At this stage, dialysis or transplant is necessary.  Symptoms can include itching, swelling, lack of voiding, fatigue, poor appetite, bone pain, trouble breathing, and trouble sleeping.  

Dietary recommendations change once you are diagnosed with ESRD and start dialysis.  Recommendations and restrictions also depend on the type of dialysis you are on.  The following dietary recommendations may be encouraged once you are on dialysis.

Hemodialysis:

  • A fluid restriction of usually 1 L or 1000 cc and an assessment of urine output. This may change based on your individual assessment.
  • 800-1000 mg phosphorus/day
  • 2000 mg potassium/day
  • 1500 mg sodium/day
  • 1.2-1.5 gm/protein/kg/day

Peritoneal Dialysis:

  • Peritoneal dialysis usually has a more flexible diet and fluid restriction as dialysis is done daily (usually overnight).
  • Peritoneal dialysis may require a lower calorie diet due to calories in the dialysate.
  • Protein needs may be higher than hemodialysis due to dialyzing daily.

Typical Dietary Recommendations After Transplant

Nutrition recommendations post transplant depend on the function of your new kidney.

  • 1.2-1.5 gm protein/kg/day immediately post transplant 
  • Protein intake may lower once the healing from surgery is complete. 
  • Anti-rejection medications prescribed to you may affect your nutrition choices.  They may contribute to changes in appetite, nausea, increased blood sugars, and fluid retention.
  • Depending on your labs and your urine output, electrolyte restrictions and fluid restrictions may be recommended.

Each stage of kidney disease may require different medical interventions and medications.  Your renal dietitian will work with you to prescribe a balanced, nutritious diet that includes consistent protein intake, electrolyte restrictions, adequate calories, and a safe amount of fluids.  Your renal diet is designed to help maintain your optimal health.

Disclaimer

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. KidneyChef urges you to seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. KidneyChef advises you to never disregard professional medical advice or delay in seeking it because of something you have read on the Website.

If you think you may have a medical emergency, call your doctor or local emergency service immediately. KidneyChef does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the website. KidneyChef does not guarantee the accuracy of information on the Website and reliance on any information provided by KidneyChef is solely at your own risk.

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