Georgette Goldson, MS, RD, CDN
Administrative Dietitian
Montefiore Care Management Organization
Challenges of CKD
People with chronic kidney disease (CKD) face many challenges. The primary nutrition concerns include maintaining a diet that is low in protein, sodium, phosphorus, potassium, and at times calorie restricted. The typical Western (American) diet consists of a high intake of meats and processed foods containing preservatives such as sodium, phosphates, and potassium. CKD patients must limit their consumption of these foods because as their disease progresses, it takes longer for their kidneys to adequately filter these minerals. They accumulate in the blood and create other problems such as cardiovascular disease and bone disorders.
Another concern for people with CKD is the lack of adequate nutrition education to help them better self-manage their disease during the early stages after diagnosis. As a result, for many the disease progresses more rapidly to its end-stage, requiring long-term treatment such as dialysis or other forms of renal replacement therapy.
Patients often have difficulty making changes in their diet to slow the progression of chronic kidney disease. These changes include consuming fewer salty foods, (for example, fresh meats instead of processed cold cuts), preparing meals by baking instead of frying, avoiding high phosphorus foods such as nuts, chocolate, and dark beverages like colas; and limiting intake of high potassium foods such as bananas, tomatoes, and oranges.
CKD in the Bronx
Our patients from the Bronx community are uniquely challenged in figuring out how to incorporate a life-style diet change that their whole family will accept, while adhering to the nutrition recommendations for chronic kidney disease. Many patients tell me that they have to eat whatever is prepared by another family member, or that time and budget do not allow for preparing separate meals for the family. These actions contribute to overconsumption of foods that are not recommended for patients with CKD.
Easy access to fast food that is high in calories, sodium, and fat, as well as to super-sized sweetened beverages, contribute to our patients’ difficulty in making good food choices and controlling comorbid conditions such as diabetes and hypertension.
How We Can Help
As a Montefiore Care Management nutritionist in the outpatient clinics, I help CKD patients understand how making good food choices and changing their lifestyles can slow the progression of their disease. I teach them how to read and understand nutrition facts on food labels, and I direct them to community resources that help them self-manage their disease and improve their overall nutritional health. These resources may include:
- Neighborhood farmer’s markets where they can buy fresh fruit and vegetables
- Food stamps to facilitate purchases of healthier foods
- Transportation to and from appointments to their primary care physicians
- Meals on Wheels for homebound patients
- Assistance with meal preparation, grocery shopping, and daily living activities
- Mental health counseling
- Ensuring that they have adequate housing
- Social activities to improve their quality of life
Eating Right with CKD
- Some foods are better for your kidneys than others, and what you eat and drink can slow the progression of chronic kidney disease.
- Choose and prepare foods with less salt and sodium to help control blood pressure.
- Use spices, herbs, and fresh seasonings such as onions, garlic, scallions, and thyme.
- Use sodium-free seasonings (such as Mrs. Dash or Lawrys Salt Free 17 Seasoning) in place of salt.
- Read the nutrition labels on food packages for sodium content. Foods containing over 140 mg of sodium per serving are considered high-sodium products.
- Eat the right amounts and types of protein foods to protect your kidneys.
- Eat small portions of protein foods. Protein is found in foods from animal sources such as meats, chicken, fish, eggs, and dairy, as well as plant sources such as nuts, beans, and grains.
- Choose foods with less phosphorus to help protect your bones and blood vessels. Too much phosphorus can build up in your blood making your bones thin, weak, and more likely to break.
- Foods lower in phosphorus include fresh fruits, vegetables, rice, corn, cereals, and clear sodas such as ginger ale and lemon-lime.
- Foods higher in phosphorus include meat, poultry, fish ,dairy, nuts, and dark sodas such as cola.
- Choose foods with lower potassium to help your muscles and nerves work the right way.
- Salt substitutes such as Morton Salt Substitute, LoSalt, Nu-Salt, and Also Salt can be very high in potassium, should not be used.
- Foods lower in potassium include apples, berries, carrots, green beans, cabbage, white rice, and grits.
- Foods higher in potassium include oranges, bananas, potatoes, tomatoes, bran cereals, and dairy.
- Choose foods that are healthy for your heart to help keep fat from building up in your blood vessels heart and kidneys.
- Heart-healthy foods include lean meats, poultry without skin, fish, beans, vegetables, fruits, and low-fat dairy products.
- Bake, boil, broil, grill, or stir fry food instead of deep frying.
- Cook with small amounts of olive oil or non-stick cooking spray instead of butter.
- Trim fat from meat and remove skin from poultry before eating.
