Nutrition Guide for Patients with Kidney Failure
(Pre-Dialysis)
1
Doctor and Patient,
This booklet includes nutrition information to help you
reduce the progression of kidney failure and improve your
quality of life. It is important to consider the following
factors:
1. Keep your blood pressure controlled;
 Reduce your salt intake
 Follow your medication regimen
2. Keep your blood sugar controlled;
 Comply with your diet plan
 Comply with your medication regimen
3. Avoid smoking (active and passive) as smoking affects kidney function.
Avoidance of smoking will also help to reduce the risks of other diseases
such as stroke, heart disease, respiratory disease, and cancer.
4. Follow the diet plan as advised by the dietitian;
 Avoid consuming excessive animal protein such as meat, chicken, fish,
eggs, or milk and its products.
 Reduce your intake of animal fat, butter, ghee, and foods rich in
cholesterol.
5. Keep active and perform regular and moderate exercises.
2
Normal Kidney Functions
 Kidneys are vital organs for health that remove excess
water, salt, and waste products from the blood and make
urine to avoid the accumulation of these in the body.
 Kidneys are involved in the production of Vitamin D,
which helps calcium absorption from intestines. This
keeps the bones strong.
 Kidneys produce the hormone called Erythropoietin,
which is important for the production of red blood cells
from the bone marrow.
Causes of Kidney Failure
Diabetes and high blood pressure are the leading causes of kidney failure.
There are other causes that include: polycystic kidney disease,
glomerulonephritis (bacterial/viral), and autoimmune diseases for example.
Health Complications of Kidney Failure
 Mild to moderate degree of kidney failure may not be noticeable.
 Nausea, vomiting, fatigue, headache, poor appetite, and weight loss are all
related to accumulation of urea waste products in the blood.
3
 Accumulation of fluids and salt in the body. This may lead to an increase in
blood pressure and edema in many parts of the body including legs. The
accumulation of fluids may also cause shortness of breath and heart
failure.
 Raised potassium and phosphorus in the blood as the kidneys are no longer
able to excrete them in urine.
 Anemia due to inability of the kidneys to produce Erythropoietin, which is
important for the formulation red blood cells.
Nutritional Guidelines to Reduce the Progression of Kidney Failure
As kidney failure progresses, a special diet is recommended to reduce the
intake of the following:
 Protein is needed for the body to repair muscles and
improve immunity, but patients with kidney failure are
unable to remove the wastes from the protein. Avoid foods
high in protein. Protein such as meat, poultry, fish, tuna,
eggs, milk, laban, yoghurt, cheese, nuts, and dried legumes
such as lentils and beans.
4
 Reducing the sodium intake will help control high blood
pressure. Sodium such as table salt and salty foods including
ketchup, olives, pickles, condiments, canned or processed
foods such as vegetables, sausages, soy sauce, chips, salted
nuts, soups, smoked meats, cheese, and sardines.
 Kidney failure diet is deficient in many vitamins including
vitamins B, C, and D. Patients should discuss the supplements
of these vitamins with their doctors.
 Many patients with kidney failure may experience poor appetite that results
in weight loss. Increasing the caloric intake is important to avoid
malnutrition. Patients can consume a high-caloric diet that is low in sodium
and potassium and divide the meals into small and frequent portions,
provided that they are not diabetic.
 Patients with kidney failure will have iron-deficiency anemia as their diet
plan is poor in iron content and they are unable to absorb iron well in the
gut. Patients, who require iron supplements, are recommended not to take
it with their calcium supplements as both interact with each other.
5
Heart Care Tips for Kidney Failure Patients
 Keep your body weight within normal range and lose
weight if obese.
 Reduce your intake of cholesterol and saturated fat
to help you reduce your risks for heart attack and
stroke. Foods rich in cholesterol are egg yolk, full
cream milk products, butter, fatty meat, sausages,
poultry with skin, and processed meat. Ghee and
shortening are cholesterol-free but they are high in
trans-fat and are not good for heart condition. The
best oils to be used in food preparation are olive oil,
canola oil, sunflower oil, and corn oil.
 Avoid smoking (active and passive).
 Practice your daily exercise.
6
Kidney Failure Diet Specifications
The below diet is recommended to patients with kidney disease in order to
reduce known complications and to slow down the progression of their kidney
failure.






Adequate calorie intake to maintain healthy weight
Low in protein (40 grams/day)
Low in sodium (2-4 grams/day)
Low in potassium (1.5 grams/day)
Low in phosphorus (0.6 grams/day)
Adequate in calcium and vitamin D
7
Nutrition Information
Patients with kidney failure are recommended to purchase foods low in sodium,
protein, phosphorus, and potassium. They should read food labels carefully.
They can consult their dietitians for nutrition advice on purchasing foods
appropriate for kidney failure.
Potassium is a mineral found in many foods including fruits, vegetables,
legumes, milk, and milk products. Healthy kidneys keep the potassium within
a normal range in the blood by removing the excess amounts.
Patients with kidney failure may have raised levels of
potassium in the blood, which can seriously affect the heart,
and may result in death. Potassium-rich foods should be
eliminated from the diet and include:
8
Foods HIGH in Potassium Content
Include:
Foods LOW in Potassium Content
Include:
Fruits
Oranges
Apples (red, green, or golden)
Orange juice
Apple sauce
Bananas
Apple juice
Dates (fresh and dried)
Strawberries
Kiwi
Strawberry jam
Mango
Grapes
Mango juice
Grapefruit
Peaches
Lemon
Sweet melon
Pears
Dried fruits (figs and raisins)
Pineapples
Watermelon
Avocados
9
Vegetables
Pumpkin
Green beans
Carrots
Cabbage
Corn
Carrot juice
Potatoes
Popcorn
Tomatoes
Cucumber
Tomato juice
Eggplant
Ketchup
Lettuce
Onions
Broccoli
Spinach
Green peas
Okra
Molukiyah
Lentils
Zucchini
Cauliflower
Hummus
Dry beans
Green pepper
10
Nuts
Garlic
Seeds
Mushrooms
Dairy
Milk
Eggs
Laban
Swiss cheese
Yoghurt
Cottage cheese
Grains
Rice
Wheat bran
Pasta/noodles
Whole grain breads
Bread
Granola
Miscellaneous
Mint
Molasses
Peanut butter
Oregano
Tahini
Vinegar
Honey
Chocolate
11
Your Daily Allowance of Potassium-Containing Food
 Milk: you are allowed to consume ½ cup per day. You can
replace the ½ cup of milk with ½ cup of laban or yoghurt.
Select low fat or nonfat items instead of full cream to reduce
your intake of cholesterol and saturated fat.
 Fruits: you are allowed to consume three portions of the fruits that contain
lower amounts of potassium per day.
 Vegetables: you are allowed to consume two portions of vegetables that
contain lower amounts of potassium per day.
 Meat or chicken or fish: you are allowed to consume one portion of meat
or chicken or fish at lunch and at dinner. The weight of the portion is only
30 grams (1 oz.). Select the lean cuts of red meat or skinless poultry.
 Eggs: you are allowed to consume 1 egg per day.
Food Preparation Method to Reduce the Potassium Content:
Drain canned vegetables and canned fruits before serving. Peel the vegetables
after washing, then cut them into thin slices or cubes and soak in water for two
hours. Drain the water then boil the vegetables in large amount of water. Then
drain the cooking water. Soaking vegetables can be repeated before boiling to
get rid of more potassium. It is advisable to peel the fruits and wash them
thoroughly before eating.
12
Phosphorus: With the progression of kidney failure, the
kidneys cannot remove phosphorus from the blood and
eating foods with high phosphorus content may cause
problems in the bones and blood vessels. A high phosphorus
level in the blood reabsorbs calcium from the bones, making
them brittle and easy to break. Patients need to avoid
foods high in phosphorus (such as cheese, yogurt, laban, milk,
organ meat, dried beans and lentils, soft drinks, and excess
amount of meat, chicken or fish). Phosphate binders should be
taken with meals and snacks to lower phosphorus. Phosphate
binders reduce the absorption of phosphorus from the
intestines.
Fluids: With the progression of kidney failure, the kidneys are unable to keep
the body's fluid balance. Avoid drinking a lot of fluids and eating food that
contains a lot of water. Fluids include water, juice, tea, coffee, soup, jello, milk,
laban, yoghurt, and ice cream. Patients need to discuss with their doctors how
many cups of fluids are allowed on a daily basis. They need to also use smaller
cups for medications. More fluid in the blood will lead to health problems, such
as respiratory, cardiac, and increase in blood pressure.
13
How to Measure Your Fluid Allowance
 Your doctor may ask you to measure the volume of your urine in milliliters
and you may be provided with a measuring container for that.
 Measure the amount of fluids you are allowed to take carefully and
don’t exceed as extra fluids will cause health problems affecting
your heart, lungs, kidney function, and blood pressure.
 Drink only when thirsty.
 To reduce your sense of thirst, it is recommended to limit your
salt intake and keep your blood sugar controlled. You can sip the
fluids slowly or suck on a frozen fruit or a lemon wedge or a piece
of ice instead of drinking water. You can chew sugarless gum if
you like.
 Brush your teeth several times a day to keep your mouth moist.
 Contact your doctor and dietitian for any questions related to the allowed
amount of fluids you can drink per day.
14
Your Medicines
 Take your medications as advised by your doctor. It is
important that you comply with your medication regimen
to help control your blood sugar, blood pressure, and
kidney function.
 Contact your doctor for any questions related to your
medications.
 Keep your medications safe at home and away from children and check the
expiry date for your medications.
 Avoid taking iron and calcium supplements together. These should be
taken separately.
 If your doctor prescribes for you a phosphorus binder, ensure taking it with
the meals.
 If your doctor prescribes for you a medication to lower your potassium
level in your blood (Kayexalate), ensure taking it with water, not with juice
or milk.
 Don’t purchase any multivitamins or mineral supplements without
consulting your doctor as many of these contain high amounts of
potassium and phosphorus and may cause complications to you.
15
Shop for Your Kidney Health
 Don’t shop when you are hungry. Take a snack before
that.
 Prepare your shopping list before proceeding to the
shopping center.
 Purchase only the food items that you are allowed to have
according to the meal plan provided to you by your dietitian.
 Read the food label and select food items that are low in potassium,
phosphorus, and sodium.
 Check the expiry date for the food items.
 Store them safely at home.
 Ensure the availability of your food items at home, including your healthy
snacks.
16
Message to Families
Families of the patients with kidney failure disease are
important members of the healthcare team and to play this
important role, it’s recommended to do the following:
 Ensure the availability of the food items that are
appropriate for the patient.
 Prepare the food for the patient according to the recommended method by
the dietitian.
 Ensure that the patient takes his/her medications according to the advice
of the doctor.
 Ensure that the patient monitors his/her blood sugar and blood pressure.
 Support the patient in all his conditions and communicate with the
healthcare team in case of any emergency condition.
 Support the patient to adhere to the nutrition and medication plan and
encourage him/her to practice exercise.
 Engage the patient in social activities and support him/her in managing
his/her stress.
17
General Health Tips for Diabetic People
 Maintaining blood sugar within the normal range and taking
medications for diabetes as advised by the doctors.
 Practicing regular and moderate exercise.
 Maintaining body weight within the healthy range and losing
weight if obese.
 Performing medical tests as advised by doctors, including
testing of protein in the urine.
 Maintaining blood pressure and lipids within normal range.
 Avoiding smoking (active or passive).
 Monitoring the blood pressure and blood sugar at home and discuss the
results with their doctors.
 Follow diet plan and discuss with the dietitian. The meals should include
less salt, potassium, phosphorus, and protein. They also should be low in
cholesterol and saturated fat.
18
Sample Menu Plan
Breakfast
-
1 serving fruit from allowed list
1 egg (any style)
2 servings bread
½ cup low fat milk
Healthy oil
Lunch
- 1 serving meat, chicken, or fish (30 grams)
- 2 servings bread or 2/3 cup rice or macaroni without
tomato
- 1 serving cooked and drained vegetables
- 1 serving salad (cucumber, green pepper, and lettuce)
- 1 serving fruit from allowed list
- Healthy oil
19
Dinner
- 1 serving meat, chicken, or fish (30 grams)
- 2 servings bread or 2/3 cup rice or macaroni without
tomato
- 1 serving cooked/drained vegetables
- 1 serving salad (cucumber, green pepper, and lettuce)
- 1 serving fruit from allowed list
- Healthy oil
Snack
- 1 serving bread
- 1 serving fruit from allowed list
- 1 serving vegetables from allowed list
Notes:
1. Menu to be adjusted for diabetic people
2. Fluids to be decided by the doctor
3. Meals to be prepared without adding salt
20