Can a dietitian help with chronic kidney disease?

Key Points

• Diet plays an important role in regulating and slowing the progression of chronic kidney disease.
• Registered dietitians are the most qualified nutrition providers to support CKD patients. 
• A dietitian can help educate you on what foods to eat and what to avoid, how much to eat, and more.

Whether you’ve been recently diagnosed with chronic kidney disease (CKD) or you’ve been dealing with CKD for some time now, you probably know the critical role diet plays in CKD management. So you may be wondering: Can a dietitian help with kidney disease?

An RD can serve as an important provider on your care team to offer nutrition information and support your overall health as you manage this condition. Here is how an RD can support patients with CKD.

How can a dietitian help with kidney disease?

People with kidney disease often have to follow a kidney-friendly diet to mitigate symptoms and avoid further kidney damage. This can be overwhelming and confusing, particularly for those who are newly diagnosed. A registered dietitian is the most qualified health professional to help create a meal plan and guidelines to slow disease progression, avoid kidney failure, and improve kidney function.

Here are ways RDs can support people with CKD:

• Explain dietary guidelines: There are many guidelines to follow to eat right for CKD, like limiting sodium, potassium, protein, and other food groups. When you first meet with your RD, they will explain exactly what limitations are relevant for you based on your doctor’s recommendations, why these changes are important, and then, of course, how to implement the adjustments. They can then help monitor your sodium, phosphorus, and potassium levels as you continue to work together.
• Create a nutrition plan: Following the dietary guidelines, your RDN will create an eating plan for you that is compliant with medical guidelines and meets your nutritional needs but still enables you to maintain the highest quality of life possible. This will include guidelines on how much protein, fat, and carbohydrates to eat, all of which ladder up to overall caloric goals.
• Address complications: CKD can come with its share of complications, like anemia, bone density loss, muscle loss, and electrolyte imbalances. A renal dietitian can help manage these conditions alongside CKD by enforcing healthy eating habits, keeping you at a healthy weight, and avoiding malnutrition.
• Manage comorbidities: Kidney patients often have diabetes and high blood pressure, as they are the two leading causes of kidney disease. Both conditions require dietary interventions, and managing multiple diagnoses at once can be complicated and overwhelming. An RD has the knowledge you need to navigate this and can support your diet to avoid further health problems.
• Improve quality of life: Managing CKD is all about delaying disease progression and avoiding dialysis until absolutely necessary. Medical nutrition therapy is one of the most effective ways to treat kidney disease to improve your day-to-day life and general symptoms.

What is medical nutrition therapy?

Medical nutrition therapy (MNT) is nutrition counseling from a registered dietitian or registered dietitian nutritionist to address health concerns and meet health goals. MNT is used for diabetes, high blood pressure, hypertension, and chronic kidney disease, amongst other diagnoses.

MNT can only be administered by an RD. Nutritionists without the RD or RDN title are not qualified to offer MNT. RDs are credentialed by the Commission on Dietetic Registration and have proven education and clinical experience. Nutritionists are not regulated in the same way and thus are not qualified to offer medical nutrition therapy.

Some RDs specialize in CKD management. They are called renal dietitians and will usually advertise themselves as such.

What is the best diet for CKD?

Kidney disease means the kidneys are not able to filter blood properly. This can lead to imbalanced salt, minerals, and fluid, all of which are greatly impacted by diet. There is no singular diet for CKD, but there are general guidelines that most kidney patients follow to slow disease progression.

These guidelines will depend on what stage of chronic kidney disease you are in. Those in the early stages will focus on symptom mitigation, whereas those on dialysis will need to focus on minimizing fluid retention and minerals.

Caloric intake

People with CKD often experience loss of hunger or find that foods don’t taste the same. A dietitian can help figure out the right amount of food and strategize ways to ensure you are getting enough food in to support your body’s needs. Eating enough calories is important to avoid losing weight, which puts additional stress on the body and can make you sicker. Being overweight comes with its share of complications, too. Your RD can offer weight management tactics that keep you as healthy as possible.

Balancing protein and fat

Protein is a critical macronutrient for building and maintaining muscle, bone, connective tissue, and more. However, protein must be broken down into waste that the kidneys remove. As such, CKD patients need to balance their protein intake. Too much will cause stress on the kidneys, but too little can lead to malnutrition. A renal dietitian can help find the right balance and provide guidance on the best protein sources for you, whether animal-based or vegetarian.

Fat is another important macronutrient that requires balancing with CKD. Fat helps your body absorb vitamins, controls cholesterol and blood pressure, and gives your body energy. Too much fat, however, can cause build-up in your blood vessels, kidneys, and heart. Having CKD means you are at higher risk for heart disease, so you will need to limit your fat consumption. You will need to avoid saturated and trans fats and focus on unsaturated fats. This means less butter and fried food and more olive oil and salmon.

Monitor minerals

Phosphorus, sodium, and potassium are the primary minerals of concern for CKD patients. Because the kidneys don’t work well, they can’t filter minerals as well, which creates a risk of build-up and other health complications.

Phosphorus can weaken your bones if it isn’t filtered out properly. It is naturally occurring in protein-rich foods, but phosphorus is also frequently added to processed foods and flavored drinks. This added phosphorus is the main cause of concern.

Your dietitian can help identify which foods to avoid to prevent phosphorus buildup. As kidney disease worsens, binders may be necessary to decrease the amount of the mineral in your blood. A phosphate binder acts like a sponge to absorb the mineral and remove it from your body via your stool instead of your kidneys.

Sodium helps regulate fluid in your body. Too much sodium causes your blood to retain fluid, which can cause swelling and high blood pressure – both of which put stress on your kidneys and heart. Sodium is naturally occurring in salt and is also added to many foods, particularly processed foods, sauces, canned foods, and seasonings. Note, however, that some salt substitutes contain potassium, which also needs to be monitored.

Regardless of their stage of kidney disease, all CKD patients need to watch their sodium intake, but your RD will determine the right amount of sodium for you individually. Your intake may change as the disease progresses.

Potassium is essential for bone and muscle function, but too much or too little can cause problems. CKD means it is harder to filter out potassium and can lead to dangerously high levels. Both food and drink influence potassium levels. The mineral is naturally occurring in many fruits and vegetables, like potatoes, spinach, squash, avocado, and some peas and beans. Potassium is also added to canned fruits and vegetables as well as spice mixes.

How does a dietitian tailor a diet plan for someone with kidney disease?

Early CKD

Kidney damage is mild in Stage 1 CKD. This means your kidneys are still working well, but they may have physical damage. At this stage, the approach is all about limiting disease progression and maintaining kidney health as best as possible. Your dietitian will work with your renal care team to address your dietary needs and create a sustainable meal plan.

Problems urinating

It is common for CKD patients to have blood or protein in their urine or experience issues urinating. Frequent urinary tract infections (UTIs) aren’t uncommon. Monitoring your mineral levels will help mitigate some of these issues, which a dietitian can help advise.

Kidney stones

Kidney stones are a dangerous and uncomfortable risk factor for CKD. Hydration is key to preventing stones. Diet also plays a role. It’s important to prioritize calcium and reduce sodium to minimize and prevent kidney stones. Your dietitian can offer guidance on how to get enough calcium while reducing sodium. Oxalate is another mineral to watch – it produces the most common type of kidney stone, called calcium oxalate stones. Oxalate is present in chocolate, berries, spinach, nuts, beets, and some teas.

Dietary guidelines

There are steps you can take to moderate your mineral levels, such as:

• Eating fresh or frozen fruits and vegetables without any added sauce or seasoning
• Consuming unprocessed meats instead of processed
• Moderating protein and fat intake
• Using herbs, spices, and salt-free seasoning mixes instead of salt
• Cooking from scratch
• Limiting consumption of processed and packaged foods
• Draining and rinsing canned foods to remove added salt
• Using products labeled “low sodium” or “sodium free”
• Reading nutrition labels to watch for phosphorus, potassium, oxalate, and sodium

How to find a renal dietitian

Working with a certified, trusted RD is a crucial step to moderating chronic kidney disease progression. A dietitian can help with kidney disease by assessing your medical history, working with your renal care team, and creating a diet plan that is custom to your specific needs.

You can find a board-certified RN or RDN specializing in kidney disease who is covered by your insurance with Fay Nutrition. You can filter by specialty to find someone who focuses on renal nutrition and get your care covered by your health insurance provider. It’s one of the best ways to take care of yourself while facing this difficult diagnosis. Get started with Fay here.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.