Nutrition for CKD Stage 4

Nutrition for CKD Stage 4

When you have chronic kidney disease, nutrition is an important part of your treatment plan. Your recommended diet may change over time if your kidney disease gets worse.

Your Dietitian will help you plan your meals with the right foods and in the right amounts. Nutrients affecting the kidney at this stage are:

  • Protein
  • Sodium
  • Potassium
  • Phosphorus
  • Vitamins

Kidney Disease and Diabetes

If you have diabetes, you may need to make a few changes to your diabetes diet, with the help of your dietitian. Check your blood sugar levels often and try to keep your levels under control. Your doctor or pharmacist may adjust your insulin or other medications if your kidney disease gets worse.

Renal Dietitian

Your doctor or renal dietitian will monitor your blood work. If any changes are required to your diet, a renal dietitian will work with you to develop a meal plan that will fit within your cultural and lifestyle needs. It is important to remember that dietary changes may vary among people with kidney disease.

Protein comes from:

  • Red meats
  • Poultry (chicken, turkey, duck)
  • Fish and seafood
  • Eggs
  • Milk and cheeses
  • Tofu, legumes and beans

Eating the right amount of protein will help to:

  • Build muscles & repair body tissues
  • Fight infections and helps with healing
  • Prevent wastes from building up in your blood

Large servings of protein foods may increase the workload of the kidney. A good serving
size is 3 ounces (about the size of a deck of cards)


  • There are two kinds of protein. A well balanced diet should include both kinds of
    proteins every day.
  • Higher quality (more complete) protein comes from animal products like meat, poultry,
    fish, eggs and dairy products. These are the easiest proteins for your body to use.
  • Lower quality (less complete) protein comes from vegetables and grains

Limiting sodium to 2300 mg or less (about 1 teaspoon of salt) per day:

  • Helps to reduce fluid build up in the body (swelling of the ankles, fingers, eyes)
  • Helps to control blood pressure within normal ranges

Sodium is a mineral and is found in most foods, but is especially high in:

  • Table salt & sea salt
  • Salty seasonings (e.g. soy sauce, teriyaki sauce, garlic salt, and seasoning salt)
  • Most canned foods and some frozen foods
  • Processed meats (e.g. ham, bacon, sausage, cold cuts)
  • Salted snack foods (e.g. chips, crackers, pickles)
  • Most restaurant and take-out foods
  • Canned or dehydrated soups (e.g. packaged noodle soup)


  • Eat foods closest to their natural state (not processed)
  • Read food labels for the amount of sodium
  • Add flavour to your food. Try a dash of:
    — Hot pepper sauce
    — Lemon juice
    — Vinegar
    — Fresh or dried herbs and spices
    — No-added salt blends (Mrs. Dash®, McCormick’s No Salt Added®)

Avoid: Salt substitutes (Half Salt® or No-Salt®)

  • Is an important mineral that helps your heart & muscles to work properly
  • Too much or too little potassium in your blood can be dangerous
  • Not everyone needs the same amount of potassium. How much you need will depend on:
    — How well the kidneys are working
    — Some types of medications you are taking
  • Potassium is found in all foods but large amounts are found in:
    — Some fruits & vegetables (bananas, melons, oranges, potatoes, tomatoes, dried fruits, dark green leafy vegetables & some fruit & vegetable juices)
    — Milk and yogurt
    — Dried beans and peas
    — Salt substitutes (Half Salt® or No-Salt®)
    — Chocolate
    — Nuts and seeds
    — Lentils and legumes


  • Know your blood potassium level (normal = 3.5-5.1). If it is too low you may need a supplement (either potassium medication or a high potassium diet) to raise your potassium level.  If it is too high you may need a binder (medication) to lower your potassium level and a low potassium diet.
  • Double boiling or soaking root vegetables will reduce the amount of potassium in the vegetables
  • Also known as phosphate
  • Is a mineral that works with calcium to form strong bones & teeth

In the later stages of kidney disease, phosphorus starts to build up in your blood. Calcium is then pulled from your bones into your blood. This causes serious problems like:

  • Damage to the heart & other organs
  • Poor blood circulation
  • Bone pain & weakness
  • Skin sores

Phosphorus is found in most foods. Large amounts are found in:

  • Dairy products (milk, cheese, pudding, yogurt, ice cream
  • Dried beans and peas (kidney beans, split peas, lentils)
  • Nuts and seeds
  • Other beverages (colas, beer, cocoa)
  • Chocolate
  • Whole grains especially bran
  • Seasoned meats & processed/convenience foods
  • Baking powder

The Dietitian will discuss ways to help you lower your phosphorus intake. The Doctor may prescribe a phosphate binding medication to be taken just before meals to help control the level in your blood.


  • Use non-dairy creamers and milk substitutes in place of milk to help lower the amount of phosphorus in your diet
  • Rice Dream Original™ is low in phosphorus (Enriched Rice Dream is higher in phosphorus)
  • When your diet is limited you may need to take a special vitamin pill made for people with kidney disease
  • Do not take over-the-counter vitamins
  • Do not take over the counter Vitamin D or calcium pills unless recommended by your kidney doctor
  • Check with the kidney doctor and/or pharmacist about herbal medications.
  • In the later stages of kidney disease, your kidneys may not be able to remove the extra fluid in your body.
  • You may need to limit how much fluid you eat or drink.Tell the health care team if you notice you have swelling (eyes, legs, arms or abdomen) or if you are making less urine.
  • Comes from the foods you eat.
  • Without enough calories, your body will use up your protein to give you energy
  • This will cause wasting (loss of muscle)

Eating enough calories helps:

  • You stay at a healthy weight
  • Your body use protein for building muscles and tissues


  • Eat 3 meals each day
  • Have something to eat every 4-6 hours
  • Watch how much or how little you eat (portion control)
  • The Dietitian will help you with your calorie needs
  • Provide energy and are part of a healthy diet


  • Include a small amount (30-45 ml or 2-3 tbsp) of unsaturated fat each day
  • This includes oil used for cooking, salad dressings, margarine and mayonnaise
  • Use vegetables oils such as canola, olive and soybean
  • Choose soft margarines that are low in saturated and trans fats (look for labels that say non-hydrogenated)
  • Limit butter, hard margarines, lard, shortening, fried and deep fried foods
  • Include lean meat and meat alternatives by consuming a portion between 2-3 ounces (about the size of a deck of cards), 2 to 3 times per day

Comparing Diets – No Restrictions vs Kidney Friendly

BREAKFASTOrange juice
Bran cereal
Coffee with milk
½ cup cranberry juice
Rice Krispies®
½ cup of milk
Coffee with non-dairy creamer
LUNCHCanned Pea soup
Bologna sandwich
Salad (lettuce, tomato,
cucumber, celery)
Homemade low salt, low potassium
vegetable soup
Roast beef sandwich
Salad (lettuce, cucumber, celery)
½ cup grapes
water /hot beverage/ non-cola soda
Canned peas
Frozen fried potatoes
3 ounces pork roast
½ cup frozen or fresh peas
½ cup homemade double-boiled potatoes
1 white dinner roll
Water/hot beverage/non-cola soda
SNACKCrackers, cheese & sausage
1 cup air popped popcorn (unsalted)
Water/hot beverage/ non-cola soda