Understanding kidney disease
Chronic kidney disease (CKD) means your kidneys have been filtering less well for three months or more. It is graded in stages from 1 to 5 by your estimated filtration rate (eGFR), and diabetes and high blood pressure are its two most common causes.
The right diet changes as CKD progresses, and generic "renal diet" lists often restrict far more than you need. Many people in the early stages never need a potassium or phosphorus limit. Your plan is set from your stage, your bloodwork and your treatment: conservative care, dialysis or a transplant.
How a dietitian helps with kidney disease
Protein set to your stage: a moderate amount before dialysis to protect kidney function, more once you are on dialysis.
Potassium and phosphorus limits only when your bloodwork calls for them, starting with phosphate additives in processed foods.
Sodium and blood pressure control, which protect the kidneys at every stage.
Diabetes and kidney disease together: one plan that balances carbohydrate control with protein, potassium and phosphorus.
Preventing muscle loss and malnutrition, a common and under-recognized problem in advanced CKD and on dialysis.
What the evidence says
KDOQI guidelines suggest about 0.55 to 0.6 g of protein per kg a day for stable stage 3 to 5 CKD without diabetes (0.6 to 0.8 g with diabetes), and 1.0 to 1.2 g per kg on dialysis.
Current guidelines adjust potassium and phosphorus to keep your blood levels normal rather than applying a fixed limit to everyone.
Phosphate additives in processed foods are absorbed almost completely, compared with roughly half of the phosphorus in plant foods.
Health Canada's ceiling of 2,300 mg of sodium a day applies to healthy adults; KDOQI also suggests staying under about 2,300 mg in CKD to help control blood pressure and fluid.
Plant-forward eating patterns are linked to slower CKD progression and lower cardiovascular risk.
Your nutrition care
Nutrition care for kidney disease starts with a full assessment: your medical history, current medications, recent lab results, weight history and the way you actually eat. From there your Registered Dietitian builds a plan around your diagnosis, your treatment goals and the foods you like, and adjusts it at each follow-up as your results come in.
We see patients in person at our Ottawa and Gatineau clinics and by secure video across Ontario and Quebec, so you can keep appointments between medical visits without travelling. With your consent, we share the plan with your physician or specialist team so everyone is working from the same numbers.
Not sure where to start? Book a free initial consultation. We will go over your situation, answer your questions and tell you honestly whether nutrition therapy is likely to help.
Book NowQuestions about nutrition care for kidney disease
Do I need to cut back on protein?
It depends on your stage and treatment. Before dialysis, a moderate protein limit set by your dietitian, often around 0.55 to 0.8 g per kg of body weight per day depending on whether you also have diabetes, may slow the decline in kidney function. Once you start dialysis the opposite applies: dialysis removes protein, so your needs go up. Cutting protein on your own can lead to muscle loss.
Do I have to avoid potassium and phosphorus?
Only if your bloodwork shows high levels, and many people with early chronic kidney disease never need to. For phosphorus, the additives in processed meats, colas and packaged foods are absorbed far more than the phosphorus in legumes and nuts, so they are the first target. For potassium, soaking and boiling vegetables lowers their content, so fewer foods are off the table.
How much fluid can I drink?
Most people with early-stage kidney disease do not need a fluid limit. A limit usually applies only on dialysis or when you retain fluid, and is set from your urine output and your weight gain between treatments.
I have diabetes and kidney disease. How do the two diets fit together?
We build one plan rather than stacking two lists of restrictions. Your dietitian balances carbohydrate control with your protein, potassium and phosphorus targets so that foods ruled out by one diet do not leave you with too few options under the other.
Can I see a dietitian for kidney disease online?
Yes. We offer secure video appointments across Ontario and Quebec, as well as in-person visits at our Ottawa and Gatineau clinics. Online visits include the same assessment, plan and follow-ups.
Sources and guidelines
This page is general information, not individual advice. Your dietitian sets your own targets. Daily intake figures for healthy adults are Health Canada's Dietary Reference Intakes.