Guide to Create a Balanced Kidney-Friendly Meal

MEAL PLANNING can be an overwhelming task for patients with chronic kidney disease (CKD) who are not on dialysis. With various nutrition restrictions, patients may have difficulty determining where to start when creating a meal or identifying a recipe that is kidney friendly. This handout provides diet recommendations and modifications for food groups that will help patients with CKD get adequate nutrition while limiting kidney disease progression.


Protein is an essential building block for skin, hair, and nails. It also plays a significant role in helping to build and maintain muscle, as well as fight off infections. The average person needs 40-65 g of protein per day; however, patients with CKD differ in protein needs due to compromised kidney function.

When protein is consumed, waste byproducts are formed and excreted through the urine. Kidney disease prohibits protein from excreting properly and increases blood urea nitrogen and creatinine levels. The recommended average protein intake for patients with CKD who are not on hemodialysis is 0.6-0.8 g/kg of body weight per day. There are about 7 g of protein in a one ounce portion of meat.

A standard serving of protein is 3 ounces, which is roughly the size of a deck cards. For patients with CKD, it is recommended that at least 50% of protein consumed is high biological value. Limiting dietary protein can help reduce the advancement of CKD.


Patients should restrict phosphorus-containing foods to maintain a safe phosphorus range between 2.7 and 4.6 g/ dL. Grains, specifically whole grains, contain phosphorus, are good sources of fiber, and should be part of the CKD diet. Working with a dietitian can help patients consume the appropriate amount of these foods. Label reading is another method to control phosphorus levels.

Patients should be encouraged to avoid foods with phosphorus additives or ‘‘phos’’ listed as part of the ingredient list. In addition to a phosphorus-restricted diet, patients with CKD may be prescribed a phosphate-binding agent that is taken with meals to limit phosphorus absorption.

Fruits and Vegetables

One important role of the kidneys is to keep a balance of minerals in the body. With CKD, potassium may build up to toxic levels in the blood stream. Hyperkalemia and hypokalemia have detrimental effects on the body including heart irregularities; therefore, it is important to keep potassium levels between 3.5 and 5.0 mmol/L.

Fruits and vegetables vary in their potassium content. Patients with CKD should consume low-potassium fruits and vegetables and limit high-potassium fruits and vegetables. Low-potassium fruits contain less than 200 mg per small fruit or ó a cup of fresh or canned fruit. Low-potassium vegetables contain less than 200 mg per cup of leafy greens or ó a cup of vegetables.

Dairy and Milk Alternatives

Dairy and milk alternatives provide essential nutrients but also contain varying levels of phosphorus, sodium, and potassium. Healthy kidneys regulate these minerals in our body, but in patients with CKD, this function can be compromised.

Hyperphosphatemia pulls calcium frombones, causing bones to weaken. Another side effect of hyperphosphatemia is itchy skin. Patients can balance phosphorus levels by reducing their intake of milk, cheese, and yogurt. If the patient has trouble controlling phosphorus levels, the dietitian should be consulted for milk alternative recommendations. In addition, patients with CKD should be evaluated for need of calcium and vitamin D supplementation.

Other Considerations

Sodium restrictions help control blood pressure, lower the risk of cardiovascular disease, and slow the progression of kidney disease. Patients with CKD should reduce their sodium intake to 2000 mg or less per day and discuss.

Source: Journal of Renal Nutrition, Vol 29, No 4 (July), 2019: pp e9-e11 e9

PATIENT EDUCATION: Feature Editor: Stacey Phillips, MS, RD

Tessa Ladsten, RDN, and Zoe Sarakatsannis RDN