If you have just been diagnosed with kidney disease, it’s important to know which stage you are in. Chronic Kidney Disease (CKD) is typically a progressive disease, starting at Stage 1 and ending at Stage 5. An increase in each stage represents a further decline in kidney function over time. 

Knowing what stage you are in is one of the first steps toward managing CKD. Diet and nutrition needs vary throughout each stage. Keep reading to find out more about a renal diet for the 5 stages of kidney disease!

New to CKD? Click Here for a general overview of CKD and how it affects Asians differently. 

What are the 5 Stages of Kidney Disease?

Each stage is defined by what your glomerular filtration rate (GFR) is, which tells you how well your kidneys are filtering toxins and waste out of your body. The lower the rate, the higher the stage. 

Stages of CKD

With each stage comes different nourishment needs. If you’re looking for more information than just a simple pamphlet from the doctor’s office, find your stage below to find out what you might be missing.

Stage 1 CKD Diet: Do I have to make changes already?

At stage 1, your eGFR is at or above 90. Your kidneys are still considered to have normal function. However, this doesn’t necessarily mean you should keep doing all the same things.

Educating yourself is one of the single best things you can do to slow your progression of CKD. Research has shown that lack of knowledge about CKD, including diet management, acts as a barrier to delaying the effects of CKD (1). 

Blood pressure and blood sugar control have been two of the most effective interventions proven to slow the progression of CKD (2). Some recommended goals are (2,3):

• Blood pressure 130/80 mm Hg
• HbA1C <7% (for those with diabetes)
• HbA1C <6.5% (for those at low risk of hypoglycemia)

It is easy to request these tests from your doctor and to come up with individualized goals, especially when it comes to blood sugar goals. Blood sugar management varies from person to person based on whether you already have diabetes or are at higher risk (3). 

Other lifestyle changes that can help are:

• Quit smoking
• Maintain a healthy weight
• Engage in regular physical activity

Lastly, it may be worth your while to start paying attention to how much protein you are consuming. When in stage 1, it is recommended to stick to 0.8g/kg of protein per day (4). Meanwhile, the average American intake is 1.3g/kg (5). 

This means that for every kilogram (kg) you weigh, you should consume 0.8g of protein. Since we typically talk about weight in pounds, let’s go over an example.

To find out your weight in kg, divide your weight in pounds by 2.2, then multiply this by 0.8 to find how many total grams of protein you should aim for in a day. 

Someone who weighs 150lbs is equal to 68.2kg (150 ÷ 2.2 = 68.2kg). This person should aim to consume about 55g of protein per day (68.2 x 0.8 = 54.56). 

Try it for yourself and see what your goal should be, then compare it with how much protein you are actually getting in a day!

Stage 2 CKD Diet: What should my plate look like?

In stage 2, you have a lot of the same goals as someone who is in stage 1 listed above. It’s likely that you won’t even know you are at this stage since few tend to show any symptoms yet. 

Ensure that your diet is nourishing and well-balanced. Aim to fill half your plate with fruits and vegetables, ¼ of protein-rich foods, ¼ carbohydrate-rich foods (choosing whole grains over processed), and choose low-fat or fat-free dairy options or dairy alternatives (6). Be sure to watch your protein and learn how to calculate your daily protein goal in the Stage 1 CKD Diet section. 

In addition to a healthy diet, it’s recommended to abstain from smoking, exercise regularly, take medications as prescribed, and have regular checkups with your doctor. If you have diabetes or hypertension, keep your blood sugar and blood pressure well controlled.

Your doctor may want to keep a closer eye on your GFR to see how the kidney disease is progressing and may check your urine to see how your kidneys are filtering waste products. 

Stage 3 CKD Diet: Time to consult a renal dietitian.

You probably noticed that stage 3 CKD is actually broken up into two substages: 3a and 3b. In 3a, kidney damage is considered mild-moderate while 3b is moderate-severe. 

For 3a, you may still not show any signs or symptoms of the damage, but you may experience fluid retention (edema) and changes in your urine. At this point, you will want to maintain the same recommendations as mentioned for the previous stages. 

For 3b, you should be working with a nephrologist, a doctor specializing in kidney disease, to develop a more individualized treatment plan. Your protein needs may drop as low as 0.6g/kg to “take it easy” on your kidneys and preserve their function (4). You may also be advised to watch the amount of phosphorus you are consuming. Typically your kidneys filter out excess vitamins and minerals that you take in, but as function declines, it is easier for them to build up in the body and can lead to other problems. It is common for people to see their phosphorus levels rise around stage 3b (7).

See the Stage 1 CKD Diet section to learn how to calculate your own protein goal, but an appointment with a renal dietitian is necessary to get individualized recommendations as you are at increased risk of malnutrition and to learn more about what you should limit or include more of at this stage.

Stage 4 CKD Diet: What else is left to do?

In stage 4, your kidneys are considered severely damaged and are working at less than 30% capacity. You may notice signs and symptoms such as:

• Fluid retention (edema)
• Tiredness
• Foamy urine
• Back pain
• Nausea/vomiting
• Changes in taste
• Decreased appetite

While it may seem like a time when things are out of your control, a healthy renal diet is still a large player in slowing the progression of CKD. A renal dietitian can work with you on learning how to monitor your sodium, phosphorus, and potassium levels along with other typical renal labs and how to tailor your diet to your lab results. 

Beware of “alternative” treatments that include herbal supplements or anything involving a “cleanse” especially when it is not under the supervision of a medical provider. There are countless wellness companies preying on those seeking answers to revert their CKD. 

Herbal remedies and supplements are not regulated by the FDA and those containing aristolochic acid or anthraquinones have been reported to worsen kidney function, including tissue death and muscle tissue breakdown (8). It’s easy to underestimate the power of a supplement when it is viewed as “natural”, but it is best to consult your doctor regarding any herbal compounds before incorporating them into your routine. 

Stage 5 CKD Diet: Getting used to a renal diet. 

Stage 5 CKD is the last of the 5 stages of kidney disease and is also referred to as end-stage renal disease (ESRD) or kidney failure. This is when your kidneys are now operating at less than 15% capacity and have lost nearly all their functional abilities. You are likely experiencing many of the symptoms listed in Stage 4 CKD, in addition to:

• Weight changes (due to fluid retention)
• Difficulty concentrating
• Itching
• Decreased urine output
• Tingling sensation in hands and feet

These signs and symptoms are due to toxins building up in the body and may also cause you to feel ill. 

Once our nephrons are damaged, the functional part of the kidney usually doesn’t recover. Yet, many people still manage to maintain their quality of life by making appropriate changes in their diet and lifestyle. 

Your dietary needs are going to vary based on your medications and which type of dialysis you may need to undergo (peritoneal dialysis or hemodialysis). A renal dietitian will help you with understanding more about your dietary needs. Some commonly monitored values that a dietitian will assess are listed below (8): 

• Iron
• Vitamin B12
• Folate
• Calcium
• Phosphorus
• Potassium
• Sodium
• Vitamin D
• Electrolyte abnormalities 

You will likely have to be a lot warier about your food choices. Be an active member of your own medical team and ask questions to better your confidence in decision-making. Soon enough, it will become second nature.

Need more guidance on the 5 stages of kidney disease? List your question below and it may be chosen as a future blog post topic! If you are seeking individual nutrition counseling, visit Healthy Mission Dietitian to work with me 1:1!

Note: The information on this site is not intended or implied as a substitute for professional medical advice, diagnosis, or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEBSITE. 

Sources

1. Lopez-Vargas, P. A., Tong, A., Phoon, R. K. S., Chadban, S. J., Shen, Y., & Craig, J. C. (2014, March 24). Knowledge deficit of patients with stage 1–4 CKD: A Focus Group Study. Wiley Online Library. Retrieved January 1, 2022, from https://onlinelibrary.wiley.com/doi/abs/10.1111/nep.12206 
2. Snyder, S., & Pendergraph, B. (2005, November 1). Detection and evaluation of chronic kidney disease. American Family Physician. Retrieved January 1, 2022, from https://www.aafp.org/afp/2005/1101/p1723.html 
3. Hahr, A. J., & Molitch, M. E. (2015, June 4). Management of diabetes mellitus in patients with chronic kidney disease. Clinical diabetes and endocrinology. Retrieved January 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469199/ 
4. Stall, S. (2008). Protein Recommendations for Individuals With CKD Stages 1-4. Nephrology Nursing, 35(3), 279–282. Retrieved 2021, from https://www.proquest.com/openview/4fa3dddd4d3d5da2b6885b6ed5bf6400/1?pq-origsite=gscholar&cbl=45638. 
5. Moore, L. W., Byham-Gray, L. D., Parrott, J. S., Rigassio-Radler, D., Mandayam, S., Jones, S. L., Mitch, W. E., & Gaber, A. O. (2013, January 9). The mean dietary protein intake at different stages of chronic kidney disease is higher than current guidelines. Kidney International. Retrieved January 1, 2022, from https://www.sciencedirect.com/science/article/pii/S0085253815557852 
6. What is MyPlate? MyPlate. (n.d.). Retrieved January 1, 2022, from https://www.myplate.gov/eat-healthy/what-is-myplate 
7. Cannata-Andía, J. B., & Martin, K. J. (2015, March 13). Challenge of controlling phosphorus in chronic kidney disease. OUP Academic. Retrieved January 1, 2022, from https://academic.oup.com/ndt/article/31/4/541/2459944?login=true 
8. Chen, T. K., Knicely, D. H., & Grams, M. E. (2019, October 1). Chronic kidney disease diagnosis and management: A Review. JAMA. Retrieved January 1, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015670/ 

SOURCES (links)

1. https://onlinelibrary.wiley.com/doi/abs/10.1111/nep.12206 lack of knowledge and diet ed on CKD prevention
2. https://www.aafp.org/afp/2005/1101/p1723.html BG and BP control
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469199/ glycemic goals for BG