User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 37, Issue Previous Article Next Article. Article Navigation. Original Articles December 01 Renal Response to Restricted Protein Intake in Diabetic Nephropathy Jeremy J Bending ; Jeremy J Bending.

Unit for Metabolic Medicine, Division of Medicine, United Medical and Dental Schools. This Site. Google Scholar. Rosemary A Dodds ; Rosemary A Dodds.

H Keen ; H Keen. Gian Carlo Viberti Gian Carlo Viberti. Address correspondence and reprint requests to Professor G. Viberti, Unit for Metabolic Medicine, 4th Floor Hunt's House, Guy's Hospital, London SE1 9RT.

Diabetes ;37 12 — Article history Received:. While additive phosphorus content varies depending on the type of soda, a ounce oz or milliliters mL cola contains As a result, sodas , especially those that are dark, should usually be avoided on a renal diet.

Dark-colored sodas should be avoided on a renal diet, as they contain phosphorus in its additive form, which is highly absorbable by the human body. Avocados are often touted for their many nutritious qualities, including heart-healthy fats, fiber, and antioxidants. While avocados are usually a healthy addition to the diet, they are considered one of the high-potassium foods to avoid with kidney disease.

In fact, one average-sized avocado provides a whopping mg of potassium By reducing the portion size to one-fourth of an avocado, people with kidney disease can still include this food in their diets while limiting potassium, if needed.

Avocados, including guacamole, should be limited or avoided on a renal diet if you have been told to watch your potassium intake.

However, remember that different individuals have different needs, and your overall diet and health goals are the most important thing to consider. Consider avoiding avocados on a renal diet if a doctor or dietitian has advised you to lower your potassium intake.

Canned foods such as soups, vegetables, and beans are often purchased because of their low cost and convenience. However, most canned foods contain high amounts of sodium, as salt is added as a preservative to increase its shelf life Additionally, draining and rinsing canned foods, such as canned beans and tuna, can significantly decrease the sodium content Canned foods are often high in sodium.

Avoiding, limiting, or buying low sodium varieties is likely the best to reduce your overall sodium consumption. For healthy individuals, whole wheat bread is usually recommended over refined, white flour bread.

Whole wheat bread may be more nutritious, mostly due to its higher fiber content. However, white bread is usually recommended over whole wheat varieties for individuals with kidney disease. This is because of its phosphorus and potassium content.

The more bran and whole grains in the bread, the higher the phosphorus and potassium contents For example, a regular slice, or gram g serving, of whole wheat bread contains about 76 mg of phosphorus and 90 mg of potassium. In comparison, a regular slice 28 g of white bread contains approximately 32 mg of phosphorus and potassium 15 , Eating one slice of whole wheat bread instead of two can help lower your potassium and phosphorus intake without giving up whole wheat bread entirely.

White bread is typically recommended over whole wheat bread on a renal diet due to its lower phosphorus and potassium levels. Like whole wheat bread, brown rice is a whole grain that has a higher potassium and phosphorus content than its white rice counterpart.

Each cup g of cooked brown rice contains mg of phosphorus and 95 mg of potassium, while 1 cup g of cooked white rice contains only 69 mg of phosphorus and 54 mg of potassium 18 , You may be able to fit brown rice into a renal diet, but only if the portion is controlled and balanced with other foods to avoid an excessive daily intake of potassium and phosphorus.

Bulgur, buckwheat , pearled barley, and couscous are nutritious, lower-phosphorus grains that can make a good substitute for brown rice. Brown rice has a high content of phosphorus and potassium and will likely need to be portion-controlled or limited on a renal diet.

White rice, bulgur, buckwheat, and couscous are all good alternatives. Bananas are known for their high potassium content. While naturally low in sodium, 1 medium banana provides mg of potassium If you have been instructed to limit your potassium intake, it may not be easy if a banana is a daily staple.

However, pineapples contain substantially less potassium than other tropical fruits and can be a more suitable yet tasty alternative Bananas are a rich source of potassium and may need to be limited on a renal diet. Pineapple is a kidney-friendly fruit, as it contains much less potassium than certain other tropical fruits.

Dairy products are rich in various vitamins and nutrients. For example, 1 cup mL of whole milk provides mg of phosphorus and mg of potassium Yet, consuming too much dairy, in conjunction with other phosphorus-rich foods, can be detrimental to bone health in those with kidney disease.

This may sound surprising, as milk and dairy are often recommended for strong bones and muscle health. However, when the kidneys are damaged, too much phosphorus consumption can cause a buildup of phosphorus in the blood, pulling calcium from your bones.

This can make your bones thin and weak over time and increase your risk of bone breakage or fracture Dairy products are also high in protein. Each cup mL of whole milk provides nearly 8 g of protein Dairy products contain high amounts of phosphorus, potassium, and protein and should be limited to a renal diet.

One large orange g provides mg of potassium. Moreover, there are mg of potassium in 1 cup mL of orange juice 24 , Given their potassium content, oranges and orange juice likely need to be avoided or limited on a renal diet. Grapes, apples, and cranberries, as well as their respective juices, are all good substitutes for oranges and orange juice, as they have lower potassium content.

Oranges and orange juice are high in potassium and should be limited to a renal diet. Try grapes, apples, cranberries, or their juices instead. Processed meats have long been associated with chronic diseases and are generally considered unhealthy due to their preservative contents 26 , Processed meats typically contain large amounts of salt, mostly to improve their taste and preserve flavor Therefore, it may not be easy to keep your daily sodium intake to less than 2, mg if processed meats are abundant in your diet.

Processed meats are high in salt and protein and should be consumed in moderation on a renal diet. Pickles , processed olives, and relish are all examples of cured or pickled foods. For example, one pickle spear can contain around mg of sodium. Likewise, there are mg of sodium in 2 tablespoons 30 g of sweet pickle relish 29 , Five green pickled olives provide about mg of sodium, a significant portion of the daily amount in only a small serving Many grocery stores stock reduced-sodium varieties of pickles, olives, and relish, which contain less sodium than their traditional counterparts.

A healthcare professional and a registered dietitian can advise you on your individual needs for protein and other nutrients, depending on your stage of kidney disease. High sodium foods are not ideal for people with kidney disease and diabetes because excess sodium can strain your kidneys, leading to high blood pressure and fluid buildup 5 , 6.

Processed meats — such as bacon, sausage, and jerky — are made by drying, salting, curing, or smoking meats to enhance their flavor, texture, and shelf life.

Because these products are typically salted, they have a high sodium content, and you should limit your consumption of them if you have kidney disease and diabetes.

Other examples of high sodium processed foods to limit are instant noodles, frozen pizza, fast food, and frozen meals. Having high blood phosphorus levels for an extended period can raise your heart disease risk, weaken your bones, and increase your risk of early death 7.

Dark-colored sodas contain phosphorus, which is used to prevent discoloration, prolong shelf life, and add flavor. However, they contain a different type of phosphorus than is naturally found in foods, and this type is absorbed into your blood more easily 8 , 9.

Beans and lentils are also relatively high in phosphorus, but if you enjoy them, you can consume them in small amounts. In fact, some research suggests that plant-based diets, which rely more on legumes, whole grains, nuts, and seeds for protein, may slow the progression of chronic kidney disease CKD Additionally, phosphorus absorption can vary for different food sources.

If left untreated, it can cause fatigue, muscle weakness, heart problems, and even death If you have kidney disease, a doctor may recommend limiting your intake of fruits high in potassium, such as bananas, avocados, apricots, kiwis, and oranges Many varieties of leafy green vegetables, such as spinach, chard, and beet greens, also contain large amounts of potassium and may need to be enjoyed in moderation on a kidney-friendly diet Potatoes and sweet potatoes are high in potassium as well.

However, they can be soaked or leached to significantly reduce their potassium content These drinks tend to be high in added sugar, which can cause rapid spikes in blood sugar. Having high blood sugar levels over a long period can damage your nerves, further damage your kidneys, and raise your risk of heart disease Consuming large amounts of alcohol can negatively affect kidney function Alcohol can also interfere with certain medications used to treat diabetes, increasing the risk of issues such as low blood sugar A healthcare professional can provide guidance on whether alcohol is safe to include in your diet plan and how much you can consume.

According to the Centers for Disease Control and Prevention, the following are a few examples of foods and drinks suitable for people with kidney disease and diabetes 9 :. A doctor or dietitian can also provide recommendations for nutritious foods to include in your meal plan.

If you have kidney disease, you may need to limit your intake of fruits high in potassium, including apricots, bananas, cantaloupes, and dates. Dried fruits are also often high in potassium and carbohydrates, which can increase blood sugar levels if consumed in large amounts Because whole grain breads are high in phosphorus, people with kidney disease and diabetes should opt for white bread instead 9.

According to the National Kidney Foundation, eating large amounts of sodium, sugar, and phosphorus can negatively affect kidney health.

Pedrini MT, Levey AS, Lau J, et al. Ann Intern Med , — Pijls LTJ, deVries H, Donker AJM, vanEijk JTM: The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial.

Nephrol Dial Transplant , 14 — Pomerleau J, Verdy M, Garrel DR, Nadeau MH: Effect of protein intake on glycaemic control and renal function in type 2 non-insulin-dependent diabetes mellitus. Diabetologia , 36 — Hansen HP, Christensen PK, Tauber-Lassen E, et al.

Kidney Int , 55 — Dullaart RPF, van Doormaal JJ, Beusekamp BJ, et al. Diabetes Care , 16 — Raal FJ, Kalk WJ, Lawson M, et al. Am J Clin Nutr , 60 — Ciavarella A, DiMizio G, Stefoni S, et al.

Diabetes Care , 10 — Zeller K, Whittaker E, Sullivan L, et al. Walker JD, Bending JJ, Dodds RA, et al. Lancet , 2 — Meloni C, Morosetti M, Suraci C, et al. J Renal Nutr , 12 — In subjects with long-standing type 1 and type 2 diabetes and overt nephropathy, severe protein restriction did not delay the progression of renal disease but did cause unwanted weight loss and indications of malnutrition.

Shichiri M, Nishio Y, Ogura M, Marumo F: Effect of lowprotein, very-low phosphorus diet on diabetic renal insufficiency with proteinuria. Am J Kidney Dis , 18 — Barsotti G, Cupisti A, Barsotti M, et al.

Nephrol Dial Transplant , 13 suppl 8 — Brodsky IG, Robbins DC, Hiser E, et al. J Clin Endocrinol Metab , 75 — Brodsky IG, Devlin JT: Effects of protein restriction on regional amino acid metabolism in insulin-dependent diabetes mellitus. Am J Physiol , :EE Kontessis P, Jones S, Dodds R, et al.

Kidney Int , 38 — Jibani MM, Bloodworth LL, Foden E, et al. Diabet Med , 8 — Kontessis PS, Bossinakou I, Srika L, et al.

Diabetes Care , 18 — Anderson JW, Blake JE, Turner J, Smith BM: Effects of soy protein on renal function and proteinuria in patients with type 2 diabetes. Am J Clin Nutr , 68 suppl SS.

Hanna TJ, Fanti P, Anderson JW: Soy protein decreases workload of kidneys in type 1 diabetics at risk for diabetic nephropathy [abstract]. FASEB J , 13 :A Wheeler ML, Fineberg SE, Fineberg NS, et al.

Diabetes Care , 25 — In subjects with type 2 diabetes and microalbuminuria there were no differences in renal function with diets of usual protein intake and either predominately vegetable or animal protein. However, renal function, glycemia, lipids, and blood pressure improved from both weight-maintaining diets meeting nutritional guidelines, regardless of the protein source.

Cutler JA, Follmann D, Allender PS: Randomized trials of sodium restriction: an overview. Am J Clin Nutr , 65 suppl 1 SS. Sacks FM, Svetkey LP, Vollmer WM, et al. DASHSodium Collaborative Research Group.

N Engl J Med , :3— Download references. Nutrition Concepts by Franz, Limerick Drive, , Minneapolis, MN, USA. Marion J. Wheeler MS, RD, FADA, CDE. You can also search for this author in PubMed Google Scholar. Reprints and permissions.

Franz, M. Nutrition therapy for diabetic nephropathy. Curr Diab Rep 3 , — Download citation. Issue Date : October Anyone you share the following link with will be able to read this content:.

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References and Recommended Reading Diabetic nephropathy position statement. Article PubMed Google Scholar Watts GF, Gregory L, Naoumova R, et al. PubMed CAS Google Scholar Ekberg G, Sjofors G, Grefberg N, et al. Article CAS Google Scholar Riley MD, Dwyer T: Microalbuminuria is positively associated with usual dietary saturated fat intake and negatively associated with usual dietary protein intake in people with insulin-dependent diabetes mellitus.

PubMed CAS Google Scholar Jameel N, Pugh JA, Mitchell BD, Stern MP: Dietary protein intake is not correlated with clinical proteinuria in NIDDM. Article PubMed CAS Google Scholar Nyberg G, Norden G, Attman P-O, et al. Article PubMed CAS Google Scholar Toeller M, Buyken A, Heitkamp G, et al.

Article Google Scholar Wrone EM, Carnethon MR, Palaniappan L, Fortmann SP: Association of dietary protein intake and microalbuminuria in health adults: Third National Health and Nutrition Examination Survey.

Article PubMed Google Scholar Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications position statement. Google Scholar Pedrini MT, Levey AS, Lau J, et al.

High-fiber carbs like whole grain bread, whole grain pasta, brown rice, and even unsalted popcorn can be smart choices in moderation. Eating high-fiber foods helps keep your blood sugar within a normal range and prevents spiking. Recipe idea: Easy Fried Rice. Balance your meals with fresh protein choices such as chicken, fish, and eggs.

Limit processed foods like deli meats or sausages because they are usually high in sodium and phosphorus. Healthy fats like unsaturated fats can be good for you. Unsaturated fats typically come from plants and are found in vegetable oils, nuts, and peanut butter.

You can also find them in fish that are high in omega-3 fatty acids. Recipe idea: Seared Salmon with Braised Broccoli. People with CKD and diabetes should minimize:. Be aware that some foods are good for people with one condition, but not the other.

Your carb and protein needs can also change depending on your health. September 18, Dietary Approaches in the Management of Diabetic Patients with Kidney Disease. Nutrients ;9 8 The Associations of Plant Protein Intake with All-Cause Mortality in CKD. American Journal of Kidney Diseases ;67 3 A Prospective Study on Total Protein, Plant Protein and Animal Protein in Relation to the Risk of Incident Chronic Kidney Disease.

BMC Nephrology ;21 1 Are low-carbohydrate diets safe in diabetic and nondiabetic chronic kidney disease? Ann NY Acad Sci. Tips for Following a Kidney Disease and Diabetes Diet.

Managing both conditions at once can be challenging, but following a diet for kidney disease and diabetes can help you take control. How Are Diabetes and Kidney Disease Related? Diabetes can make it difficult to control blood sugar and can damage the blood vessels in your kidneys.

It can also raise your blood pressure, which causes more kidney damage. Eating well can help you manage both diabetes and kidney disease. Stick to your customized diet with these tips.

Start with the right foods. Recipe idea: Cobb Salad with Dijon Dressing - Fruits. There is no one-size-fits-all kidney disease and diabetes diet, so speak with your doctor or dietitian about your unique needs.

Below is an example of food choices that are usually recommended on a typical kidney diet for people with diabetes. This list is based on heath value of foods in addition to sodium, potassium, phosphorus and high sugar content of foods included.

Ask your dietitian if you can have any of these listed foods and make sure you know what the recommended serving size should be. Some of the foods in the Limit or Avoid lists may be worked into your meal plan based on your dietitian's recommendations.

Chocolate milk, buttermilk, sweetened yogurt, sugar sweetened pudding, sugar sweetened ice cream, sugar sweetened nondairy frozen desserts. White, wheat, rye, sourdough, whole wheat and whole grain bread, unsweetened, refined dry cereals, cream of wheat, grits, malt-o-meal, oatmeal, noodles, white or whole wheat pasta, brown, white or wild rice, bagel small , hamburger bun, unsalted crackers, cornbread made from scratch , flour or corn tortilla.

Bran bread, frosted or sugar-coated cereals, instant cereals, bran or granola, gingerbread, pancake mix, cornbread mix, biscuits, salted snacks including: potato chips, corn chips and crackers.

Whole wheat cereals like wheat flakes and raisin bran, and whole grain hot cereals contain more phosphorus and potassium than refined products, but may still be included in limited amounts. Apples, apple juice, applesauce, apricot halves, berries including: strawberries, raspberries, cranberries, blackberries and blueberries, low sugar cranberry juice, cherries, fruit cocktail, grapefruit, grapes, grape juice, kumquats, mandarin oranges, pears, pineapple, plums, tangerine, watermelon, fruit canned in unsweetened juice.

Avocados, bananas, cantaloupe, dried fruits including: dates, raisins and prunes, honeydew melon, kiwis, kumquats, star fruit, papaya, nectarines, oranges and orange juice, pomegranate, fruit canned in syrup. Corn, peas, mixed vegetables with corn and peas eat these less often because they are high in phosphorus , potatoes soaked to reduce potassium, if needed Dried beans and peas may be included in limited amounts based on your dietitian's recommendations.

Artichoke, fresh bamboo shoots, beet greens, cactus, cooked Chinese cabbage, kohlrabi, rutabagas, sauerkraut , cooked spinach, tomatoes, tomato sauce or paste, tomato juice, vegetable juice. Lean cuts of meat, poultry, fish and seafood; eggs, low cholesterol egg substitute; natural cheeses limited amounts cottage cheese limited due to high sodium content.

Bacon, canned and luncheon meats, processed cheeses, hot dogs, organ meats, nuts, pepperoni, salami, salmon, sausage. Soft or tub margarine low in trans fats, mayonnaise, sour cream, cream cheese, low fat mayonnaise, low fat sour cream, low fat cream cheese.

Bacon fat, back fat, butter, Crisco®, lard, shortening, margarines high in trans fats, whipping cream. Regular or diet dark colas, beer, fruit juices, fruit-flavored drinks, bottled or canned iced tea or lemonade containing sugar, syrup, or phosphoric acid; tea or lemonade sweetened with sugar.

For example, you may need to limit some of the free foods you have been using may need to be limited on your kidney diet. Your dietitian will help make a meal plan especially for you. If you would like more information, please contact us. All rights reserved.

This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations. Give Hope. Fund Answers. End Kidney Disease. Skip to main content. You are here Home » A to Z » Dietary Guidelines for Adults Starting on Hemodialysis.

Dietary Guidelines for Adults Starting on Hemodialysis. English Español. Now that you are beginning hemodialysis, there may be many changes in your daily life.

Your doctor has probably told you that you may need to make some changes in your diet. Your diet is an important part of your treatment.

Your kidneys cannot get rid of enough waste products and fluids from your blood and your body now has special needs. Therefore, you will need to limit fluids and change your intake of certain foods in your diet. The kidney dietitian at your dialysis center will help you plan a diet for your special needs.

Use this brochure as a guide until your dietitian prepares a personalized meal plan for you. You will need to:. Big victories are possible with your voice. Become an NKF advocate. Learn More. Use less salt and eat fewer salty foods: This may help to control blood pressure.

It may also help reduce fluid weight gains between dialysis sessions since salt increases thirst and causes the body to retain or hold on to fluid. People on dialysis need to eat more protein. Protein can help keep healthy blood protein levels and improve health.

Protein also helps keep your muscles strong, helps wounds heal faster, strengthens your immune system, and helps improve overall health. Limit processed foods like deli meats or sausages because they are usually high in sodium and phosphorus.

Healthy fats like unsaturated fats can be good for you. Unsaturated fats typically come from plants and are found in vegetable oils, nuts, and peanut butter. You can also find them in fish that are high in omega-3 fatty acids. Recipe idea: Seared Salmon with Braised Broccoli.

People with CKD and diabetes should minimize:. Be aware that some foods are good for people with one condition, but not the other. Your carb and protein needs can also change depending on your health.

September 18, Dietary Approaches in the Management of Diabetic Patients with Kidney Disease. Nutrients ;9 8 The Associations of Plant Protein Intake with All-Cause Mortality in CKD. American Journal of Kidney Diseases ;67 3 A Prospective Study on Total Protein, Plant Protein and Animal Protein in Relation to the Risk of Incident Chronic Kidney Disease.

BMC Nephrology ;21 1 Are low-carbohydrate diets safe in diabetic and nondiabetic chronic kidney disease? Ann NY Acad Sci. Tips for Following a Kidney Disease and Diabetes Diet. Managing both conditions at once can be challenging, but following a diet for kidney disease and diabetes can help you take control.

How Are Diabetes and Kidney Disease Related?