A Complete Guide to Slow Down Kidney Disease
by Chantelle Greentree, RD
Being diagnosed with early Chronic Kidney Disease (CKD) can be scary. Making lifestyle and nutrition changes can help slow down the progression of CKD, but navigating nutrition changes without the support of a registered dietitian can be confusing. Patients often end up using outdated food lists and over restricting their diet leading to protein energy malnutrition, unintentional weight loss and frustration.
Kidneys filter the blood in your body to remove waste and extra water to make urine. The kidneys help maintain fluid balance as well as electrolyte balance by removing excess sodium, potassium and phosphorus. CKD is an irreversible progressive disease that impacts 1 in 10 Canadians. The disease is characterized by reduced kidney function which can sometimes, but not always, result in kidney failure. For early CKD (stage 1 to 3) nutrition interventions can protect your kidney’s function and slow down damage.
Nutrition FAQ for Early CKD:
- Diabetes, Hypertension & CKD
- Protein
- Sodium
- Potassium
- Phosphorous
For most people with early CKD, dietary restriction of protein, potassium and phosphate are not needed. You should NOT restrict dietary intake of protein, potassium and phosphate unless under the supervision and guidance of a registered dietitian.
Manage Co-Morbidities: Diabetes and Hypertension
In Canada, diabetes is the leading cause of CKD, accounting for about 38% of cases. High blood glucose causes your kidneys to work harder to filter, increasing pressure in your kidneys. This causes irreversible damage to your kidneys. Those with diabetes should aim to keep their blood glucose within target levels and an A1C <7.0% (blood glucose average over past 3 months) to reduce the risk of kidney damage.
The second leading cause of CKD at 12.2% is hypertension (high blood pressure). Hypertension narrows the blood vessels in your kidneys which prevents the removal of extra fluid and waste from your body. This leads to fluid building up in the blood vessels which increases the blood pressure even more and further damaging your kidneys. This becomes a vicious cycle kidney damage causing hypertension which damages your kidneys more leading to worsening of your CKD.
Managing both diabetes and hypertension can help slow down damage to your kidneys.
Reduce Sodium Intake
Sodium is a mineral that is found in food and table salt (as sodium chloride). Our body uses sodium to maintain blood pressure and fluid balance as well as for muscle and nerve function.
A diet high in sodium can lead to fluid retention in the body causing increased blood pressure which can damage your kidneys and increase your risk of stroke and heart disease. Aim to reduce your daily sodium intake to <2300 mg/d.
Tips for reducing dietary sodium intake:
- Limit processed and packaged foods (ie: instant soups/noodles, chips, canned foods)
- Foods labeled with “No Added Salt” or “Low Sodium” are okay
- Flavouring alternatives eg. herbs, spices or citrus
Patients with CKD should avoid salt substitutes or seasonings that replace the sodium chloride (table salt) with potassium additives like potassium chloride such as “No-Salt” or “Half-Salt” as well as products labeled as “sodium-reduced.” If you are looking for a kidney friendly salt substitute in Canada you can try Mrs. Dash which is a salt free seasoning.
Protein Recommendation for Early CKD
For early CKD, the general recommendation of 0.8 g/kg/d of protein is appropriate. For a 70kg adult, this would be 56g of protein per day.
Protein is an important part of your daily diet to maintain and build muscle, heal and fight infections. Too little protein in your diet can lead to muscle loss.
Protein intake for early kidney health:
- High quality animal proteins eg. fish, eggs and lean meats
- Spread protein intake throughout the day
- Avoid concentrated sources like protein powders
Choose plant-based proteins (e.g., beans, lentils, seeds) more often as they are rich in fiber which support kidney health by:
- Better Blood Sugar Control: Fiber slows digestion which prevents blood glucose spikes after meals
- Heart health support: Soluble fiber binds and excretes LDL (“bad” cholesterol) which can reduce risk of heart disease and high blood pressure.
- Gut Health & Decreased Inflammation: Fiber supports regular bowel movements and healthy gut bacteria which can help reduce inflammation.
- Lower Phosphorous Absorption: Phosphorus in plant foods is bound to fiber which is excreted in stool and absorbed less.
- Potassium Balance: Fiber can potentially help increase excretion of potassium in stool.
If Advised: Manage Phosphorous Intake
Phosphorus is a mineral that occurs in two forms: organic phosphorus, found naturally in foods like meats, poultry, fish, nuts, beans, and dairy products, and inorganic phosphorus, which is added to foods as a preservative or additive. Inorganic phosphorus is commonly found in items such as dark colas, packaged foods, and deli meats. Check the ingredients list for “Phos” to find phosphorous additives in food.
Phosphorus is an important mineral for building and maintaining strong bones. Other functions of phosphorus in our body include helping us make energy and is a part of our DNA and cell structures. Too much phosphorus causes the body to pull out calcium from your bones which will make your bones weak. The high phosphorus and calcium in your blood can increase the risk of building up in your blood vessels, lungs and heart which can lead to heart attacks, stroke or death.
In early CKD, phosphorus levels are generally not a concern as the kidneys still have sufficient function to remove excess phosphate from the body. Phosphorous management is always individualized and determined by your healthcare team based on kidney function and labwork.
The amount of phosphate your body absorbs depends on the source of phosphate: Organic (20-40% for plant-based and 40-60% for animal-based) vs In-Organic (90-100%).
Continue to include a variety of organic phosphate foods: fruits, vegetables, nuts, whole grains, beans, fresh meat, egg and dairy
Reduce your intake of inorganic phosphates, such as foods with added phosphorus. You can identify these by checking the ingredient list for terms that contain “phos” (eg. phosphoric acid, polyphosphate, and pyrophosphates).
If Advised: Manage Potassium Intake
Potassium is a mineral needed for our nerves to send signals so our muscles work and our heart beats regularly. When there is too much potassium (hyperkalemia) it can lead to heart palpitations, an irregular heart beat, chest pain, shortness of breath or heart attack.
There are several non-dietary factors that can impact your serum potassium status that should be considered like common cardiovascular disease medications (ACE inhibitors, ARBs), diuretics (thiazides, lasix, spironolactone) and uncontrolled diabetes. When blood glucose is high, potassium moves from the cells and into the blood stream causing increased serum potassium levels. Reducing constipation should also be considered because potassium is removed from the body through stool.
Potassium management is always individualized and determined by your healthcare team based on kidney function and labwork.
Dietary Potassium Recommendations:
- Include whole fruits and vegetables – the fiber decreases potassium absorption
- Check ingredient list for potassium additives eg. potassium lactate, potassium chloride (common salt substitute), potassium phosphate and potassium acetate
- Reduce processed foods (sodas, processed meats/cheeses, packaged snacks like cookies, chips, cakes)
- Boiling and soaking can reduce potassium content eg. potatoes, beans
- Ingredient preparation fresh vs frozen vs canned vs dried impacts potassium content. ie. dried fruits have higher potassium compared to fresh whole fruit.
- All foods can be enjoyed by adjusting portion size
KEY TAKEAWAYS for Early CKD Nutrition
Nutrition interventions for early CKD should focus on maintaining a general healthy diet and managing comorbidities (diabetes, CVD and hypertension) to slow down disease progression.
- Continue to include a variety of fruits and vegetables.
- Adequate protein intake to minimize muscle loss
- Choose plant-based proteins more often.
- Reduce sodium <2300mg/d to minimize fluid retention and hypertension
- Potassium and phosphate additives in processed foods have high absorption in the body.
- Potassium and phosphorus in whole foods (fruits, vegetables, grains, fresh meats, dairy products etc) are less absorbed in the body and are part of a healthy diet.
For more individualized nutrition advice, speak with a registered dietitian for kidney health. They can help you determine the appropriate dietary measure to take for your kidney health.
FAQ
Do I need to cut out protein if I have early CKD?
No. Unless a dietitian or nephrologist has told you otherwise, the standard recommendation of 0.8 g/kg/day applies — the same as for most healthy adults. Cutting protein without guidance is one of the most common mistakes people make after a CKD diagnosis, and it can lead to muscle loss.
Can I still eat bananas, oranges, and potatoes?
In early CKD, yes — for most people. Potassium and phosphate restriction are only necessary if your labs and healthcare team indicate a need. Whole fruits and vegetables come with fiber that actually helps regulate mineral absorption, so cutting them out preemptively isn’t doing your kidneys any favours.
What’s the difference between organic and inorganic phosphorus?
Organic phosphorus occurs naturally in whole foods and is only partially absorbed. Inorganic phosphorus is added to processed foods as a preservative and is nearly 100% absorbed. If you need to manage phosphorus, the ingredient list matters more than the food group — look for “phos” on the label.
Is a salt substitute a good swap if I’m cutting sodium?
Not automatically. Many salt substitutes replace sodium chloride with potassium chloride, which can be a problem if you also need to watch potassium. Check labels, and ask your dietitian before switching.
When should I actually see a dietitian for CKD?
Any time you’ve been diagnosed — earlier is better. A dietitian can confirm whether restriction is even necessary yet (often it isn’t), catch comorbidities like diabetes or hypertension that are driving progression, and help you avoid the malnutrition risk that comes from self-imposed over-restriction based on outdated food lists.
About the Author
Chantelle Greentree is a Registered Dietitian with over 17 years of clinical experience, focusing in chronic kidney disease and kidney stone prevention. She runs Greentree Nutrition, a virtual nutrition counselling practice serving clients across BC and Alberta, and writes Kidney Healthy Foods, a resource dedicated to practical, evidence-based kidney nutrition — without the fear-mongering and outdated food lists that dominate the space. Learn more at kidneyhealthyfoods.substack.
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