The kidneys are small but powerful bean-shaped organs that perform many important functions.
They are responsible for filtering waste products, releasing hormones that regulate blood pressure, balancing fluids in the body, producing urine, and many other essential tasks.
Your kidneys are bean-shaped organs that perform many important functions.
They’re in charge of filtering blood, removing waste through urine, producing hormones, balancing minerals, and maintaining fluid balance.
There are many risk factors for kidney disease. The most common are unmanaged diabetes and high blood pressure.
Alcoholism, heart disease, hepatitis C, and HIV are also causes of kidney disease.
When the kidneys become damaged and are unable to function properly, fluid can build up in the body and waste can accumulate in the blood.
However, avoiding or limiting certain foods in your diet may help decrease the accumulation of waste products in the blood, improve kidney function, and prevent further damage.
Diet and kidney disease
Dietary restrictions vary depending on the stage of kidney disease.
For instance, people with early stages of chronic kidney disease will have different dietary restrictions than those with end stage renal disease, or kidney failure.
Those with end stage renal disease who require dialysis will also have varying dietary restrictions. Dialysis is a type of treatment that removes extra water and filters waste.
The majority of those with late or end stage kidney disease will need to follow a kidney-friendly diet to avoid a buildup of certain chemicals or nutrients in the blood.
In those with chronic kidney disease, the kidneys cannot adequately remove excess sodium, potassium, or phosphorus. As a result, they’re at a higher risk of elevated blood levels of these minerals.
A kidney-friendly diet, or renal diet, usually limits sodium to under 2,300 mg per day, as well as your potassium and phosphorus intake.
The National Kidney Foundation’s most recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines don’t set specific limits on potassium or phosphorus.
Potassium and phosphorus are still a concern for people with kidney disease, but they should work closely with their doctor or dietitian to determine their personal limits for these nutrients, which are usually based on lab results.
Damaged kidneys may also have trouble filtering the waste products of protein metabolism. Therefore, individuals with chronic kidney disease of all stages, especially stages 3–5, should limit the amount of protein in their diets unless they’re on dialysis.
Foods that you should likely avoid on a renal diet
Pickles, olives, and relish
Pickles, processed olives, and relish are high in sodium and should be limited on a renal diet.
Pickles, processed olives, and relish are all examples of cured or pickled foods.
Usually, large amounts of salt are added during the curing or pickling process.
For example, one pickle spear can contain more than 300 mg of sodium. Likewise, there are 244 mg of sodium in 2 tablespoons of sweet pickle relish.
Processed olives also tend to be salty, as they’re cured and fermented to taste less bitter. Five green pickled olives provide about 195 mg of sodium, which is 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.
However, even reduced sodium options can still be high in sodium, so you will still want to watch your portions.
Processed meats are high in salt and protein and should be consumed in moderation on a renal diet.
Processed meats have long been associated with chronic diseases and are generally considered unhealthy due to their preservative contents.
Processed meats are meats that have been salted, dried, cured, or canned.
Some examples include hot dogs, bacon, pepperoni, jerky, and sausage.
Processed meats typically contain large amounts of salt, mostly to improve their taste and preserve flavor.
Therefore, it may be difficult to keep your daily sodium intake to less than 2,300 mg if processed meats are abundant in your diet.
Additionally, processed meats are high in protein.
If you have been told to monitor your protein intake, it’s important to limit processed meats for this reason as well.
Oranges and orange juice
Oranges and orange juice are high in potassium and should be limited on a renal diet. Try grapes, apples, cranberries, or their juices instead.
While oranges and orange juice are arguably most well known for their vitamin C content, they’re also rich sources of potassium.
One large orange (184 grams) provides 333 mg of potassium. Moreover, there are 473 mg of potassium in 1 cup (240 mL) of orange juice.
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 contents.
Dairy products contain high amounts of phosphorus, potassium, and protein and should be limited on a renal diet. Despite milk’s high calcium content, its phosphorus content may weaken bones in those with kidney disease.
Dairy products are rich in various vitamins and nutrients.
They’re also a natural source of phosphorus and potassium and a good source of protein.
For example, 1 cup (240 mL) of whole milk provides 222 mg of phosphorus and 349 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, which can pull 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. One cup (240 mL) of whole milk provides about 8 grams of protein.
It may be important to limit dairy intake to avoid the buildup of protein waste in the blood.
Dairy alternatives like unenriched rice milk and almond milk are much lower in potassium, phosphorus, and protein than cow’s milk, making them a good substitute for milk while on a renal diet.
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.
Bananas are known for their high potassium content.
While they’re naturally low in sodium, 1 medium banana provides 422 mg of potassium.
If you have been instructed to limit your potassium intake, it may be difficult to do so if a banana is a daily staple.
Unfortunately, many other tropical fruits have high potassium contents as well.
However, pineapples contain substantially less potassium than other tropical fruits and can be a more suitable yet tasty alternative.
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.
Like whole wheat bread, brown rice is a whole grain that has a higher potassium and phosphorus content than its white rice counterpart.
One cup of cooked brown rice contains 150 mg of phosphorus and 154 mg of potassium, while 1 cup of cooked white rice contains only 69 mg of phosphorus and 54 mg of potassium (16, 17).
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.
Whole wheat bread
White bread is typically recommended over whole wheat bread on a renal diet due to its lower phosphorus and potassium levels. All bread contains sodium, so it’s best to compare food labels and choose a lower sodium variety.
Choosing the right bread can be confusing for individuals with kidney disease.
Often for healthy individuals, whole wheat bread is usually recommended over refined, white flour bread.
Whole wheat bread may be a more nutritious choice, 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 1-ounce (30-gram) serving of whole wheat bread contains about 57 mg of phosphorus and 69 mg of potassium. In comparison, white bread contains only 28 mg of both phosphorus and potassium.
Eating one slice of whole wheat bread instead of two can help lower your potassium and phosphorus intake without having to give up whole wheat bread entirely.
Note that most bread and bread products, regardless of whether they’re white or whole wheat, also contain relatively high amounts of sodium.
It’s best to compare the nutrition labels of various types of bread, choose a lower sodium option, if possible, and monitor your portion sizes.
Canned foods are often high in sodium. Avoiding, limiting, or buying low sodium varieties is likely best to reduce your overall sodium consumption.
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.
Due to the amount of sodium found in canned goods, it’s often recommended that people with kidney disease avoid or limit their consumption.
Choosing lower sodium varieties or those labeled “no salt added” is typically best.
Additionally, draining and rinsing canned foods, such as canned beans and tuna, can decrease the sodium content by 33–80%, depending on the product.
Avocados are often touted for their many nutritious qualities, including their heart-healthy fats, fiber, and antioxidants.
While avocados are usually a healthy addition to the diet, those with kidney disease may need to avoid them.
This is because avocados are a very rich source of potassium. One average-sized avocado provides a whopping 690 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 also 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.
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.
In addition to the calories and sugar that sodas provide, they harbor additives that contain phosphorus, especially dark-colored sodas.
Many food and beverage manufacturers add phosphorus during processing to enhance flavor, prolong shelf life, and prevent discoloration.
Your body absorbs this added phosphorus to a greater extent than natural, animal-based, or plant-based phosphorus.
Unlike natural phosphorus, phosphorus in the form of additives is not bound to protein. Rather, it’s found in the form of salt and highly absorbable by the intestinal tract.
Additive phosphorus can typically be found in a product’s ingredient list. However, food manufacturers are not required to list the exact amount of additive phosphorus on the food label.
While additive phosphorus content varies depending on the type of soda, most dark-colored sodas are believed to contain 50–100 mg in a 200-mL serving.
According to the United States Department of Agriculture (USDA) food database, a 12-ounce cola contains 33.5 mg of phosphorus.
As a result, sodas, especially those that are dark, should be avoided on a renal diet.
Pretzels, chips, and crackers
Pretzels, chips, and crackers are easily consumed in large portions and tend to contain high amounts of salt. Additionally, chips made from potatoes provide a considerable amount of potassium.
Ready-to-eat snack foods like pretzels, chips, and crackers tend to be lacking in nutrients and relatively high in salt.
Also, it’s easy to eat more than the recommended portion size of these foods, often leading to even greater salt intake than intended.
What’s more, if chips are made from potatoes, they’ll contain a significant amount of potassium as well.
Dates, raisins, and prunes
Nutrients are concentrated when fruits are dried. Therefore, the potassium content of dried fruit, including dates, prunes, and raisins, is extremely high and should be avoided on a renal diet.
Dates, raisins, and prunes are common dried fruits.
When fruits are dried, all of their nutrients are concentrated, including potassium.
For example, 1 cup of prunes provides 1,274 mg of potassium, which is nearly 5 times the amount of potassium found in 1 cup of plums, its raw counterpart.
Moreover, just 4 dates provide 668 mg of potassium.
Given the high amount of potassium in these common dried fruits, it’s best to go without them while on a renal diet to ensure your potassium levels remain favorable.
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Swiss chard, spinach, and beet greens
Leafy green vegetables like Swiss chard, spinach, and beet greens are full of potassium, especially when served cooked. Although their serving sizes become smaller when cooked, their potassium contents remain the same.
Swiss chard, spinach, and beet greens are leafy green vegetables that contain high amounts of various nutrients and minerals, including potassium.
When served raw, the amount of potassium varies between 140–290 mg per cup.
While leafy vegetables shrink to a smaller serving size when cooked, the potassium content remains the same.
For example, one-half cup of raw spinach will shrink to about 1 tablespoon when cooked. Thus, eating one-half cup of cooked spinach will contain a much higher amount of potassium than one-half cup of raw spinach.
Raw Swiss chard, spinach, and beet greens are preferable to cooked greens to avoid too much potassium.
However, moderate your intake of these foods, as they’re also high in oxalates. Among sensitive individuals, oxalates can increase the risk of kidney stones.
Kidney stones may further damage renal tissue and decrease kidney function.
Packaged, instant, and premade meals
Packaged, instant, and premade meals are highly processed items that can contain very large amounts of sodium and lack nutrients. It’s best to limit these foods on a renal diet.
Processed foods can be a major component of sodium in the diet.
Among these foods, packaged, instant, and premade meals are usually the most heavily processed and thus contain the most sodium.
Examples include frozen pizza, microwaveable meals, and instant noodles.
Keeping sodium intake to 2,300 mg per day may be difficult if you’re eating highly processed foods regularly.
Heavily processed foods not only contain a large amount of sodium but also commonly lack nutrients.
Tomatoes are another high potassium fruit that may not fit the guidelines of a renal diet.
They can be served raw or stewed and are often used to make sauces.
Just 1 cup of tomato sauce can contain upwards of 900 mg of potassium.
Unfortunately for those on a renal diet, tomatoes are commonly used in many dishes.
Choosing an alternative with lower potassium content depends largely on your taste preferences. However, swapping tomato sauce for a roasted red pepper sauce can be equally delicious and provide less potassium per serving.
Potatoes and sweet potatoes
Potatoes and sweet potatoes are high potassium vegetables. Boiling or double cooking potatoes can decrease their potassium content by about 50%.
Potatoes and sweet potatoes are potassium-rich vegetables.
Just one medium-sized baked potato (156 grams) contains 610 mg of potassium, whereas one average-sized baked sweet potato (114 grams) contains 541 mg of potassium (31, 32).
Fortunately, some high potassium foods, including potatoes and sweet potatoes, can be soaked or leached to reduce their potassium contents.
Cutting potatoes into small, thin pieces and boiling them for at least 10 minutes can reduce the potassium content by about 50%.
Potatoes that are soaked in water for at least 4 hours before cooking are proven to have an even lower potassium content than those not soaked before cooking.
This method is known as potassium leaching or the double-cook method.
Although double cooking potatoes lowers the potassium content, it’s important to remember that their potassium content isn’t eliminated by this method.
Considerable amounts of potassium can still be present in double-cooked potatoes, so it’s best to practice portion control to keep potassium levels in check.
Apricots are a high potassium food that should be avoided on a renal diet. They offer over 400 mg per 1 cup raw and over 1,500 mg per 1 cup dried.
Apricots are rich in vitamin C, vitamin A, and fiber.
They’re also high in potassium. One cup of fresh apricots provides 427 mg of potassium.
Furthermore, the potassium content is even more concentrated in dried apricots.
One cup of dried apricots provides over 1,500 mg of potassium.
This means that just 1 cup of dried apricots provides 75% of the 2,000-mg low potassium restriction.
It’s best to avoid apricots, and most importantly dried apricots, on a renal diet.
If you have kidney disease, reducing your potassium, phosphorus, and sodium intake can be an important aspect of managing the disease.
The high sodium, high potassium, and high phosphorus foods listed above are likely best limited or avoided.
Dietary restrictions and nutrient intake recommendations will vary based on the severity of your kidney damage.
Following a renal diet can seem daunting and a bit restrictive at times. However, working with a healthcare professional and renal dietitian can help you design a renal diet specific to your individual needs.