Having chronic kidney disease (CKD) requires that you be aware of your dietary choices, and sometimes adjust your diet, in order to receive the nutrition that you need while being sensitive to the limitations of your hard-working kidneys. For those individuals who are interested in a vegetarian diet, you may have additional concerns about whether this eating pattern is appropriate for you. CKD patients often learn that they may need to limit their protein intake, as well as their intake of many other staples of a vegetarian diet, such as certain fruits and vegetables, nuts, beans and dairy products. This may lead you to conclude that perhaps a vegetarian diet is not advisable for those with chronic kidney disease. In fact, with careful planning a vegetarian diet is not only possible, but may help to retain kidney function and slow down the progression of the disease.
According to the National Kidney Foundation, patients with early kidney disease (30-50% of kidney function) are advised to limit their protein intake to .8 mg/kg of body weight. Avoiding high protein foods such as beef, poultry and other animal meats can assist in limiting protein to appropriate amounts. Conversely, those with advanced kidney disease requiring dialysis may need twice as much protein (1.5 g/kg) due to protein losses associated with dialysis. Yet even under these circumstances, it is possible to obtain sufficient protein from vegetarian sources that can be part of a healthy diet suitable for patients with kidney disease.
There are a number of benefits of being on a vegetarian diet with kidney disease. For instance, plant protein sources have been shown to decrease protein in the urine, slow the decline of glomerular filtration rate (GFR) and kidney blood flow, result in less kidney tissue damage when compared to animal proteins, reduce kidney cyst growth and improve the lipid profile of the blood.
A recent study found the urine of lacto-ovo vegetarians to have a 60% lower amount of two different sulfates that are thought to be toxic, and are problematic for patients with kidney disease. The lower amounts were thought to be due to a combination of lower protein intake, higher fiber intake, and differences in bacteria in the digestive tract. (Patel et al., 2012)
Individuals who do choose a vegetarian diet need to take special care to ensure that they are receiving an adequately nutritious diet that is providing the right amount of vitamins and minerals. Some things for the client, and the dietitian, to consider when incorporating a vegetarian diet for individuals with chronic kidney disease include:
- Some foods that are allowed on vegetarian diets such as meat analogs, marinated tofu products, salted nuts, miso, frozen entrees and savory snacks are high in sodium and patients may need to limit intake.
- Some individuals may benefit from a renal vitamin that contains vitamin B12 and zinc.
- Choosing fruits and vegetables that are low in potassium may help to limit potassium levels to within a healthy range.
- Dialysis patients should be regularly monitored by their doctor and registered dietitian and, when necessary, prescribed calcium, vitamin D, and iron.
- Based on lab results, patients may need to increase phosphate binders to adjust for their meals and snacks.
- Patients on dialysis may need a lower potassium dialysate to control for potassium levels.
- Patients on dialysis need to make sure they are receiving sufficient protein to meet their needs. Trying new protein sources such as Seitan, which is a low phosphorus, low potassium protein source, may help to ensure adequate protein intake.
Working with a dietitian can help you to make sure you are getting sufficient calories and protein, while getting ideas about how to adjust your diet in order to achieve acceptable urea clearances. Additionally, finding support through connecting with other patients with chronic kidney disease, whether that be through online sources, or through in-person support groups, can be help patients in making diet changes that will need to be sustained over the long term.