When you have stage 4 chronic kidney disease (CKD), your diet goals should help minimize symptoms, and help you maintain adequate nutrient intake to prevent weight loss and malnutrition. Kidney function is severely decreased in stage 4 CKD.

Protein waste, toxins, and minerals build up in the body and lead to uremia with symptoms such as nausea, vomiting, loss of appetite, abnormal taste, bad breath, nerve and sleep problems, difficulty concentrating, and fatigue. Fluid retention due to a decrease in urine output may also occur. Knowing your nutritional goals can help you enjoy a better quality of life.

When kidneys aren’t able to remove enough potassium to maintain normal blood levels in stage 4 CKD, you will need to limit high-potassium foods. Your doctor may prescribe a potassium restriction of 2,000 to 3,000 mg a day. Some high-potassium foods to limit, with your dietitian’s guidance, include:

• Avocados, bananas, cantaloupe, and honeydew melon
• Dried fruit
• Certain dairy products
• Certain nuts, seeds, and legumes
• Oranges and orange juice
• Potatoes and potato products (french fries, potato chips)
• Pumpkin and winter squash
• Tomatoes and tomato products (juices, sauces, paste)

Most kidney diets start with a goal of 1,500 to 2,000 mg per day or the amount recommended by your doctor or dietitian. The sodium recommendation for stage 4 CKD is 1,000-4,000 mg/day based on fluid balance, blood pressure, and other diseases that may affect sodium requirements.

When you’re choosing proteins, it’s a good idea to avoid processed or fast foods. Instead, choose plant-based options or fresh, lean animal proteins. Watch your portion sizes and how often you eat protein-rich foods, especially if your doctor has discussed reducing your protein (about 10% of your total daily calories is common) to protect your kidneys. If you’re unsure of how much protein you should eat, ask your doctor or renal dietitian for help. Some healthy protein choices to consider include:

• Lean beef, pork chops (fresh, minimally-processed)
• Poultry (fresh, minimally-processed chicken, turkey)
• Fish and seafood (fresh salmon, mackerel, rainbow trout, shrimp) 
• Eggs (omelets, deviled eggs, egg whites)
• Dairy (cottage cheese, Greek yogurt)
• Plant-based proteins (tofu, whole grain pasta and cereals, beans, lentils, nuts)

Eating foods that are fresh is important because they contain more of their natural nutrients, and are not packed with preservatives like sodium.

It is important to consult a healthcare professional for personalized advice on the best diet for stage 4 kidney disease. Your doctor or renal dietitian will monitor your blood work. If any changes are required to your diet, a renal dietitian will work with you to develop a meal plan that will fit within your cultural and lifestyle needs. Nutritional needs and dietary changes can vary among people with CKD, even those in the same stage of the disease. For instance, protein and fluid needs may be different for people on dialysis v. those who are not on dialysis.

Discuss with your renal dietician the best nutrition options for your specific case. Image from Shutterstock. 

When you have stage 4 CKD, your primary diet goals are to minimize symptoms and help you maintain adequate nutrient intake to prevent weight loss and malnutrition. Knowing what foods to eat can help you achieve these goals. Here are some typically good food choices when you have stage 4 kidney disease:

• Fresh fruits and vegetables. Low in sodium and potassium, grapes, pineapples, lettuce, cucumber, and green beans.
• Tofu, peas, beans, lentils, nuts, and nut butters. With some variations, these all tend to be high in protein and fiber, and low in phosphorus and potassium. Nuts and nut butters also contain healthy fats.
• Eggs. Eggs are versatile and can be prepared in a wide range of ways to suit your tastes and keep your diet interesting.
• Cheese. A good source of protein and calcium, cheese is low in phosphorus and potassium.
• Fish and other seafood. Fish, including some shellfish, are rich in omega-3 fatty acids. 
• Poultry. Like eggs, poultry can be prepared in numerous ways, and is easy to customize to your preferences. 
• Red meat. Choose lean cuts and avoid deli meats, which are chock-full of salt, bad fats, and preservatives that place strain on your heart and kidneys and promote fluid retention.
• Breads, pasta, and rice. Choose whole grain options if possible (e.g. brown rice, bulgur, oats, etc.) for maximum nutrients. Rice milk can also replace cow’s milk if you have phosphorus restrictions.

Optimal diets for people with CKD are highly individual. Work closely with your nephrologist and renal dietitian to craft the best meal plans for your nutritional needs, cultural traditions, and taste preferences.