Chronic kidney disease (CKD) is a progressive condition where the kidneys lose their ability to filter waste and excess fluids from the body. There are five stages of CKD, and stage 4 is the last stage before kidney failure.

Knowing what to eat during each stage of chronic kidney disease is one of the biggest challenges to people living with the condition. While your renal dietitian can help you craft customized meal plans for your tastes and needs, here are some general ideas for kidney-friendly meal plans for people with stage 4 CKD.

In stage 4 chronic kidney disease (CKD) your remaining kidney function is between 15 and 29%, and you may be experiencing symptoms such as fatigue, swelling in your limbs, and changes in your urine output. Adjusting your diet plays a significant role in delaying the need for dialysis and kidney transplantation.

Your doctor will likely suggest restricting certain foods or nutrients during this stage, and you will likely have many questions about which foods are ok to eat, in what amounts, and in what combinations.

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

Some considerations when creating a meal plan for stage 4 CKD include:

• Lowering protein intake, to reduce strain on the kidneys
• Controlling phosphorus and calcium levels, to prevent bone disease and bone loss
• Limiting potassium intake, to avoid hyperkalemia, which affects heart function
• Reducing sodium (salt) consumption, to manage blood pressure and avoid fluid retention
• Drinking an appropriate amount of fluids, to be determined by your doctor and renal dietitian
• Adjusting sugary foods and treats, to control blood sugar levels

It’s helpful to work with a registered renal dietitian, because as the stages of CKD change, so will your diet.

Here is a sample, generalized 7-day meal plan for people with stage 4 CKD, focusing on the general dietary needs and likely adjustments pertinent to your kidney function at this stage.

Since many people with stage 4 CKD also have diabetes, these sample meals, provided by experts, include adjustments and suggestions appropriate to both a renal diet and a diabetes diet, to help regulate your blood sugar. Your own doctor and dietitian will help you individualize your meal plans regarding safe amounts of protein, minerals, sugary and starchy carbohydrates, and fluids.

Day 1

• Breakfast. Oatmeal with blueberries, pecans, and unsweetened almond milk.
• Lunch. Chickpea salad, whole wheat bread, cucumber slices, mixed greens, and strawberries.
• Dinner. Burrito bowl of brown rice, black beans, steamed broccoli, and diced tomatoes.

Day 2

• Breakfast. Scrambled egg, coffee, bowl of cornflakes, blackberries, and 2% milk.
• Lunch. Minestrone soup, dinner roll with margarine and cheddar cheese, and salad.
• Dinner. Vegetable and tofu stir-fry, white rice, and canned pears.

Day 3

• Breakfast. Apple-cinnamon pancakes, raspberries, low-sodium cottage cheese, coffee.
• Lunch. Egg salad on whole wheat bread, carrots and cucumber, and honeydew melon.
• Dinner. Rosemary and lemon steak, mashed potatoes, boiled peas, raspberry sherbet.

Day 4

• Breakfast. Poached egg with toast and jam, a medium mango, and coffee.
• Lunch. Chicken wrap with cauliflower side, apple, and 2% or plant-based milk.
• Dinner. Lemon dill fish, steamed white rice, and mixed vegetables, with vanilla yogurt and mixed berries.

Day 5

• Breakfast. French toast, medium pear, and coffee.
• Lunch. Veggie and cheese pita, baby carrots with hummus, and fruit cocktail.
• Dinner. Roast pork with lemon-broccoli orzo salad, and dark chocolate, 2% milk, and sliced strawberries.

Day 6

• Breakfast. Oatmeal with brown sugar, grapes, and white toast with peanut butter.
• Lunch. Tuna salad, whole wheat crackers, sour cream herb dip, and a mandarin orange.
• Dinner. Baked chicken, pasta, tomato sauce, and dilled green beans, with vanilla ice cream and blueberries.

Day 7

• Breakfast. Cornflakes or Rice Krispies with 2% milk, coffee, and fruit.
• Lunch. Turkey or roast beef sandwich, cup of low-sodium vegetable soup, salad, grapes.
• Dinner: Pork chops/roast, peas or green beans, double-boiled potatoes, an apple.

Tasty, healthy snacks can consist of carrots or other raw vegetables with hummus, or small portions of fresh fruit and a handful of nuts.

Adhering to a specialized diet in Stage 4 CKD can help manage symptoms and potentially slow disease progression. Remember, individual dietary needs can vary, so it’s crucial to consult with healthcare professionals, especially your nephrologist and your renal dietitian, before making significant dietary changes.