because some vitamins and minerals may be harmful to people with kidney disease. •Check with your doctor before taking any herbal supplements or medicines you can buy without a doctor’s prescription. Some may be harmful to people with kidney disease. Your doctor and dietitian will tell you what choices are good for you. How will I know if I am getting enough calories and nutrients? Your doctor will give you blood tests and urine tests. These will help show whether or not you are getting enough nutrients. Your dietitian may also ask you about the foods you eat. You may also be asked to keep a "food diary." To learn more about the tests your doctor and dietitian will use to check your nutrition, visit www.kidney.org or call NKF CARES at 1.855.NKF.CARES (855.653.2273). www.kidney.org 9 What if I don't want to eat or don't like my food choices? As a person with kidney disease, it may be difficult to get enough nutrients from food, especially if you are on a limited-protein diet. Many people with kidney disease also find it hard to eat enough calories each day. Nutritional supplements can help you get the calories and nutrients you need. Ask your dietitian if they are right for you. Supplements can come in the form of liquid drinks, shakes, juices, bars, soups, cookies, puddings, and more. Many supplements are available, but some nutritional supplements are made just for people with kidney disease, diabetes, or kidney failure. Check with your doctor or dietitian before taking any supplements. TIPS n Ask your doctor or dietitian which tests will be used to check your nutritional health. n Discuss the results of the tests with your doctor or dietitian. TIP If you have diabetes and chronic kidney disease (CKD), ask your dietitian how to get the right amount of calories and how to keep your blood sugar under control. Adding sweet, high-calorie foods to your meals may not be a good choice for you. 10 National Kidney Foundation How will I know if I need a nutritional supplement? Your doctor and dietitian will tell you if you need to take nutritional supplements. Use only the supplements recommended by your doctor or dietitian. Remember, not all people with kidney disease have the same dietary needs. Depending on what you eat, you may need less protein, but someone else might need extra protein. Or, you may need extra calories, but someone else might need fewer calories. Your dietitian will help you choose the right supplements. www.kidney.org 11 Will I need to control any other nutrients? You may need to balance fluids and other important nutrients too. They are: •sodium •phosphorus •calcium •potassium Sodium Sodium is a mineral found in most foods. It is also found in table salt. Sodium affects blood pressure and water balance in your body. Healthy kidneys can control sodium. But, if your kidneys do not work well, sodium and fluid build up in your body. This can cause high blood pressure and other problems, like swelling of your ankles, fingers, or eyes. Your doctor or dietitian will tell you if you need to limit sodium. You can limit sodium by avoiding table salt and foods such as: •seasonings like soy sauce, sea salt, teriyaki sauce, garlic salt, or onion salt •most canned foods and frozen dinners (unless they say "low sodium"; check the label) 12 National Kidney Foundation •processed meats like ham, bacon, hot dogs, sausage, and deli meats •salted snack foods, like chips and crackers •canned or dehydrated soups (like packaged noodle soup) •most restaurant foods, take-out foods, and fast foods* Your dietitian can teach you how to choose foods that are lower in sodium. Learning how to read food labels can help you choose foods with less sodium. *This food list is not complete. TIPS n Learn to read food labels so you know what you are eating. Reading labels can help you shop for foods with lower sodium and to check for "added" nutrients that may be bad for you. n Do NOT use salt substitutes unless approved by your doctor. n Try fresh or dried herbs and spices instead of table salt to bring out the flavor of foods. When you limit salt, you may have to use more herbs and spices to get more flavor. Also, try adding a dash of hot pepper sauce or a squeeze of lemon juice for flavor. www.kidney.org 13 Phosphorus People with kidney disease may need to closely monitor phosphorus in foods, especially if their kidney disease is advanced. Phosphorus is a mineral found in many foods. Large amounts of phosphorus are found in: •dairy products such as milk, cheese, yogurt, ice cream, and pudding •nuts and peanut butter •dried beans and peas, such as kidney beans, split peas, and lentils •beverages such as cocoa, beer, and dark cola drinks •bran breads and bran cereals •processed, convenience, and fast foods, including some meats that have additives to make them tender* Eating high-phosphorus foods can raise the level of phosphorus in your blood. Your kidneys may not be able to remove all of this extra phosphorus. *This food list is not complete. 14 National Kidney Foundation What happens when phosphorus builds up in your blood? Your blood calcium levels drop and calcium is pulled from the bones. Over time, your bones will become weak and break easily. A high level of phosphorus in your blood may also cause calcium to build up in your blood vessels, heart, joints, muscles, and skin, where it does not belong. This may cause serious problems