such as: •damage to the heart and other organs •poor blood circulation •bone pain •skin ulcers To keep phosphorus at safe levels in your blood, you may need to limit phosphorus-rich foods. You may also need to take a type of medicine called a phosphate binder. These binders are www.kidney.org 15 taken with your meals and snacks. Your doctor will tell you if you need to limit high-phosphorus foods or take phosphorus binders. Calcium Calcium is a mineral that is important for building strong bones. However, foods that are good sources of calcium are often high in phosphorus. The best way to prevent calcium loss from your bones is to limit high-phosphorus foods. You may also need to take phosphate binders and avoid eating calcium-fortified foods. Your doctor may have you take a special form of vitamin D to help keep calcium and phosphorus levels in balance, and to prevent bone disease. Do not take over-the-counter vitamin D or calcium supplements unless recommended by your kidney doctor. TIP Using recommended milk substitutes without added phosphorus is one way to lower the amount of phosphorus in your diet. 16 National Kidney Foundation Potassium Potassium is another important mineral found in most foods. Potassium helps your muscles and heart work properly. Large amounts of potassium are found in: •certain fruits and vegetables (like bananas, melons, oranges, potatoes, tomatoes, dried fruits, nuts, avocados, deep-colored and leafy green vegetables, and some juices) •milk and yogurt •dried beans and peas •most salt substitutes •protein-rich foods, such as meat, poultry, pork, and fish* Too much or too little potassium in the blood can be dangerous. Some people with kidney disease need more potassium; others need less. How much you need depends on how well your kidneys are working. It also depends on whether or not you are taking any medicine that changes the level of potassium in your blood. *This food list is not complete www.kidney.org 17 Fluid Most people with kidney disease do not need to limit the amount of fluids they drink if they are in the early stages. If you do not know your stage of kidney disease, ask your doctor. If your kidney disease gets worse, your doctor will let you know if you need to limit fluids and how much fluid is okay for you each day. To avoid dehydration, let your doctor and dietitian help plan your fluid intake. To learn more about chronic kidney disease contact the National Kidney Foundation 855.NKF.CARES (855.653.2273). TIP How do you know if your potassium is normal? A simple blood test can check your potassium level. If it is not normal, you may need to take: n potassium supplements n a special medicine to help get rid of too much potassium Take only the supplements your doctor recommends. Your dietitian can help you plan a diet that will give you the right amount of potassium. 18 National Kidney Foundation What if I have diabetes? You may need to make a few changes in your diet if you have diabetes and kidney disease. If your doctor says that you should eat less protein, your diet may need to include more carbohydrates or high-quality fats to give you enough calories. Work with your dietitian to make a meal plan that is right for you. Ask your doctor how often to test your blood sugar levels. Try to keep your levels under control. Your dosage of insulin or other medications may need to change if your kidney disease gets worse. Contact your doctor if your blood sugar levels are too high or too low. What if I’m a vegetarian? Most vegetarian diets are not rich in higher quality protein. But eating a variety of foods and getting enough calories can help. Without enough calories, your body will break down the protein you eat to create energy instead. If protein is broken down, more waste products have to be removed by your kidneys. Ask about ways to check that the amount of protein you are eating is right for you. Talk with your dietitian about the best sources of vegetable protein www.kidney.org 19 with lower amounts of potassium and phosphorus. Your doctor or dietitian can check your blood to make sure you are getting the right amount of protein and calories. What if I need help planning meals? Your doctor can refer you to a registered dietitian with special training in kidney disease. The dietitian can: •help you choose foods that will give you the right nutrients in the right amounts •explain why the diet changes you need to make are important •answer your questions TIP Help from a dietitian is very important for people with kidney disease. You may be eligible for reimbursement for medical nutrition therapy with a dietitian under Medicare or your health insurance plan. (See www.medicare.gov.) TIP 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. 20 National Kidney Foundation Where can I get more information? You can speak to your doctor or other members of your healthcare team, or you can call the National Kidney Foundation for information at 855. NKF.CARES (855.653.2273). To learn more about kidney disease, you may also want to read some of the free publications from the National Kidney Foundation: Brochures: •About Chronic Kidney Disease: A Guide for Patients and Their Families (English 11-50-0160;