The purpose of kidneys is to filter blood of toxins, waste, and excess ions while preserving essential substances in the blood. Kidneys maintain electrolyte stability, blood pressure, acid-base balance, regulate the production of (Erythropoietin) the hormone that stimulates red blood cell production, and converts vitamin D to its active form. In addition, the kidneys are responsible for the production of urine and its excretion.  

When kidneys sustain injury, either through impact or over time, their ability to conduct vital functions decreases. Kidney impairment, known as chronic kidney disease, is the progressive and irreversible decline of kidney function.  

More than 1 in 7 US adults—about 35.5 million people, or 14%—are estimated to have CKD.  Approximately 1 in 3 adults with diabetes has CKD. 

Causes of impairment: 

• Diabetes, especially uncontrolled, can lead to excess glucose (sugar) in your blood that can damage the filters  

• High blood pressure: can cause damage to the vessels in kidneys, impacting their effectiveness  

• Genetics  

• Infection 

• Medications 

• Autoimmune disorders 

• Physical injury 

When renal function declines, urine production is directly affected. Other manifestations include edema (fluid retention), hypertension (high blood pressure), and abnormal electrolyte values.  

Electrolytes are minerals in the body that help balance hydration, control muscle and nerve function, and facilitate daily functions from thinking, to walking and breathing. The body is constantly in pursuit of equilibrium, or balance. When electrolytes are out of balance you can experience extremes in either high or low heart rate, blood sugar, and breathing rate. For example, when Potassium is too high you can experience heart palpitations, muscle weakness, or even paralysis. That is why you may get a cramp in your leg or a stitch in your side when you’re dehydrated!  

It is the kidney’s job to balance electrolytes by filtering out excess. When kidneys are not working properly, we can see buildup of electrolytes and other toxins that can lead to serious health complications.  

Kidney failure is classified by 5 stages. As function declines, stages increase. It is important to remember that kidney damage is irreversible. Once an individual reaches Stage 5, their kidneys can no longer sustain normal function and external interventions are required. This is known as End Stage Renal Failure, which requires the initiation of Dialysis treatment or kidney transplant. To learn more about End Stage Renal Failure, please click here (hyperlink to ESR page).   

Acute Kidney Injury (AKI) is an event or injury sustained by the kidneys that results in temporary renal impairment. Common causes of an AKI are physical injury (accident), severe dehydration, medications, surgery, blockages or kidney stones, reduced blood flow, or even CKD. Yes-you can have an AKI and have CKD! The good news is that an AKI often resolves on its own without the need for longterm lifestyle changes or medical intervention. 

Managing CKD requires a combination of diet and lifestyle interventions to slow progression of renal failure and preserve kidney function. 

Lifestyle

• Manage Blood Sugar

  • Uncontrolled blood sugar can increase the strain on kidneys. With prediabetes or diabetes, it is important to monitor sugar levels, dose insulin correctly, and stay within target ranges 

• Control Your Blood Pressure

  • This directly impacts the force on kidneys. Think of waves on the shore: strong waves will erode the beach faster, but calm water will preserve the sand!  

• Exercise at least 30 minutes per day 

  • This decreases the risk for heart disease, help with glucose control, and maintain muscle mass. Walking, biking, jogging, and swimming are all effective! 

• Don’t smoke or try to quit smoking

  • Smoking can increase blood pressure and the risk of heart disease. 

• Maintain a healthy weight for your body 

• Avoid overuse of nonsteroidal anti-inflammatory drugs (NSAIDs)

  • These are drugs like ibuprofen (Advil) which can damage kidneys 

• Take medications as prescribed by your provider 

Diet  

• Protein intake should be low, around 0.8 g/kg body weight. The reason being to limit the strain on kidneys.  

  • To calculate yours, take your weight in lbs, divide it by 2.2 to find your weight in kg, and multiply it by 0.8 g.  

• Fats should be heart healthy. 

  • Limit saturated while emphasizing ‘healthy’ fats to reduce risk of plaque buildup in arteries. Swap butter for olive or avocado oil, opt to grill or bake foods instead of deep frying, trim the fat from meat protein sources, and use food labels to guide your choices.  

• Fluid recommendations vary based on progression of CKD. 

  • In the early stages, it is recommended to consume about 64 oz of water a day. However, as CKD advances, fluid intake should be adjusted due to the risk for fluid retention, and the possible strain on your heart.  

• Sodium should be limited to control blood pressure. 

  • Opt for fresh foods over prepared or packaged. Cook foods from scratch to control the amount of sodium, and opt for spices, herbs, and sodium free seasonings. Practice reading Nutrition Facts Labels, consuming foods with less that 15% daily value of sodium. Chose low sodium versions of foods (like broth or canned items).  

• Alcohol should be consumed only in moderation. 

  • Excess alcohol intake can damage the liver, heart, and brain causing serious heart problems and addition strain on kidneys. 

• Phosphorus intake may be reduced. 

  • As mentioned above, CKD can lead to a build up in the blood. Too much phosphorus pulls calcium from the bones, resulting in thin, brittle, and weak bones. Elevated phosphors can also cause uncomfortable itching, bone and joint pain. Deli meats, beans and lentils, as well as bran cereals often contain phosphorus.  Dark colored sodas, fruit punch, and some bottled teas use contain phosphorus. Use ingredient labels to identify foods with added phosphorus (may say PHOS).  

• Potassium is also often limited in CKD.  

  • When levels are too high, excess buildup can cause heart problems. Monitor ingredients of salt substitutes, drain canned fruits and vegetables, and avoid foods with high potassium.  

1. Cupisti A, Gallieni M, Avesani CM, D'Alessandro C, Carrero JJ, Piccoli GB. Medical Nutritional Therapy for Patients with Chronic Kidney Disease not on Dialysis: The Low Protein Diet as a Medication. J Clin Med. 2020;9(11):3644. Published 2020 Nov 12. doi:10.3390/jcm9113644 

2. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2023. 

3. National Institute of Diabetes and Digestive and Kidney Diseases. Eating Right for Chronic Kidney Disease | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Published 2019. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition