Client Name ______________________________________ Date ________________ RD/DTR ______________________________________________________________ Email ____________________________________ Phone ______________________

Chronic Kidney Disease Stage 5 Nutrition Therapy For People Not on Dialysis
Since your kidneys are not working as well as they used to, it is time to change what you eat and drink so that your body can work better and you can feel good. This meal plan will help lower the levels of protein, potassium, sodium, fluid, and phosphorus in your body. Carefully following your meal plan will help you have fewer problems with kidney disease. Some of the goals for this meal plan are to keep nutrients in your blood at normal levels, lessen the amounts of fluids your body retains, and prevent bone loss.

Recommended Foods
Adapted from National Renal Diet (Harvey KS. A Healthy Food Guide for People on Dialysis. Chicago, IL: American Dietetic Association Renal Practice Group; 2002.)

Protein Choices
High-Protein Foods You may have _____ servings each day. One serving is: Beef (1 ounce) Egg replacements ( cup) Eggs (1 large) Fish (1 ounce) Lamb (1 ounce) Pork (1 ounce) Poultry (1 ounce) Shellfish (1 ounce) Veal (1 ounce) Wild game (1 ounce)

Copyright American Dietetic Association. This handout may be duplicated for client education. Chronic Kidney Disease Nutrition Therapy For People Not on DialysisPage 1

High-Protein Foods with Phosphorus Limit these foods to ______ servings each day: Cheese (1 ounce) Cooked, dried beans and peas ( cup) Evaporated milk ( cup) Milk (1 cup) Nut butters (2 tablespoons) Organ meats (such as beef liver) (1 ounce) Soy milk (1 cup) Sweetened, condensed milk ( cup) Tofu ( cup) Yogurt (1 cup) High-Protein Foods with Sodium Limit these foods to ______ servings each day. Bacon (4 slices) Canned tuna or salmon (1 ounce or cup) Cottage cheese, low-fat ( cup) Deli-style roast beef, ham, turkey Frankfurters, bratwurst, Polish sausage (2 ounces) Luncheon meats, bologna, liverwurst, salami (2 ounces) Vegetarian meat replacements (such as Garden burgers and Boca burgers) (2 ounces)

Notes:

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Lower Protein Foods

Vegetables You may have _____ servings each day. For less salt, choose fresh or frozen vegetables instead of canned. Unless otherwise stated, serving sizes are cup. The chart groups vegetables by potassium content. Your doctor and dietitian will let you know if you need to avoid vegetables that are high in potassium. Low-Potassium Vegetables Alfalfa sprouts Bamboo shoots (canned) Cabbage Carrots Cauliflower Corn Cucumber Eggplant Endive Green beans Lettuce (1 cup) Mushrooms Onions Radishes Water chestnuts (canned) Watercress Medium-Potassium Vegetables Asparagus Broccoli Celery Kale Mixed vegetables Peas Peppers Summer squash Turnips Zucchini High-Potassium Vegetables Artichokes Avocado Beets Brussels sprouts Chard Greens (beet, collard, etc.) Kohlrabi Okra Parsnips Potatoes Pumpkin Rutabagas Spinach Sweet potatoes Tomatoes Tomato juice (low-sodium) V-8 juice (low-sodium) Wax beans Winter squash Yams

Breads, Cereals, and Grains You may have _____ servings each day. Breads and Rolls: Bagel ( small) Bread, all kinds (1 slice or 1 oz) Bun, hamburger or hot dog type () Cornbread, homemade (2 oz) Danish, pastry, or sweet roll ( small) Dinner roll or hard roll (1 small) Doughnut (1 small)
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 English muffin () Pita or pocket bread, 6-inch diameter () Tortilla, flour, 6-inch diameter (1) Cereals and Grains: Low-salt, dry cereals, such as Corn Pops, Cocoa Puffs, Sugar Smacks, Fruity Pebbles, puffed wheat, or puffed rice (1 cup or 1 oz) Cereal, cooked, such as cream of rice or wheat, farina, or Malt-o-Meal ( cup) Grits, cooked ( cup) Pasta (noodles, macaroni, spaghetti, etc.), cooked ( cup) Rice, cooked ( cup) Crackers and Snacks: Crackers, unsalted, 2-inch size (4) Graham crackers (3 squares) Melba toast (3 oblong pieces) Popcorn, unsalted (1 cups, popped) Pretzels, unsalted sticks or rings ( oz or 10 sticks) Tortilla chips, unsalted ( oz or 9 chips)

Desserts: Sugar cookies (4) Shortbread cookies (4) Sugar wafers (4) Vanilla wafers (10)

Grain Foods with Added Sodium and Phosphorus: Limit the following grain foods to _______ servings per _________. Biscuits, muffins (1 small) Cake (1/20th of a round cake, or 2 2-inch square) Cornbread from mix (2 oz) Fruit pie (th of a pie) Oatmeal ( cup) Pancakes, waffles, 4-inches across (1) Dry cereals, most brands ( cup) RyKrisp crackers (3) Sandwich cookies (4) Whole wheat cereals, bran cereals ( cup)
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Fruits You may have _____ servings of fruit per day. Unless otherwise stated, serving sizes are cup. The chart groups fruits by potassium content. Your doctor and dietitian will let you know if you need to avoid fruits that are high in potassium. Low-Potassium Fruits Apple (1) Apple juice Applesauce Apricot nectar Blackberries Blueberries Cranberries Cranberry juice cocktails Fruit cocktail Gooseberries Grape juice Grapes Lemon or lime (1) Papaya nectar Peach (canned) Peach nectar Pear (canned) Pear nectar Pineapple Plums Raspberries Strawberries Tangerines Watermelon Notes: Medium-Potassium Fruits Cherries Cantaloupe Figs (2 whole) Grapefruit Grapefruit juice Mango nectar Papaya Peach (fresh) Pear (fresh) Rhubarb Prunes (5) Raisins High-Potassium Fruits Apricots Banana (1 small) Dates ( cup) Honeydew melon Nectarines Orange (1) Orange juice Prune juice

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High-Calorie Foods and Drinks You may have _____ servings each day. Chewy fruit snacks and candies (1 ounce) Cranberry sauce or relish ( cup) Cream cheese (2 tablespoons) Fruit chews (4 pieces or 1 ounce) Fruit roll-ups (2) Gumdrops (8) Hard candy (4 pieces) Honey (2 tablespoons) Jam or jelly (2 tablespoons) Jelly beans (15) Lifesavers (13) Margarine or butter (1 tablespoon) Marmalade (2 tablespoons) Marshmallows (5 large) Mayonnaise (1 tablespoon) Flavorings with Added Salt You may have _____ servings each day. Accent ( teaspoon) Barbecue sauce (2 tablespoons) Bouillon or broth ( cup) Chili sauce (1 tablespoons) Dill pickle ( large or ounce) Ketchup (2 tablespoons) Light soy sauce (1 teaspoon) Mustard (4 teaspoons) Olives (3 medium) Salt ( teaspoon) Seasoning salts ( teaspoon) Soy sauce ( teaspoon) Steak sauce (1 tablespoons) Sweet pickle relish (2 tablespoons) Taco sauce (3 tablespoons) Tamari sauce ( tablespoon) Teriyaki sauce (1 teaspoons) Worcestershire sauce (1 tablespoon) Mints (13) Non-dairy creamer ( cup) Non-dairy topping ( cup) Popsicles, juice bars (1 bar) Salad dressing (1 tablespoons) Soda pop (1 cup) Sorbet ( cup) Sour cream (1 tablespoon) Sugar, brown or white (2 tablespoons) Sugar, powdered (3 tablespoons) Syrup (2 tablespoons) Tartar sauce (2 tablespoons) Vegetable oil (1 tablespoon) Whipped cream ( cup)

Notes:

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Foods Not Recommended

Adapted from National Renal Diet (Harvey KS. A Healthy Food Guide for People on Dialysis. Chicago, IL: American Dietetic Association Renal Practice Group; 2002.)

Avoid eating too much of these foods: High-protein foods that are high in sodium (salt) Whole wheat products Milk products Sodium (Salt) Do not add salt to your food at the dining table. Read food labels and choose foods that have less than 300 milligrams (mg) of sodium per serving. Avoid the following foods: o Table salt and salt blends o Soy sauce o Convenience foods (such as TV dinners, canned or dried soups, stews, casseroles, and deli meals) o Fast foods (hamburgers, pizzas, and tacos) o Cured or processed meats and cheeses o Vegetables canned or or processed with salt o Salted snack foods o Other high-sodium foods and flavorings High-Phosphorus Foods To best control the level of phosphorus in your body, stay within the limits given in the Recommended Foods section.

Exchange Meal Pattern (if applicable)

Plan your daily menu to have: _____servings of meats and other high-protein foods _____servings of vegetables _____servings of breads, cereals, and grains _____servings of fruits _____servings of high-calorie foods _____servings of flavor (salt and salt blends)

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Meal Planning Tips

Stick to the recommended foods and servings on your meal plan. Plan menus based on what you usually eat. Add snacks as desired. Carefully plan the fluids that you eat and drink to avoid having too much. When measuring fluids, include all liquids (water and anything that melts into a liquid at room temperature). Plan ahead for special occasions and eating at restaurants so that you can choose the foods that are best for your health. Develop simple, quick menus for days that you cant cook.

Sample 1-Day Menu

Breakfast cup apple juice 1 cup puffed wheat 1 slice toast 1 teaspoon margarine 1 teaspoon jelly 1 teaspoon sugar cup milk 2 tablespoons non-dairy creamer 1 cup coffee Turkey sandwich: 2 slices bread, 2 ounces sliced turkey, 1 lettuce leaf, and 1 slice of tomato with 2 teaspoons mayonnaise cup cucumber salad with 1 tablespoon oil and vinegar dressing 1 medium apple 1 cup lemonade cup grape juice 2 ounces broiled fish cup rice cup green beans 1 cup tossed lettuce salad 1 tablespoon oil and vinegar dressing 1 dinner roll 2 teaspoons margarine cup sliced peaches 1 cup iced tea 1 slice pound cake cup strawberries

Lunch

Evening Meal

Snack

Approximate Nutrition Analysis: Calories: 1,715; Protein: 49g (11% of calories); Carbohydrate: 257g (59% of calories); Fat: 58g (30% of calories); Cholesterol: 136mg; Sodium: 1,570mg; Potassium: 1,775mg; Phosphorus: 585mg; Fiber: 14g
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