Your kidneys are bean-shaped organs that perform many important functions including filtering blood, removing waste through urine, producing hormones, balancing minerals, and maintaining fluid balance. If you have kidney disease, it’s important to watch your intake of sodium, potassium, and phosphorus. When the kidneys become damaged and cannot function properly, fluid can build up in the body, and waste can accumulate in the blood. However, following a kidney-friendly diet and avoiding or limiting certain foods may help decrease the accumulation of waste products in the blood, improve kidney function, and prevent further damage.

One of the best things you can do to help manage your disease and keep it from progressing is to eat a healthy, balanced diet. For patients with chronic kidney disease, a low-protein diet is recommended, but for someone on dialysis, a high-protein diet is best. Depending on your individual needs, your physician may also recommend limiting additional fluids, minerals or electrolytes.

If your kidney function continues to deteriorate or develops end-stage renal disease (ESRD), you may need be referred to a vascular surgeon for the evaluation of dialysis access. At Vascular Care Specialists of Los Angeles, Dr. Mathew Cheung and Dr. Peter Lin discuss 15 foods you should avoid if you have chronic kidney disease. Understanding which foods to avoid if you have kidney disease may help you to modify your diet and preserve your kidney functions.

Your specific dietary restrictions will depend on your stage of kidney disease. Those with end-stage kidney disease who require dialysis also have varying dietary restrictions. Most of those with late or end-stage kidney disease need to follow a kidney-friendly diet to avoid a buildup of certain chemicals or nutrients in the blood. In those with chronic kidney disease, the kidneys cannot adequately remove excess sodium, potassium, or phosphorus. As a result, they’re at a higher risk of elevated blood levels of these minerals. A kidney-friendly diet, or renal diet, usually limits sodium to under 2,300 milligrams (mg) per day, as well as your potassium and phosphorus intake.

Damaged kidneys may also have trouble filtering the waste products of protein metabolism. Therefore, individuals with chronic kidney disease of all stages, especially stage 3–5, should limit the amount of protein in their diets unless they’re on dialysis. However, those with end-stage kidney disease undergoing dialysis have an increased protein requirement.

Bananas are known for their high potassium content. While naturally low in sodium, 1 medium banana provides 422 mg of potassium. If you have been instructed to limit your potassium intake, it may not be easy if a banana is a daily staple. Unfortunately, many other tropical fruits have high potassium content as well. However, pineapples contain substantially less potassium than other tropical fruits and can be a more suitable yet tasty alternative.

Not only are they high in sugar and calories, but additives to extend shelf life and prevent discoloration. Dark-colored soft drinks especially are loaded with phosphorus, an additive that is easily absorbed by the body. Many food and beverage manufacturers add phosphorus during processing to enhance flavor, prolong shelf life, and prevent discoloration. Your body absorbs this added phosphorus more than natural, animal-based, or plant-based phosphorus. Unlike natural phosphorus, phosphorus in the form of additives is not bound to protein. Rather, it’s found in the form of salt and is highly absorbable by the intestinal tract. Additive phosphorus can typically be found in a product’s ingredient list. However, food manufacturers are not required to list the exact amount of additive phosphorus on the label. While additive phosphorus content varies depending on the type of soda, a 12-ounce (oz) or 355 milliliters (mL) cola contains 33.5 mg of phosphorus. As a result, sodas, especially those that are dark, should usually be avoided on a renal diet.

From vegetables to soups and beans, the convenience of canned foods are hard to deny. But, the extended shelf life that these products offer come at a cost. Almost all canned foods contain high amounts of sodium, as salt is added as a preservative to increase its shelf life. Due to the amount of sodium found in canned goods, it’s often recommended that people with kidney disease avoid or limit their consumption. Choosing lower sodium varieties or those labeled “no salt added” is typically best. Additionally, draining and rinsing canned foods, such as canned beans and tuna, can significantly decrease the sodium content.

Choosing the right bread can be confusing for individuals with kidney disease. For healthy individuals, whole wheat bread is usually recommended over refined, white flour bread. Whole wheat bread may be more nutritious, mostly due to its higher fiber content. However, white bread is usually recommended over whole wheat varieties for individuals with kidney disease. This is because of its phosphorus and potassium content. The more bran and whole grains in the bread, the higher the phosphorus and potassium contents. For example, a regular slice, or 36-gram (g) serving, of whole wheat bread contains about 76 mg of phosphorus and 90 mg of potassium. In comparison, a regular slice (28 g) of white bread contains approximately 32 mg of phosphorus and potassium. Eating one slice of whole wheat bread instead of two can help lower your potassium and phosphorus intake without giving up whole wheat bread entirely.

Note that most bread and bread products, regardless of whether they’re white or whole wheat, also contain relatively high amounts of sodium.

Like whole wheat bread, brown rice is a whole grain that has a higher potassium and phosphorus content than its white rice counterpart. You may be able to fit brown rice into a renal diet, but only if the portion is controlled and balanced with other foods to avoid an excessive daily intake of potassium and phosphorus. Bulgur, buckwheat, pearled barley, and couscous are nutritious, lower-phosphorus grains that can make a good substitute for brown rice.

Avocados are often touted for their many nutritious qualities, including heart-healthy fats, fiber, and antioxidants. They are also rich in potassium which should be avoided in many patients with kidney disease. In fact, one average-sized avocado provides a whopping 690 mg of potassium. By reducing the portion size to one-fourth of an avocado, people with kidney disease can still include this food in their diets while limiting potassium, if needed. Avocados, including guacamole, should be limited or avoided on a renal diet if you have been told to watch your potassium intake. However, remember that different individuals have different needs, and your overall diet and health goals are the most important thing to consider.

While oranges and orange juice are arguably most well known for their vitamin C content, they’re also rich sources of potassium. One large orange (184 g) provides 333 mg of potassium. Moreover, there are 458 mg of potassium in 1 cup (240 mL) of orange juice. Given their potassium content, oranges and orange juice likely need to be avoided or limited on a renal diet. Grapes, apples, and cranberries, as well as their respective juices, are all good substitutes for oranges and orange juice, as they have lower potassium content.

While dairy products such as milk and yogurt are great sources of vitamins and nutrients, over-consumption can be detrimental to those with kidney disease. Dairy products are rich in phosphorus, potassium and are a good source of protein. On their own, they may be fine but combined with other phosphorus-rich foods the effects can be detrimental. Research shows that when the kidneys are damaged, too much phosphorus consumption can cause a buildup of phosphorus in the blood. This can make your bones thin and weak over time and increase the risk of bone breakage or fracture.

Foods that have been processed or created to remain shelf-stable for extended periods of time that otherwise would expire in their natural state should be avoided as much as possible. In the case of processed meats, these products have typically been salted, dried, cured or even canned, making foods such as hot dogs, bacon, pepperoni, jerky and sausage high in sodium. These foods are also high in protein–another area of your diet that those with kidney disease are advised to monitor closely. Kidney disease or not, what you eatand drink affects your health. Maintaining a healthy weight and eating a balanced diet is key to controlling your blood pressure and blood sugar. High blood pressure and diabetes are two of the leading causes of kidney disease, as well as many other conditions including heart disease, heart attacks and stroke. A kidney-healthy diet isn’t so much about eliminating a ton of foods entirely, but more about portion control and finding the right balance of protein, fats and carbohydrates to ensure you are consuming enough calories and nutrients.

Pickles, processed olives, and relish are all examples of cured or pickled foods. Usually, large amounts of salt are added during the curing or pickling process. For example, one pickle spear can contain around 283 mg of sodium. Likewise, there are 244 mg of sodium in 2 tablespoons (30 g) of sweet pickle relish. Processed olives also tend to be salty, as they’re cured and fermented to taste less bitter. Five green pickled olives provide about 211 mg of sodium, a significant portion of the daily amount in only a small serving. Many grocery stores stock reduced-sodium varieties of pickles, olives, and relish, which contain less sodium than their traditional counterparts. However, even reduced sodium options can still be high in sodium, so you will still want to watch your portions.

Processed foods can be a major component of sodium in the diet. Among these foods, packaged, instant, and premade meals are usually the most heavily processed and thus contain the most sodium. Examples include frozen pizza, microwaveable meals, and instant noodles. Keeping sodium intake to 2,300 mg per day may be difficult if you’re eating highly processed foods regularly. Heavily processed foods not only contain a large amount of sodium but also commonly lack nutrients.

Potatoes and sweet potatoes are potassium-rich vegetables. Just one medium-sized baked potato (156 g) contains 610 mg of potassium, whereas one average-sized baked sweet potato (114 g) contains 542 mg of potassium. Fortunately, some high-potassium foods, including potatoes and sweet potatoes, can be soaked or leached to reduce their potassium contents. In fact, some research suggests that boiling potatoes can significantly decrease their potassium content, especially if you start with cold water. Soaking potatoes in water for 5–10 minutes could also reduce potassium by up to 20%. This method is known as potassium leaching or the double-cook method. Although double-cooking potatoes lowers the potassium content, it’s important to remember that their potassium content isn’t eliminated by this method. Considerable amounts of potassium can still be present in double-cooked potatoes, so it’s best to practice portion control to keep potassium levels in check.

Tomatoes are another high-potassium fruit that may not fit the guidelines of a renal diet. They can be served raw or stewed and are often used to make sauces. Just 1 cup (245 g) of tomato sauce can contain 728 mg of potassium. Though tomatoes are commonly used in many dishes, several substitutes are available. Choosing an alternative with lower potassium content depends largely on your taste preferences. However, swapping tomato sauce for a roasted red pepper sauce can be equally delicious and provide less potassium per serving.

Ready-to-eat snack foods like pretzels, chips, and crackers tend to be lacking in nutrients and relatively high in salt. Also, it’s easy to eat more than the recommended portion size of these foods, often leading to an even greater salt intake than intended. What’s more, if chips are made from potatoes, they’ll contain a significant amount of potassium as well.

Apricots are rich in vitamin C, vitamin A, and fiber. They’re also high in potassium. Each cup (165 g) of fresh, sliced apricots provides 427 mg of potassium. Furthermore, the potassium content is even more concentrated in dried apricots. Just 1 cup (130 g) of dried apricots provides over 1,500 mg of potassium. This means that just 1 cup of dried apricots provides 75% of the 2,000-mg low potassium restriction. It’s best to avoid apricots and, most importantly, dried apricots on a renal diet.

If you have kidney disease, reducing your potassium, phosphorus, and sodium intake can be an important aspect of managing the disease. The high sodium, potassium, and phosphorus foods listed above are likely best limited or avoided.

Dietary restrictions and nutrient intake recommendations will vary based on the severity of your kidney damage. Following a renal diet can seem daunting and a bit restrictive at times. However, working with a healthcare professional and renal dietitian can help you design a renal diet specific to your individual needs.

At Vascular Care Specialists of Los Angeles, we strive to provide the best service, care, and results possible. If you have end-stage renal disease with dialysis access related problems, give us a call at 626-275-9566 to schedule an appointment. You can also visit us at www.vcsla.com for more information.