Chronic kidney disease (CKD) is a condition brought on by damage to the kidneys. There are 5 stages of kidney disease. If the kidneys go unprotected, additional damage occurs and the condition will worsen. Though stage 5 kidney disease is very serious, there is still a lot you can do to strengthen the kidneys. Read on to learn all about kidney disease stage 5. This post will detail how to know you have it, how to treat it, and what you can do to improve your kidney function.
Table of Contents
What is Chronic Kidney Disease?
When healthy kidneys become damaged a condition known as chronic kidney disease (CKD) sets in. This is a big problem for many Americans. There are currently 37 million people who are suffering from CKD according to the National Kidney Foundation.
What are the 5 Stages of Kidney Disease
Before we start chatting about stage 5 kidney disease we want to briefly go over the 5 stages of kidney disease to show how if no efforts are made to manage CKD, kidney function will quickly decline.
Kidney damage goes from a little to more severe as it progresses across each level. Stage 1 and 2 are mild with little change in function and no symptoms.
Stage 3 is right in the middle. Not as bad as stages 4 and 5, but worse than stages 1 and 2. This is when the condition is physically detected. In this stage, the kidneys still have an adequate amount of function.
Learn more about stage 3 kidney disease in this post.
Stage 4 is when you really start to see severe damage. This is also when the discussion of diet changes and possible dialysis can start to happen.
Learn more about stage 4 kidney disease in this post.
So if you’re wondering what is end-stage renal disease, it is when stage five kicks in. Stage 5 kidney disease is the final, end-stage of kidney failure.
What is Stage 5 Kidney Disease?
What Causes Stage 5 Kidney Disease To Occur?
However, many people can lose up to 90% of their kidney function without even realizing it. This is how many people only learn about their kidney damage in stage 4 or 5.
Health Conditions that Impact Stage 5 Kidney Disease?
Consequently, other conditions can negatively affect kidney function. This increases the chances of stage 5 kidney disease setting in. These include
- High blood pressure
- Inherited diseases
- Autoimmune disorders
When diabetes goes uncontrolled it can increase the risk of moving into stage 5 renal failure. As a result of unmanaged diabetes, blood sugar will rise. Subsequently, blood vessels in the kidneys will become damaged and weaken the kidneys over time.
High Blood Pressure
Similarly, high blood pressure can also increase the chances of renal failure stage 5. Hypertension will weaken the kidneys. Poor functioning kidneys cannot regulate blood pressure. Fluid imbalances will develop further increasing blood pressure and damaging blood vessels.
Glomerulonephritis is inflammation of the kidney’s filtration system. As a result of inflammation kidney filters become destroyed. This affects the kidney’s ability to filter wastes. It is one of the leading causes of kidney disease.
Unfortunately, some people are born with diseases that can weaken kidney function. These include the following conditions:
- Polycystic kidney disease
- Alport syndrome
- Tuberous sclerosis
- Von Hippel Lindau disease
- Thin Basement Membrane Disease
- Gitelman and Bartter Syndromes
- Lowe Syndrome
- Hereditary Interstitial Kidney Disease
- Fabry Disease
- Nephrogenic diabetes insipidus
Some conditions occur due to an overactive immune system. Known as autoimmune disorders, the body will see itself as a threat and attack its cells. Autoimmune diseases that attack the kidneys include the following
How is Stage 5 Kidney Disease Diagnosed?
What Measures Kidney Function?
The lab value creatinine clearance tells how the kidneys are functioning. This number shows how much creatinine is in the urine.
Creatinine is a compound the kidneys excrete. Muscles produce this substance from everyday wear and tear.
So creatinine levels indicate how well the kidneys are doing their job of filtering and excreting wastes.
Estimated Glomerular Filtration Rate (eGFR) Indicates the 5 Stages of Chronic Kidney Disease
The creatine clearance is the same as the estimated glomerular filtration rate (eGFR). This number also takes into account the age, body size, and gender of a person. So it is the most accurate measure of kidney function.
Your doctor can calculate your specific eGFR. It is a percent range that goes as high as 100. Lower numbers will indicate poorer functioning kidneys. Below is a breakout of the eGFR for each stage of kidney disease.
CKD Stage 1 eGFR
Stage 1 has some kidney damage, however, there is still about 90 to 100 percent kidney function left. So things are pretty normal.
CKD stage 1 eGFR is 90 mL/min or higher.
CKD Stage 2 eGFR
Stage 2 damage has occurred and there is a mild loss of function. In addition, the kidneys are still working pretty well with between 60 to 89 percent of function left.
CKD stage 2 eGFR is between 60 and 89 mL/min.
CKD Stage 3 eGFR
There are two eGFR levels for stage 3 CKD. They are 3A and 3B. Function varies from mild to severe in these stages.
CKD Stage 3A eGFR
Mild to moderate loss of kidney function occurs in stage 3A. So now the kidneys are functioning between 45 to 59 percent capacity.
CKD Stage 3A eGFR is between 45 and 59 mL/min.
CKD Stage 3B eGFR
There is moderate to severe damage in 3B with significant loss of function. Consequently, the kidneys are working at only 30 to 40 percent of function.
The CKD stage 3B eGFR is between 30 and 40 mL/min.
CKD Stage 4 eGFR
Stage 4 is where we serve loss of kidney function. As a result, there is only between 15 and 29 percent function left.
The CKD stage 4 eGFR runs between 15 and 29 mL/min.
CKD Stage 5 eGFR
Stage 5, or end-stage renal diesease is when there is less than 15 percent of function. Dialysis and/or a kidney transplant often accompany ESRD.
The CKD Stage 5 eGFR is less than 15 mL/min.
Factors are increasing the risk for stage 5 kidney disease to set in. These include
- Unmanaged co-existing health conditions
- Controllable risk factors
- Uncontrollable risk factors
Unmanaged Co-Existing Conditions Increase CKD Risk
If you’re looking to prevent and/or control stage 5 kidney disease you first want to start by taking control of any existing conditions that will affect the health of the kidney. These include:
- High blood pressure/hypertension
- Autoimmune disorders
- High cholesterol
- Kidney stones
- Urinary Tract Infections (UTIs)
- Enlarged prostate
- A genetic disorder that produces cysts in and/or damages the kidneys
- A kidney infection
- Liver disease
- A drug that is toxic to the kidneys
- Conditions that inflame the kidney
- Heavy metal poisoning (lead poisoning)
- Conditions that damage blood vessels in the kidneys (hemolytic uremic syndrome)
- Conditions that damage arteries in the kidneys (renal artery stenosis)
- Obstructive sleep apnea
Uncontrollable CKD Risk Factors
On the other hand, some risk factors are out of your hands. These include
- Family history of CKD
- Family history of kidney failure
- Being born with a low birth weight
In addition, certain populations are more likely to end up with CKD. This includes African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders. These groups of people are also more prone to getting diabetes and heart disease.
It is really important to manage any outlying health conditions. This will protect kidney health during stage 5 kidney disease.
Controllable CKD Risk Factors
Even if you have ESRD, there is still a lot you can do to preserve kidney function during stage 5 kidney disease. It starts with making lifestyle changes.
Please stop smoking. If you’re not a smoker don’t start! Secondly, start exercising. It can do wonders for your health. Thirdly, you may need to stop drinking. When in doubt, talk to your doctor to know if you should limit or avoid alcohol.
Getting enough sleep, maintaining a healthy weight, and having a good diet also play a role in kidney health. We will go more into detail on how to achieve these habits below.
What are the Symptoms of Stage 5 Kidney Disease?
Early on in chronic kidney disease, there is no indication of kidney damage. As the disease progresses from stage 3 to stage 4 and finally to end-stage kidney disease there are clear signs that something is going on.
Stage 5 kidney disease symptoms are similar to those found in stages 3 and 4. They consist of the following:
- Swollen extremities
- Back pain
- Poor mobility
- Poor appetite
- Low energy and fatigue
- Difficulty breathing
- Poor sleep
- Bone or joint pain
- Going to the bathroom a lot
- Color changes in urine (red, dark orange, brown)
- Foamy urine
- Bloody urine
- Bad breath
- Weird taste in the mouth
- Poor concentration
- Dry skin
- Puffy eyes
Complications From Unmanaged Kidney Disease
If you have been chugging along not managing your kidney disease, consequently, you could be in for a rude awakening. You may find yourself with a bunch of health problems and other severe complications.
This is because as kidney function dips, the body will not be able to adequately filter the blood. With nowhere to go over time, they will build up. High levels of waste will accumulate in the body.
These waste products become toxic and cause a person to feel sick. It can also develop into additional health complications including
- High blood pressure
- Reduced red blood cell count (anemia)
- Bone and Mineral abnormalities
- Cardiovascular disease
- Nutrient deficiencies/digestion issues/poor absorption
- Neurological problems
- Elevated cholesterol
- Hardening of the arteries
- Electrolyte imbalances
- Toxin build up in the blood
- Increased acid production
High Blood Pressure
Damaged kidneys cannot filter out fluids. Fluids build up and as a result, blood pressure will also become elevated.
A higher risk of death occurs with either high or low systolic blood pressure. So managing blood pressure is very important in CKD.
Low red blood cell count (anemia)
When hemoglobin is below certain numbers anemia is present. For men, this is having hemoglobin less than 13 g/dL. It is less than 12 g/dL for pre-menopausal women and 13 g/dL for post-menopausal women.
There are a lot of reasons why this condition occurs but the most important seems to be due to a lack of erythropoietin.
The kidneys release the hormone erythropoietin. This hormone makes red blood cells (RBC). Poor kidney function makes less erythropoietin and fewer RBCs.
As CKD progresses so does the risk for anemia. About 75 percent of CKD patients starting dialysis will have anemia. This is 25 percent higher than those in stages 2, 3, and 4. The risk for anemia is 50 percent higher among people with ESRD than those in stage 1.
CKD Mineral and Bone Disorders (MBD) / Renal Osteodystrophy
Renal osteodystrophy and CKD mineral and bone disorders occur where there is kidney damage from CKD.
Poor functioning kidneys are unable to excrete phosphorus or synthesize active vitamin D. As a result, there is excess phosphorus and too little vitamin D. This causes calcium levels to drop. The body reacts by pulling calcium from the bones.
When calcium levels drop the parathyroid hormone (PTH) will rise. PTH will react like phosphorus and also take calcium from the bones to compensate for mineral imbalances. As a result, renal osteodystrophy will develop.
Those with ESRD in dialysis are likely to suffer from low bone turnover. It happens because there is too much PTH and calcium in the dialysate. Other reasons for this condition include acidosis and poor vitamin D synthesis.
If not corrected these disorders can lead to heart disease and death.
As CKD progresses the risk for cardiovascular disease increases. Between 40 and 50 percent of the deaths among those with stage 5 kidney disease are due to heart disease.
Unmanaged diabetes and anemia can also lead to cardiovascular disease.
Diabetes often coincides with kidney disease. Damaged kidneys cannot remove wastes and as a result, urea will build up in the blood.
High levels of urea can prevent insulin production in animals. Without enough insulin, blood sugar cannot get into cells. Excess blood sugar levels will lead to the development of diabetes.
Unmanaged diabetes can cause CKD and further weaken the blood vessels in the kidneys.
Nutrition Deficiencies/Poor Absorption
Malnutrition is a result of poor diet and oversight of dietary restrictions. In addition, some will experience uremic malnutrition. The body cannot produce enough energy, despite how despite having high intakes of protein and carbs.
Nutrient deficiencies are also common in those with CKD. Consequently, people who don’t get enough protein folate, iron, and pantothenic acid are at risk for anemia, heart disease, metabolic imbalances, and uremic malnutrition.
Neurological problems are apparent in ESRD. Having hypertension in stage 5 kidney disease can increase may cause posterior reversible encephalopathy syndrome (PRES). This condition causes headaches, seizures, and an inability to stay awake.
People on dialysis are also prone to sepsis. This blood infection can impair consciousness.
Anyone with existing unmanaged HBP or diabetes can also suffer from nerve damage and poor brain function.
If you have a numbness or tingling sensation you may have a case of peripheral neuropathy. This occurs when there has been damage to your nerves. It can occur due to
- High blood pressure
- High parathyroid hormone (PTH)
- Electrolyte imbalance
- High uremia
- Inflammatory compounds called advanced glycation end products (AGE’s)
AGE’s are a by-product of digestion. They are also in processed foods. Too many of these can lead to nerve damage. Non-diabetic individuals also can have AGE’s in their body.
Neurological conditions can also affect digestion. It slows transit time leading to indigestion and other stomach issues.
People with unmanaged CKD and other health conditions are more likely to have neurological problems.
Mortality risk increases among people with a total cholesterol level greater than 200. It is unknown if inflammation and malnutrition affect this risk.
Hardening of the Arteries and Plaque Build-Up (Atherosclerosis)
When the body sees damaged blood vessels, the immune system will respond by sending cells to heal the damage. These cells will cause plaque to build upon the artery walls. This also happens in the kidneys. So damaged kidney blood vessels are at risk for atherosclerosis.
In addition, those with stage 5 kidney disease have fewer immune cells and are susceptible to increased inflammation.
Accelerated atherosclerosis occurs in the later stages of CKD. It may arise from hypertension, inflammation, anemia, and MBD disorders.
The risk of atherosclerosis increases with age. It may also be the result of smoking, high cholesterol, diabetes, metabolic acidosis, and excessive blood clotting.
Electrolyte imbalances are common among those with stage 5 kidney disease. Changes in sodium, potassium, and water balance can occur in those with ESRD before and after dialysis.
High Potassium (Hyperkalemia)
The severe kidney dysfunction seen in ESRD elevates blood levels of potassium. Known as hyperkalemia, this is a life-threatening problem for those with stage 5 kidney disease.
There are three levels of hyperkalemia. They are based on potassium levels and fall into the categories of
- Mild (5.1- <6 mmol/l)
- Moderate 6- <7 mmol/l)
- Severe (≥7 mmol/l)
The onset of hyperkalemia is due to several reasons including:
- Insulin deficiency
- Metabolic acidosis
- Cell, muscle, and tissue breakdown
- High potassium intake
- Medications that don’t excrete potassium
- Angiotensin-converting enzymes (ACE) inhibitors
- Angiotensin Receptor Blockers (ARBs)
- Mineralocorticoid receptor antagonists
- Potassium-sparing diuretics
- Calcineurin inhibitors
- Uncontrolled diabetes
When potassium levels reach 6.5 mEq/L it is a medical emergency that needs treatment immediately. Levels often get this high when there is an excessive intake of certain medications that build up potassium in the blood as noted above.
Low Calcium (Hypocalcemia)
Hypocalcemia or low calcium in the blood is common in those with stage 5 kidney disease and often a result of renal failure. Weak kidneys cannot produce vitamin D. This nutrient helps absorbs calcium from the gut. High levels of phosphorus and PTH will also keep calcium levels low.
As a result of hypocalcemia secondary hyperparathyroidism develops in ESRD. This will increase deficiencies in mineral metabolism. Consequently, the bones will also lose calcium and weaken.
Toxin Build Up in the Blood (Uremia)
Uremia is the buildup of waste products in the blood. It is a common problem during stage 5 kidney disease. It affects reproductive hormone health and can lead to impotence in men and infertility in women.
Uremia is when there is a creatine clearance below 10 mL/min. However, some people may get it at a higher eGFR. It has the following symptoms:
- Fatigue from anemia
- Weight loss
- Muscle cramps
- Changes in mental status
- Ammonia or urine-like breathe
- Bleeding in the stomach or intestines
Uremia has a lot of negative consequences and can lead to
- Narrowed blood vessels
- Chronic heart failure
- Chest pain
- Nerve and brain damage
- Damage to the central nervous system
As kidney function declines from too much uremia, the risk for hypoglycemia increases in those with both diabetes and CKD.
Increased Acid Production and Metabolic Acidosis
Metabolic acidosis is when there is too much acid in the body. There will be a pH of less than 7.35 and a low bicarbonate level.
Uremia can lead to metabolic acidosis in stage 5 kidney disease. Kidney cells regulate the acid-base balance of the body. Damage to them will prevent them from being able to do their job.
This will cause a decrease in hydrogen ions. As a result, acid production will run rampant. In addition, the kidneys will no longer be able to excrete ammonium. Eventually phosphate and organic acids such as lactic acid, sulfuric acid, hippuric acid buildup to toxic levels.
Chronic metabolic acidosis causes protein breakdown leading to malnutrition-inflammation-atherosclerosis (MIA) syndrome. MIA is a condition that occurs in ESRD. It is classified by having malnutrition, inflammation, and atherosclerosis all at the same time.
Symptoms of metabolic acidosis include:
- Muscle weakness
- Congestive heart failure
Can CKD Stage 5 Be Reversed?
Questions like, “can CKD stage 5 be reversed?” or “can kidneys recover from stage 5?” often come up with kidney patients.
We hate to burst your bubble but there is no way to reverse chronic kidney disease stage 5. Regardless of what you find online, consequently, there is no going back.
However, don’t let this get your down! There is still a lot you can do for your kidneys. It starts with learning how to manage this disease. This will stop further damage and preserve kidney function.
If you don’t already have one in place, the first thing you should do is put together a healthcare team to make a medical, lifestyle, and nutrition plan to fit your needs.
When Should You See a Kidney Doctor?
Those in stage 5 of CKD usually will see their doctor at least every month. This is to monitor how well the kidneys are functioning.
If you have stage 5 kidney disease and are not already seeing a kidney doctor you need to find one pronto. Your primary care physician or insurance company can refer you to someone who specializes in renal health
When Should You See a Renal Dietitian?
You should also be seeing a renal registered dietitian (RD). A renal RD knows all about renal nutrition. They are responsible for helping to improve any nutrition issues that may arise from CKD.
Renal RDs put together individualized plans that improve nutrition status and help kidney function. They can
- Preserve eGFR
- Improve weight management
- Eat without limitations
- Reduce metabolic acid
- Improve nutrient status
- Find foods for real life that also tastes great
- Help you forget you have CKD
If you don’t have an RD on your healthcare team be sure to get one. You can find a skilled renal dietitian by reaching out to your insurance company or find a local RD in the National Kidney Foundations’ dietitian directory.
For anyone outside the states check out these international dietetic associations to find renal RD in your own country.
Stage 5 Chronic Kidney Disease Treatments
By the time stage 5 kidney disease sets in, you should already have a treatment plan in place. This is because treatment for kidney disease is crucial. This will improve health status and prevent additional damage and/or complications.
So if you don’t have a treatment plan in place now is the time to get one!
The first thing you need to do is get a healthcare team together. This will consist of your primary care doctor, a kidney doctor, and a renal RD. Together they can work on a treatment that includes an array of interventions including
Medical treatments will come from your doctors. The renal RD will put together nutritional interventions and a diet plan that is right just for you. All of your healthcare team members will help establish lifestyle interventions
Medical Treatment of Chronic Kidney Disease Stage 5
Your doctors will provide medical advice and possibly prescribe medications to manage underlying conditions like hypertension and diabetes.
Once someone goes past stage 3, the kidneys will have trouble clearing substances from the body. Consequently, there will be restrictions on certain medications. These include
- Other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Selective COX-2 inhibitors
Those with an eGFR than 20 mL/min should avoid medications that increase potassium levels:
- Potassium-sparing diuretics
- Angiotensin-converting enzymes (ACE) inhibitors
- Angiotensin-receptor blockers
People with stage 5 kidney disease are also at risk when they go for magnetic resonance imaging (MRI). MRI preparations contain a compound called gadolinium. It can cause the kidneys to become scarred and hardened.
In addition, medications will vary from person and person. It is best to ask your doctor about any possible restrictions.
Stage 5 Kidney Disease May Include Dialysis
Unlike other stages of CKD, in stage 5 kidneys are in a severely low state of function. At this low of function, dialysis will be discussed by your kidney doctor.
While dialysis is discussed in any stage of kidney disease, a person can only qualify to start dialysis in stage 5. This is also not mandatory just because of the stage 5 diagnosis. Newer guidelines show that earlier initiation of dialysis does not improve quality nor duration of life.
Ultimately, the decision to start dialysis will be up to you. This is a very personal decision and not one to take lightly. Once dialysis is started, it is generally not advised to discontinue.
Generally, starting dialysis is recommended when symptoms become very severe and impact daily life. Some of these symptoms may include:
- irregular heart beat
- extreme edema
Other symptoms may arise. It’s important to keep note of how you feel and what changes you notice to help identify shifts in what is “normal” for you.
Types of Dialysis
Dialysis is a medical treatment that removes wastes and extra fluid from your blood. There are two types of dialysis:
- Hemodialysis (HD)
- Peritoneal dialysis (PD)
Hemodialysis can be done at home or in a dialysis center. Hemodialysis done at home is called home dialysis.
The blood pumps through soft tubes into a dialysis machine where an artificial kidney known as a dialyzer filters it. Then it goes back into your bloodstream.
Hemodialysis in a dialysis center runs three to four times a week. It lasts for about 3 to 5 hours, based on your size, residual kidney function and other lab markers.
Home dialysis has more flexibility and can occur daily for 1 and ½ to 2 hours a day.
Peritoneal dialysis (PD) is a daily at-home dialysis treatment. In PD the blood gets filtered inside the body. A cleansing solution known as a dialysate flows into the abdomen through a surgically placed tube called a PD catheter.
Wastes and excess fluid are drained through the belly. The dialysate needs to be drained and replaced every half hour.
Stage 5 Kidney Disease May Require a Kidney Transplant
There are both pros and cons to having a kidney transplant. Some of the benefits include fewer food restrictions, more energy, and greater longevity.
On the other hand, there are still risks to this treatment. Like any surgery, you don’t know what can happen while you’re under the knife.
Following a transplant, you will need to take medication to prevent the kidney from rejecting your body for as long as it continues to work. These medications also have side effects that could be annoying.
Having a kidney transplant also increases the risk of infections and cancers. In addition, there may be a need for more than one transplant depending on the life of the kidney.
If you are interested in learning more about kidney transplants talk to your healthcare team to see if they are a viable option for your ESRD.
Lifestyle Treatments for Chronic Kidney Disease Stage 5
In addition to medical and nutrition treatments, lifestyle changes can go a long way in improving kidney health. They include:
- Manage stress and anxiety
- Stop smoking
- Increase sleep
Kidney health depends on exercise. For those with stage 5 kidney disease exercise should be implemented with care. Start slow and see what you can manage.
Movement is key. No matter whether you do aerobic, weight lifting, balance, or stretching exercises, the bottom line is to just keep moving.
Aerobic exercise is great for your heart health. Exercises like walking, running, biking, rowing, dancing, and elliptical training can lower blood pressure.
There can also be limitations for exercise in people with ESRD. So don’t push yourself if you feel sick, tired, or were told by your doctor not to exercise.
When in doubt ask your healthcare team what is the best exercise regimen for you.
Learn more about exercise for kidney health in this post.
Manage Stress and Anxiety
Stress and anxiety put a real toll on the body. If you are someone with a full plate you are at risk for further kidney damage. However, stress-reducing activities can stop this from happening. They include
- Start moving with some exercise
- Find a companion in a pet or look at pictures of pets
- Get good nutrition
- Reduce your caffeine consumption
- Learn how to exhale with deep breathing techniques
- Let your mind wander with meditation
- Give thanks with gratitude practices
Learn more about how to manage chronic stress in this post.
Smoking causes a ton of damage including reducing blood flow. This weakens the kidneys and leads to CKD. That is why smoking during stage 5 kidney disease can worsen your CKD.
People with high blood pressure who smoke have a higher risk of stroke and heart attack than those who don’t. Smoking can also alter the effectiveness of some blood pressure medications.
Damage to the heart and blood vessels is increased for smokers with diabetes. It also can make wounds fester and not heal well.
If you are around someone who smokes, the effects second-hand can also lead to the same health problems found among smokers.
If you are having no luck quitting smoking ask your doctor for help.
Get More Sleep
How well you sleep determines how effective the kidneys are working. That is because kidney health is regulated by the sleep cycle. Bad sleep equals a faster decline in kidney health.
So make sure you give yourself enough time for bed. This means getting at least 7 or 8 hours of sleep a night. Here are some tips to make bedtime better.
- Pick one time to go to bed and get up in the morning and stick with it every day
- Get rid of electronics, lights, and screens an hour before bed
- Don’t eat too close to bedtime
- No alcohol before bed
- Avoid stimulants like caffeine and nicotine before bed
- Get outdoors every day if you can
- Make your bedroom a cool, quiet, and dark oasis
- Wind down with a hot bath or stress management techniques before bed
If you’ve tried all these and you still have trouble sleeping talk to your doctor and renal RD to get some more tips for improved bedrest.
Other Important Lifestyle Recommendations
Other important lifestyle recommendations include the following:
- Managing a healthy weight
- Alcohol limitation or avoidance
- Lowering blood pressure
- Reducing blood sugar
We go over these more in-depth in the nutritional treatment section below.
Nutritional Treatments for Chronic Kidney Disease Stage 5
The nutritional treatments for chronic kidney disease stage 5 revolve around improving diet. This manages not only CKD but also the other underlying conditions and complications that may arise during stage 5 kidney disease.
As a result, improvements will be seen within a person’s
- Blood pressure
- Cholesterol levels
- Blood sugar
These nutritional treatments will outline how improved nutritional status in stage 5 kidney disease prevents further kidney damage. It will include the following:
- Nutrition for existing health conditions
- Labs to monitor for kidney function
- Nutrients to monitor
- Foods to avoid kidney damage
- Foods to preserve kidney function
This section will also offer a sample stage 5 renal diet menu plan.
Manage Pre-Existing Conditions and Complications
Good nutrition is so helpful in managing complications that occur in CKD. In this section, we will tell you everything you need to do nutritionally to improve the following conditions:
- High blood pressure
- CKD Mineral and Bone Disorders (MBD)
- Nerve and neurological function
- Electrolyte Levels
- Uremia and blood toxin buildup
- Acid production
- Heart Disease
Nutritional Treatments for High Blood Pressure
The more sodium you have in your diet the higher your blood pressure will be. This is because the kidneys cannot excrete excess sodium in the blood.
The easiest way to lower your blood pressure is to cut back on your sodium. This also will prevent further damage to the kidneys.
Sodium intake recommendations are about 2,000 mg a day. Anyone with high blood pressure should decrease this to about 1,500 mg. However, everyone’s needs are different and your healthcare team may recommend a different sodium level. If this is the case follow their advice.
It is easy to cut back on sodium when you implement The Dietary Approaches to Stop Hypertension (DASH) diet. This consists of fruits, vegetables, low-fat dairy, whole grains, fish, poultry, dry beans, seeds, and nuts.
You can also throw in some low-sodium snacks too.
This diet ensures less sodium while getting more nutrients you need like fiber and protein.
Get more ideas for how to follow a low sodium diet in this post.
Nutrition for Anemia
Anemia chronic kidney disease can be corrected with iron-rich foods. These consist of both plant and animal sources of iron such as
- Greens like spinach
- Garbanzo beans
If you eat iron plant foods be sure to eat them with vitamin C-containing food. This will enhance absorption. Foods rich in vitamin C are
- Bell peppers
- Chili peppers
- Citrus fruit
Cooking with cast iron pans can also give your body an iron boost.
Some foods will reduce your iron absorption. So be sure to eat iron-rich foods at least a few hours apart from the following
- Foods with tannins like coffee and tea
- Phytates (grains, legumes, nuts, seeds)
If hemoglobin drops below 10 g/dL erythropoietic stimulating agents, such as erythropoietin or darbepoetin, may be initiated. These medications are risky to take. They can increase the risk of cardiovascular disease and are only used in low doses.
Talk with your renal RD to find out if you need any of these therapies.
CKD Mineral and Bone Disorder (MBD) Nutrition Interventions
Metabolism imbalances during CKD result in mineral and bone disorders. One way to overcome these problems is to learn how to regulate vitamin D and minerals like phosphorus and calcium.
Regulate Phosphorus Levels
People with stage 5 kidney disease cannot properly excrete phosphorus. So the easiest way to prevent this mineral from building up is to eliminate it from the diet.
Sometimes diet alone is not enough to keep phosphorus levels in check. If this is the case you may be told to take phosphorus binders. This medication will excrete phosphorus from the blood Do not take phosphate binders unless you have been instructed by your healthcare team.
Learn more about phosphate binders in this post.
Regulate Calcium Levels
High phosphorus levels can lead to low calcium. This is a problem it will signal PTH to remove calcium from the bone.
Too much calcium is also a problem in kidney disease. It will prevent vitamin D from working. As a result, bone health is at stake.
One way to increase calcium is through diet. It is important to know that some calcium-rich foods may be removed from the diet if phosphorus levels are high.
Foods like milk, cheese, yogurt, ice cream, and leafy greens are good sources of calcium. However, dairy foods high in phosphorus need to be avoided if there are any phosphorus restrictions in the diet.
If you have questions about how to regulate calcium through diet, ask your renal RD.
Regulate Vitamin D Levels
Vitamin D levels can be regulated with food and supplements. Trout, salmon, tuna, mackerel, and cod liver oil are the best food sources of vitamin D.
Other foods that have vitamin D are beef liver, mushrooms, beef, and egg yolks. Some of these foods may need to be avoided if there are any calcium, phosphorus, or protein restrictions in the diet.
The sun can also be a good source of vitamin D but it can be hard to get enough.
If your diet is not providing you enough vitamin D you may need to supplement. Be sure to ask your renal RD if you have any questions about phosphate binders, calcium, or vitamin D supplements. Don’t take them unless you are instructed by your healthcare team.
Nutrition for Diabetes
Diabetes is often the main cause of stage 5 kidney disease. So a big key to managing CKD is getting your diabetes under control. This is done by regulating blood sugar, sodium, potassium, and phosphorus levels.
Regulate Blood Sugar in CKD Stage 5-Related Diabetes
Blood sugar regulation helps both diabetes and CKD. This means cutting back on added sugar and monitoring your carbohydrate intake will lower blood sugar. Be sure to get less than 10% of your calories from added sugar. So if you have 2,000 calories diet you want less than 200 calories from added sugar.
If you have diabetes you should be getting only 50% of your calories from carbs. So on a 2,000 calorie diet, you want to get only 500 calories from carb foods. This is about 200 grams of carbohydrates since each carb has 4 calories per gram.
Sticking to the same amount of carbs at each meal is another way to keep your blood sugar stable. However, if you’re on insulin you don’t have to worry about this since the insulin administered will cover your carb intake.
Another thing to consider is that all carbs are not created equal. This means you should be aware of the type of carb you’re consuming. Refined carbs are not recommended and should be limited or removed from the diet to ensure your blood sugar will stabilize.
Instead of refined carbs like cookies, candies, cakes, pastries, white pasta, and bread you should be consuming whole vegetables and fruits. These foods are the best carbs for regulating sugar levels.
They contain fiber which can slow digestion. It keeps you fuller longer and does not require insulin to be utilized. So it will keep insulin levels in check compared with refined carbs that contain no fiber.
Learn more about the best foods for a renal diabetic diet here.
Regulate Certain Mineral Levels in Stage 5 Kidney Disease-Related Diabetes
When you have diabetes along with CKD you also need to watch your sodium, potassium, and phosphorus intake.
Sodium intake should be around 2,300 mg per day but if you have high blood pressure you need to limit it to about 1,500 mg a day.
Potassium needs will vary depending on where your potassium levels lie. Too little or too much potassium can have severe health risks. If you are unsure about how much potassium you should have in your diet, ask your healthcare team about how much potassium is right for you.
Phosphorus intake should be limited depending on how the kidneys are clearing this nutrient from the body. People with stage 5 kidney disease will have phosphorus restrictions and may need to remove it from their diet.
If you’re curious about how to avoid and/or limit these minerals in your diet check out the foods to avoid section below
Nutrition for Nerve and Neurological Function
Getting blood sugar levels in a good place will also help to combat neuropathy that is associated with diabetic CKD.
Increasing your fiber and fluid intake can also improve autonomic neuropathy. Ask your renal RD about your fluid needs in case you need to stick to certain fluid requirements.
Potassium is a nutrient involved in neurological health. Lowering elevated potassium levels will prevent potential nerve damage that leads to uremic neuropathy.
Vitamin B12 is another nutrient that causes cognitive problems in CKD. Getting adequate levels of this nutrient helps the brain function. Foods that are a good source of B12 include fish, meat, poultry, eggs, dairy products, and fortified nutritional yeast.
Some people may need to supplement B12 if diet alone is not increasing levels. Ask your healthcare team about your B12 needs before taking any supplements.
Nutrition to Lower Cholesterol
When you have stage 5 kidney disease you may have high cholesterol. This condition can further damage the kidneys so it’s important to learn how to improve levels with nutrition.
Improving your cholesterol, especially the “good” HDL can preserve kidney function.
You should consume foods high in soluble fiber and low in saturated fat and cholesterol. These include fruits, vegetables, low-fat dairy, and whole grains. They lower the “bad” LDL cholesterol and increase your HDL levels.
You also want to avoid salt, red and processed meats, and sweetened beverages, and any foods with trans-fat.
Sometimes people will be prescribed medications to lower cholesterol. However, these should be a last resort after lifestyle and diet changes have been implemented.
Nutrition for Improving Atherosclerosis
When there is inflammation, the body will respond by sending immune cells to go and heal damaged blood vessels. As a result, a buildup of plaque will form on the arterial wall. Known as atherosclerosis, this condition also affects blood vessels in the kidneys.
Inflammation from unmanaged CKD and underlying issues like hypertension, high cholesterol, diabetes, and metabolic acidosis. These inflammatory conditions cause plaque to form in the walls of blood vessels in the kidneys.
Having a diet low in sodium, saturated fat, and sugar can help to prevent kidney atherosclerosis. The addition of fiber and antioxidant-rich fruits and vegetables also reduces the incidence of this disease.
Nutrition to Balance Electrolyte Levels
Potassium, sodium, phosphorus, calcium, and magnesium are minerals known as electrolytes. They are needed for nerve and muscle function along with fluid and acid balance. Imbalances of these minerals are common in stage 5 kidney disease.
Excess potassium in the blood is known as hyperkalemia and occurs in the end-stage of renal disease. Patients with a creatinine clearance of less than 20 mL/min should avoid intake of high potassium foods to improve this condition.
Waning kidneys can also no longer regulate fluids. This causes sodium levels to get out of hand. The way to overcome this is by limiting sodium intake.
Shifts of electrolytes sodium, calcium, and magnesium cause damage to the brain and nervous system.
These problems increase as CKD worsens so those with stage 5 kidney disease need to monitor and lower their intake of sodium, potassium, and phosphorus to avoid further damage.
- Eating foods with little to no sodium (less than 130 mg per serving)
- More fresh whole fruits and vegetables
- Ditch foods high in potassium (see “Limit High Potassium Foods” section)
- Avoid foods high in phosphorus (see “Avoid High Phosphorus Foods” section)
Nutrition to Prevent Blood Toxin Build-Up (Uremia)
If the kidneys are damaged they cannot remove waste products from the blood. Consequently, they will build up and become toxic to the body and uremia develops.
Uremia can be prevented by balancing phosphorus, potassium, protein, and sodium levels. They are regulated by reducing the intake of certain nutrients. Recommendations are as follows:
- Potassium is limited to 2,000 mg per day
- Sodium is limited to 2,300 mg per day or lower if you have hypertension
- Phosphorus is limited to 3,000 mg per day
- Protein is limited unless there is any protein found in the urine
However, actual needs will still vary from person to person so you should ask your renal RD what mineral recommendations should you follow.
Some nutrients should be added to the diet to improve uremia. These include
- Vitamin D
Foods like liver and leafy greens contain the minerals iron and calcium. Be sure to only have calcium foods that are low in phosphorus (see a list below).
Vitamin D aids in increasing calcium levels. Foods rich in vitamin D are found in the above section “CKD Mineral and Bone Disorder (MBD) Nutrition Interventions.”
Nutrition to Lower Acid Production
Unmanaged CKD can lead to metabolic acidosis. This is when there is too much acid produced by the body. Dietary changes can prevent acid production. This is done by incorporating more foods that produce a base when digested.
They include vegetables, fruits, beans and legumes, and some nuts.
Learn how to lower your risk of metabolic acidosis in this post.
Nutrition for Weight Management
You can manage weight by having
- A nutritious diet
- Following dietary restrictions
- Adding healthy food to your day
- Reducing how much you eat
- Eating healthy fats
- Eat high fiber food at all your meals
- Add fruits and vegetables
- Have low-fat dairy (no phosphorus)
- Look at food labels
- Reduce sugar intake
- Increase water consumption (unless you have a fluid restriction)
- Limit and avoid alcohol
- Journal your daily food intake
- Plan ahead at the grocery store
- Don’t go food shopping hungry
Work with your renal RD to find out what a healthy weight is for your body.
Nutrition to Manage Heart Disease
The key to managing heart disease is to reduce the incidence of other complications. So improving the health conditions below you will also be reducing your risk of cardiovascular disease
- High blood pressure and hypertension
- Nerve and neurological function
- Lowering cholesterol
- Balancing electrolytes
- Metabolic acidosis
- Weight management
Labs to Monitor in Stage 5 Kidney Disease
Assessing kidney function and nutrient status is important during stage 5 kidney disease. Specific labs will give a picture of your overall health. They can also tell your healthcare team of any medical and dietary changes that should be done to preserve kidney function.
Labs to monitor include the following:
- Renal Function Panel
- Comprehensive Metabolic Panel (CMP)
- Complete Blood Count (CBC)
- Iron, Ferritin, and Transferrin Saturation (TSAT)
- Thyroid Panel
- Intact Parathyroid Hormone (iPTH)
- Vitamin D
Renal Function Panel
A renal function panel will tell the health of the kidneys during this stage of the disease. It looks at the body’s
- Glucose (blood sugar)
- Waste products
- Additional calculated values
Electrolytes are particles in the body that have an electrical charge. They control the acid-base balance along with the nerve and muscle function. They are necessary for life and consist of the following:
- Bicarbonate (carbon dioxide)
Minerals compounds are responsible for growth and function. Two minerals we are most concerned with are phosphorus and calcium.
Phosphorus prevents metabolic acidosis while calcium keeps the heart beating and prevents excessive bleeding.
Protein is measured by albumin in a renal lab. It consists of 60 percent of the protein in the blood. Albumin helps move hormones, vitamins, drugs, electrolytes, and minerals through the body. This protein is also needed for heart health.
A value of 4.0 g/dL is recommended for people with stage 5 kidney disease.
Waste products are used to measure kidney function. They consist of the following:
- Urea or blood urea nitrogen (BUN)
Urea or blood urea nitrogen (BUN) is created when protein foods are digested. Creatinine is the other waste product. It is a byproduct of muscle breakdown. Both of these substances are moved to the kidneys to be removed by the body.
Glucose (Blood Sugar)
The sugar in our blood is called glucose. The blood should contain a certain level of glucose to be used for energy. However, when blood sugar is high it shows a risk of diabetes.
The urine can also be tested for high glucose levels.
Typical recommendations for glucose are 90 to 130 mg/dL before meals. If they are measured two hours after the start of the meal they should be below 180 mg/dL.
Your healthcare team may also measure your A1C. This is a snapshot of your average glucose levels over a three-month period. Anyone with CKD should keep their A1C at 7%.
Remember healthy glucose levels vary from person to person. When in doubt about your levels ask your renal RD to know if you have high blood sugar.
Additional Calculated Values
Renal labs also include the additional calculated values. These consist of the following:
- BUN/creatinine ratio
- Estimated glomerular filtration rate (eGFR)
- Anion gap
The comparison of BUN to creatinine gives a better picture of kidney health. When the ratio is high it means the kidney function is poor.
The estimated glomerular filtration rate or eGFR lets you know if the kidneys can filter blood properly. Creatinine levels are assessed along with the persons’ age, race, and gender. Sometimes height and weight are included in the eGFR for a more accurate account.
Electrolyte and fluid levels are measured by the anion gap. If sodium and chloride are low with high fluid levels it tells you the kidneys are not working well. Dehydration can also cause high levels of potassium, sodium, and chloride.
Comprehensive Metabolic Panel (CMP)
The comprehensive metabolic panel (CMP) test assesses 14 substances found in the blood. Most of these are measured in a renal panel except for the following three tests:
- Total Protein
- Liver Enzymes and Bilirubin
- Cholesterol levels
How much protein is found in the blood is called the total protein.
Liver Enzymes and Bilirubin
Liver function is measured by liver enzyme tests. They consist of
- Alkaline phosphatase (ALP)
- Alanine transaminase (ALT)
- Aspartate aminotransferase (AST)
A high alkaline phosphatase or (ALP) indicates there could be liver damage.
Elevated aspartate aminotransferase (AST) means possible problems with the heart, pancreas, and/or liver.
Liver damage and/or liver disease may also be verified by increases in alanine transaminase (ALT). High levels of ALT can occur before any symptoms show up.
Bilirubin is also part of this panel. Bilirubin is a byproduct of digestion. It is a substance produced by the liver. High bilirubin may be a sign of liver damage.
Other things can also alter liver function. These include certain foods, supplements, and strenuous exercise.
Before you get worried about your liver enzyme test results ask your renal RD for possible reasons why your liver enzymes and bilirubin are high.
Checking cholesterol levels will help prevent heart disease and atherosclerosis. There are three types of cholesterol monitored. They include
- LDL the “bad” cholesterol
- HDL the “good” cholesterol
Strive to have your cholesterol levels are as follows:
- HDL should be 40 or higher
- LDL should be less than 100
- Triglycerides should be less than 150
The sum of the good and bad cholesterol is looked at as well. This is known as total cholesterol. This number should be less than 200.
If your cholesterol does not match these recommendations you can ask your healthcare team how to improve your levels.
Complete Blood Count (CBC) Panel
The health of their blood is important for managing stage 5 kidney disease. This is monitored with a complete blood count (CBC). It looks at the following:
- Red blood cells
- White blood cells
As we mentioned above, too few red blood cells can lead to anemia, iron deficiency, and possibly heart disease. So it is really important to know your RBC levels.
The immune system is made up of white blood cells (WBC). They are needed to fight infections. There are five different types of WBC. The WBC test tells you how many immune-fighting cells you have in your blood.
Some CBCs will have a CBC differential test. This measures the total number of each type of WBC in your blood.
Abnormally high or low WBC could indicate a health condition. However, these shifts in WBC levels are also due to medications, diet, and the menstrual cycle for women.
The platelets measure how well your blood clots.
Hemoglobin is a protein in RBC that helps move oxygen into cells. Low levels of this protein lead to anemia. Hemoglobin levels in healthy people should measure around 12 to 15 g/dL for women and 13 to 17 g/dL for men.
Those with stage 5 kidney disease may have lower hemoglobin levels. Your doctor will tell you if your levels are in a healthy range for someone with CKD.
Hematocrit tells us how much blood is in the body’s red blood cells. This compound is low in those with kidney problems.
Urinalysis is used to know how well kidneys are working. This test can also monitor diabetes. The urine is analyzed for its
- Appearance (clear or cloudy)
- Its acidity (pH level)
- Presence of bacteria and other germs
It also looks at stuff that shouldn’t be in the urine like blood, proteins, glucose, ketones, bilirubin cells, and crystals.
Ferritin and Transferrin Saturation (TSAT) (Additional Ways to Monitor Iron)
The iron status is also indicated by the transferrin saturation (TSAT) and ferritin tests.
Transferrin saturation (TSAT) levels show how much transferrin is in the blood. Transferring is a protein that is made by the liver. It is the body’s defense to protect against low iron levels.
If TSAT gets below 20% it could signal low iron levels.
Those with stage 5 kidney disease should have their thyroid checked annually. If you have thyroid dysfunction and CKD you need to get your thyroid tested three to six times a year.
The tests included in a full thyroid panel include the following:
- Thyroid Stimulating Hormone (TSH)
- Free Thyroxine (Free T4)
- Free Triiodothyronine (Free T3)
- Thyroid antibodies
- Reverse Triiodothyronine (rT3)
- Signs and Symptoms
- Thyroid Ultrasound
TSH is short for thyroid-stimulating hormone (TSH). This substance indicates how much hormone is made by the thyroid gland.
Free thyroxine (free T4) is the main thyroid hormone. It is tested to see how much free T4 is available for cells to use. It is used with TSH to tell if there is thyroid dysfunction.
Free triiodothyronine (free T3) is another hormone test measuring thyroid function. Like free T4, It is evaluated along with TSH levels.
Reverse Triiodothyronine (rT3) reflects if T4 is being used by the body. It is secreted in small amounts and is a measurement of dysfunction when free T3 is normal but someone still has symptoms.
Medications can also elevate rT3 so check with your healthcare team to learn about your results.
What the Thyroid Panel Test Results Mean
When TSH, free T4, and T3 results are normal show there is no thyroid dysfunction. On the other hand, thyroid abnormalities can occur when there is an illness.
This condition is called nonthyroidal illness or sick euthyroid syndrome. It is indicated by
- TSH that is low OR normal
- Free T4 that is low OR normal
- Free T3 is low
A mild form of an underactive thyroid is also possible. This is known as subclinical hypothyroidism. It also occurs in people with low thyroid function on thyroid medications. It results in the following:
- TSH is high
- Free T4 is normal
- Free T3 is normal
Hypothyroidism is when the thyroid is underactive. The tests results are as follows:
- TSH is high
- Free T4 is low
- Free T3 is normal OR low
Hypothyroidism can also be caused by a problem with the pituitary gland. When this occurs TSH, free T4, and free T3 are all low.
An overactive thyroid with no symptoms is called subclinical hyperthyroidism. It occurs after giving excess thyroid hormone. Results of this condition are
- TSH is decreased
- Free T4 is normal
- Free T3 is normal
When there is excess thyroid hormone present the condition is known as hyperthyroidism. It is identified as
- TSH is low
- T4 is high OR normal
- Free T3 is high
A problem with the pituitary gland or receptors can also result in hyperthyroidism. These results will be as follows:
- TSH is high OR normal
- Free T4 is high
- Free T3 is high
Thyroid Antibody Tests
Thyroid antibody tests are good to see if there is an autoimmune thyroid condition present like Hashimoto’s and Grave’s disease. These tests include
- Thyroid peroxidase (TPO) antibodies
- Thyroglobulin antibody (TG) antibodies
- Thyroid-stimulating immunoglobulin (TSI) Antibodies
- Thyroid binding inhibitory immunoglobulin (TBII) Antibodies
Signs and Symptoms to Include in a Thyroid Panel
For a complete list, you can check out this post.
Thyroid Ultrasound Test
If your blood work looks normal but you still have some physical indications of thyroid issues you can get an ultrasound test. To see if there are any problems with your thyroid gland.
Intact Parathyroid Hormone (iPTH)
An intact parathyroid hormone (iPTH) test can tell why your calcium levels are imbalanced. It determines the following:
- What is making your calcium out of balance
- The parathyroid calcium imbalances
- The non-parathyroid calcium imbalances
- Parathyroid function
- Primary, secondary, and/or tertiary hyperparathyroidism
The iPTH test can tell how well treatment for a parathyroid-related condition is working.
Each iPTH test also checks calcium levels. This will give information on the following:
- Calcium levels in the blood
- Difference between calcium and parathyroid hormone (PTH) levels
- How parathyroid glands respond to changing calcium
Testing is done to find out if the imbalance between calcium and PTH is severe and needs attention. Or if it is ongoing and is due to an underlying condition.
What the Calcium and iPTH Test Results Mean
An iPTH test looks at both calcium and PTH levels. When the iPTH is between 10 and 65 pg/mL it is normal. When the kidneys are damaged the iPTH is above this number.
Having LOW calcium and HIGH PTH indicates the parathyroid gland is working but something is causing low calcium.
Possible reasons for low calcium include vitamin D, phosphorus, and magnesium.
Having LOW or NORMAL calcium along with LOW PTH means there can be dysfunction in the parathyroid gland and there is possibly hypothyroidism. See the possible causes here.
When BOTH calcium and PTH are HIGH there is hyperparathyroidism. With this condition, the parathyroid gland is not making enough PTH.
Dysfunction can be in primary, secondary, or tertiary glands of the parathyroid leading to primary, secondary, or tertiary hyperparathyroidism. Getting imaging and x-rays will determine the cause of this condition.
HIGH calcium and LOW PTH show the parathyroid gland works but something else is going on. Often a mutation in the calcium receptors or a tumor is to blame for these results.
Vitamin D testing needs to be done when you have CKD. Low levels of this nutrient are due to damaged kidneys that don’t work well.
A normal test shows levels to be above 20 ng/mL. Balance is important for this vitamin. Consequently, getting too much or too little is harmful and can result in toxicity when levels get above 100 ng/mL.
Some people with stage 5 kidney disease may need to supplement depending on test results. Make sure you ask your renal RD before taking any vitamins.
Magnesium is a mineral that is found in bones, cells, and tissue. It is needed for energy production and controls muscle and nerve function. The nutrient also helps build strong bones.
Magnesium is regulated by the kidneys. As CKD progresses the kidneys lose their ability to remove magnesium from the body. So during stage 5 kidney disease excess magnesium can occur. Too much magnesium also lowers calcium levels.
As a result, the magnesium test evaluates kidney function. Normal levels of magnesium are between 0.75 and 0.95 millimoles (mmol)/L.
Having low magnesium can lower calcium and potassium levels. That is why this test is used to know if there are any issues with potassium, calcium, phosphorus, and/or PTH.
Too much or too little magnesium causes changes in heart rate, nausea, anorexia, tiredness, muscle cramps, confusion, seizures, and numbness or tingling of the extremities.
Magnesium blood tests only measure what is released from bones and tissues. This is a result of the body trying to maintain stable levels of this nutrient. So a mineral deficiency could be occurring even where there are normal blood levels.
If you have any fluctuations in magnesium it could be due to a medication. Some drugs increase magnesium levels while others decrease them.
Lithium, aspirin, and thyroid medication will increase magnesium levels.
Medications that lower magnesium levels are digoxin, cyclosporine, diuretics, insulin, laxatives, and phenytoin. Some antibiotics will possibly increase or lower magnesium levels.
Nutrients to Monitor
To keep the kidneys functioning it is imperative to monitor certain nutrients during stage 5 kidney disease. They include the following:
Sodium is an important nutrient to monitor. Our bodies will lower fluid levels to balance sodium. Sodium levels will also tell if your fluids are regulated.
Normal sodium levels should be 135 and 145 milliequivalents/liter (mEq/L). Having less than 135 is too little sodium and you will be in a hyponatremic state. Sodium levels above 145 mEq/L show the body to be in hypernatremia with too much sodium in the blood.
High levels of sodium also occur due to dehydration. Alternatively, a test showing hypernatremia can be due to too much water intake before the blood test. Hyponatremia is also a result of edema and fluid retention.
If your sodium levels are out of range ask your renal RD what dietary changes can improve sodium balance.
Kidneys regulate calcium so monitoring this mineral will give you information on how you are managing your CKD. This can be done with a calcium blood test.
Calcium between between 8.5 and 10.5 mg/dL (4.3 to 5.3 mEq/L or 2.2 to 2.7 mmol/L) are normal. Lab ranges vary up to 0.5 mg/dL in either direction.
During stage 5 kidney disease calcium levels can get too high (hypercalcemia) and/or too low (hypocalcemia). When calcium gets out of whack they need to be continuously tested. Especially when people are getting therapy for problems with calcium, phosphorus, and/or PTH levels.
If you find you have calcium issues talk to your healthcare team about how to improve your levels.
Phosphorus is regulated by the kidneys. Weakened kidneys cause elevations of this mineral. As a result, continuous monitoring of phosphorus is necessary during CKD.
For those with stage 5 kidney disease, phosphorus levels should between 3.5 and 5.5 mg/dL.
If diet cannot maintain phosphorus levels, phosphate binders may be needed. Consequently, this medication can cause elevated calcium. So this medication should not be taken without medical supervision.
Healthy kidneys are needed to maintain normal potassium levels. Potassium levels that are too high or too low are very dangerous. The normal level runs between 3.5 and 5.0 mEq/L. There are three zones for potassium. They move from safe to dangerous and are as follows:
- Safe zone: 3.5 – 5.0 mEq/L
- Caution zone: 5.1- 6.0 mEq/L
- Danger zone: higher than 6.0 mEq/L
If your levels fall out of the safe zone you should get help from your renal RD on how to improve potassium immediately.
Iron is a mineral that needs to be constantly monitored in people with stage 5 kidney disease. This is because iron deficiency is very common in CKD.
Iron should be between 60 to 170 mcg/dL. If your levels deviate from this you could have anemia or hepatitis. It could also be due to a medication you are taking. Women with heavy menstrual periods will also have lower iron levels.
In addition, you should know that hemoglobin, ferritin, and transferrin saturation in the CBC panel will give a full picture of your iron status.
If your iron is out of range, talk with your healthcare team to find what could be the problem.
If you have a fluid restriction a renal RD can help you keep your fluid intake under control.
Do You Need Renal Vitamins in Stage 5 Kidney Disease?
Those with stage 5 kidney disease may have problems getting enough calories and nutrients from their diet due to restrictions and limitations that are needed to maintain kidney health. Another reason for poor nutrition is the lack of appetite that accompanies ESRD.
This gap in the diet should be filled with nutritional supplements and renal vitamins. There are specific products available for people with diabetes and/or kidney failure. They often come in the form of liquid drinks, shakes, juices, bars, soups, cookies, or puddings.
People who are on dialysis may also need supplements. These include
- Magnacal Renal
- Nepro with Carb Steady
- Novasource Renal
If you have diabetes and are on dialysis you may want to try products like
- Boost Glucose Control Beverage
- Glucerna shakes, cereals or bars
- Nutren Glytrol
- Resource No Sugar Added Health Shake
Those with a protein restriction can take protein-only supplements such as
- ProStat RC (Renal Care)
- Resource Beneprotein
You may also need a special renal multivitamin (MV). They contain nutrients like thiamin, riboflavin, pantothenic acid, niacin, pyridoxine, cyanocobalamin, folic acid, biotin, vitamin C, vitamin D, iron, zinc, selenium, and vitamin D.
Typical renal MV supplements include Renavite, ProRenal +D, and omega-3s. These MVs give enough nutrition without any A, E, and K vitamins. This is to avoid the large toxic doses that are found in regular over-the-counter MV.
Many supplements can be harmful to the kidneys so it is important to ask your renal RD about what supplements are suitable for your needs.
Stage 5 Kidney Disease Diet Foods to Avoid
The kidney failure diet may have more restrictions but it can be helpful to preserve remaining kidney function. Read on to learn what stage 5 kidney disease diet foods to avoid.
Avoid Sugary Foods and Drinks
Knowing that sugary foods and drinks elevate blood sugar, these foods should be avoided during stage 5 kidney disease to improve kidney function.
Added sugar is found in processed foods, drinks, and even some healthy foods. Juices have a lot of sugar and should be eliminated from the diet.
Simple sugars increase the risk of type 2 diabetes and provide no nutrition. The following foods should be avoided
- White bread
- White pasta
Artificial sweeteners are no better than regular sugar. They have been shown to increase sugar cravings.
Avoid High Sodium Foods
High sodium foods need to be avoided in those with stage 5 kidney disease. This can preserve kidney health, lower blood pressure, and prevent fluid imbalances.
High sodium foods to avoid include
- Table, sea, and garlic salt
- Soy sauce
- Bottled sauces like Teriyaki sauce
- Canned and dehydrated foods and soups
- Frozen dinners that are not listed as “low sodium”
- Processed meats like ham, bacon, hot dogs, sausage, and deli meats
- Take out, restaurant, and fast food
For a full list of foods high in sodium see this post.
Possibly Avoid Foods Fortified with Calcium
During stage 5 kidney disease if calcium levels are elevated, foods fortified with this nutrient will need to be eliminated from the diet.
Limit High Potassium Foods
Foods high in potassium need to be limited and possibly avoided during stage 5 kidney disease when potassium levels are high. They include vegetables, dairy, fruit, nuts, seeds, beverages, along with some grains, beans, and legumes.
Vegetables high in potassium include
- Brussels sprouts
- Sweet potatoes
- Bamboo Shoots
- Beets/beet greens
- Butternut Squash
- White Mushrooms
- Brussels Sprouts
- Chinese Cabbage
- Leafy greens (except Kale)
- Hubbard Squash
- Tomatoes/Tomato products
Dairy products high in potassium include
Fruits high in potassium include
- Figs, raisins, and other dried fruits
- Prunes/prune juice
Nuts and seeds high in potassium include
- Hemp seeds
- Squash and pumpkin seeds
- Flax seeds
- Brazil nuts
- Peanuts and peanut butter
- Sunflower seeds
- Pine nuts
Grains high in potassium include
- Bran/bran products
Beans and legumes high in potassium include
- Baked Beans
- Refried Beans
- Black beans
- Dried beans and peas
Beverages high in potassium include
- Vegetable Juices
- Coconut water
- Grapefruit juice
- Orange Juice
- Pomegranate Juice
In addition to the above groups, other foods high in potassium include
- Salt Substitutes
- Lite Salt
- Salt-Free Broth
- Snuff/Chewing Tobacco
A renal RD can help customize a diet that will meet your potassium needs.
Avoid High Phosphorus Foods
Damaged kidneys cannot excrete phosphorus. This means foods high in this mineral should be eliminated during stage 5 kidney disease.
Phosphorus is found in two forms organic and inorganic. Organic phosphorus occurs naturally, while inorganic phosphorus is added to foods during processing. Inorganic phosphorus works as a preservative.
Foods with naturally organic phosphorus include
- Cheese (especially hard cheeses)
- Dried beans
- Peanut Butter
- Game meats
- Whole eggs
- Cottage Cheese
- Leavened bread (rice, cereals, flatbreads)
Foods with inorganic phosphorus include
- Canned foods
- Canned drinks
- Processed meats
- Chocolate drinks
- Dark colas
- Canned iced teas
- Beverages with phosphate additives
- Pepper type soda (Dr., Pepper)
- Chocolate candy
- Oat bran
- Muffins/Pastries/baked goods
- Deli meats
- Hot dogs
- Caramel candies
- Ready to eat foods
- Non-dairy creamers
- Jarred sauces
- Energy drinks
- Flavored waters
- Deli meats
- Frozen meats (chicken nuggets, meal kits, etc)
- Seasoned marinated meats
- Processed cheeses
- Products containing aluminum phosphate baking powder
Learn how to spot phosphorus by reading food labels. If you see the word “PHOS” it most likely contains inorganic phosphorus. Some examples of phosphorus additives include
- Dicalcium phosphate
- Disodium phosphate
- Monosodium phosphate
- Phosphoric acid
- Sodium hexameta-phosphate
- Trisodium phosphate
- Sodium tripolyphosphate
- Tetrasodium pyrophosphate
For a specific no phosphorus diet you can ask your renal dietitian for a guide on what food and drinks to avoid.
Avoid Animal Sources of Protein
- Game meats
If you have protein limitations you also should avoid eating too much tofu, legumes, and beans. This is because these foods are very high in protein. Limiting these foods will also preserve kidney health.
If you need a low-protein diet your renal RD can give you ideas on how to meet your protein needs while still maintaining kidney health.
Avoid Refined Carbohydrates
- White bread
- Pizza dough
- White flour
- White rice
- Breakfast cereals
- Sugary beverages
If you have carbohydrate restrictions ask your dietitian how to meet your carbohydrate needs with a healthy diet.
Avoid Unhealthy Fatty Foods
Saturated and trans fats are unhealthy fats that should be eliminated from the diet. They are found following foods
- Fatty meats
- Full fat dairy
- Baked goods (cakes, cookies, pies)
- Fried foods
- Foods with “hydrogenated” oils
Alcohol and kidney disease are an explosive combination when done in excess. Drinking too much damages kidney function increases blood pressure, and leads to weight gain.
When it comes to stage 5 kidney disease, even just one drink may be toxic for your health. Avoiding alcohol altogether might be the right call to preserve kidney function.
Foods to Include in the Stage 5 Chronic Kidney Disease Diet
Like other phases of CKD, there is also a specific stage 5 kidney disease diet that should be followed. This kidney disease treatment diet includes
- Foods with low sodium
- Low potassium foods
- Low phosphorus foods
- Calcium foods that are low in phosphorus
- Adequate protein mainly from plant sources
- Complex carbs
- Healthy fat foods
We will also talk about food for dialysis patients that should be added to the diet.
Low Sodium Foods
Low sodium foods should be part of the low kidney function diet. It is necessary for preserving kidney health. It lowers blood pressure and the risk of cardiovascular disease.
Look for no and low-sodium foods. Some naturally contain little or no salt. Others are made as low and salt-free options.
Dry beans, fresh and dry herbs, whole grains, rice, fruit, and vegetables do not contain any sodium.
If you eat rice and pasta be sure to get ones with no added salt.
Frozen fruits and vegetables without added dressings or seasonings also are free of sodium.
Spices and herbs that are fresh have no salt. You can also get sodium-free dried versions of herbs and spices.
Snacks with no sodium include unsalted popcorn, unsalted pretzels, and unsalted tortilla or corn chips.
Vinegar and dry mustard are naturally sodium-free. If you use other salad dressings or sauces, it is best to make them yourself or buy only low sodium brands.
Fresh meat, eggs, poultry, fish, and natural cheeses don’t have any sodium. If you have deli meat make sure it is low in sodium unless you have a phosphorus restriction. In that case, it should be avoided completely.
Soup is ok if you make one with no sodium or you buy a low-sodium variety. The same goes for casseroles and canned foods.
Types of Food with Varying Sodium Levels
Processed foods tend to be higher in sodium so you want to look for foods that are either
- Reduced sodium
- Low sodium
- Very low sodium
- No Salt added
Reduced sodium foods that have 25% less sodium than the original product. There is still sodium but it is reduced when compared with the original food. These products can still have a lot of sodium per serving so be cautious of what you’re eating.
Low sodium foods will contain 140 mg or less of sodium per serving.
Foods that are labeled “very low sodium” will have 35 mg or less sodium per serving.
Foods with “no salt added” means that no salt has been added to the product. This does not include any sodium that is naturally occurring. So be sure to check the label for how much salt is in the product.
If salt is listed as the first few ingredients this means there is a lot of sodium in the food. This is is because ingredients are listed by how much they weigh
For more low sodium snack ideas check out this post.
Low Potassium Foods
The stage 5 kidney disease diet plan also includes low potassium foods.
There are many options of low potassium foods among fruits, vegetables, dairy, protein foods, grain, and beverages.
Low potassium vegetables include alfalfa sprouts asparagus, arugula, bamboo shoots, broccoli, carrots, cauliflower, celery, collard greens, cucumber, eggplant, green beans, kale, lettuce, mustard greens, onions, peas, peppers, radicchio, red cabbage, scallions, summer squash, zucchini, tomatillo, water chestnuts, and white mushrooms.
Fruits that are low in potassium are apples, applesauce, apricots, blueberries, cherries, cranberries, fruit cocktail, grapes, lemons, limes, mandarin oranges, pears, pineapple, plums, raspberries, rhubarb, strawberries, tangerine, watermelon, and tangerines.
Dairy products that are low in potassium are cottage cheese and eggs. Protein foods low in potassium are pecans, seitan, walnuts, tofu, and tuna.
Grains low in potassium include barley, brown rice, buckwheat, bulgar, plain oatmeal, pasta, popcorn, teff, whole wheat bread, and wild rice.
Beverages low in potassium are apple juice, coconut milk, coffee, cranberry juice, ginger ale, grape juice, lemonade, oat milk, pineapple juice, rice milk, and brewed tea.
Despite these foods being low in potassium, eating too many of them can add up to a lot of this nutrient. So be sure to watch your serving sizes.
In addition, protein foods and beverages may need to be limited if you have protein or fluid restrictions. Check with your renal RD about how to get enough potassium without going overboard.
Get a full list of low potassium foods in this post.
Low Phosphorus Foods
The best diet for kidney disease in stage 5 includes low phosphorus foods. Often during ESRD, the kidneys cannot filter phosphorus and it needs to be limited in the diet.
If you have phosphorus restrictions you need to incorporate more low phosphorus foods. These include foods from the vegetable, dairy, fruit, protein, and grain food groups. There are snacks and beverages also low in phosphorus.
Vegetables low in phosphorus are carrot sticks, cucumbers. Some fruits low in phosphorus are apples, berries, and grapes. For a whole list of low phosphorus fruits and vegetables see this post.
Dairy foods low in phosphorus are vegan cheeses, sherbert, cottage cheese, popsicles, and greek yogurt.
Protein foods low in phosphorus consist of both animal and plant varieties. Chicken, turkey, fish, beef, veal, eggs, lamb, and pork are animal proteins with low phosphorus. Plant proteins low in phosphorus are tofu, soybeans, tempeh edamame, nuts, seeds, beans, and legumes.
A list of grains low in phosphorus can be found in this post.
Unsalted pretzels, unsalted popcorn, unsalted crackers, pound cake, and sugar cookies are snacks low in phosphorus.
Be sure to limit your servings of these foods because too many of these foods can lead to elevated phosphorus. When in doubt ask your renal RD how you can keep your phosphorus intake low.
Calcium-Rich Foods (Low in Potassium and Phosphorus)
Anyone with stage 5 kidney disease and bone loss or low vitamin D levels need to make sure they get enough calcium.
The one thing to remember with calcium foods is you need to make sure they are also low in potassium and phosphorus.
If you have a lot of nutrient restrictions calcium needs can be met by adding foods like kale, arugula, tofu, and sardines to the diet.
Adequate Protein from Plant Protein Sources
As discussed earlier, the consumption of animal protein can lead to metabolic acidosis. To avoid this we encourage you to get most of your protein from plant sources.
The benefits of a plant-based diet will also improve heart health. This diet will be high in grains, fruits, vegetables, and healthy fats (learn more about these below).
If you decide to go vegan or vegetarian that can also reduce your risk of metabolic acidosis.
Don’t feel like you can give up meat? Instead of going cold turkey, try to scale back how much you are using. Learn how to stretch out your protein intake with these tips
- Slice meat thin and use it sparingly
- Use milk substitutes to fill up your soups, rice, and pasta dishes
- Don’t make meat the star of the show, move it to a side dish as a complement to vegetables
- Cut meat into small pieces and mix with a lot of vegetables
- Fill your plate with grains and veggies and just a little bit of meat
- Make a hearty salad and top with small pieces of egg or meat
- In a casserole increase the number of veggies and decrease the meat
- Use pasta and other low-protein foods in soups
- A small quantity of a strong cheese will enhance flavor
Ask your healthcare team about your protein needs and how to get adequate intake.
Complex Carbs and Foods High In Fiber
Diets for kidney failure need to include complex carbohydrates and high fiber foods. As we discussed earlier, refined carbs do nothing but hurt the kidneys. So it is important to amp up your fiber and complex carbohydrates intake.
This means more vegetables, fruits, and whole grains. These foods will lower blood sugar, blood pressure, and keep you full longer.
You should aim for at least 6 servings of whole grains a day. Some examples of whole grains include grain pasta, brown rice, barley, quinoa, millet, couscous, and amaranth. For a more comprehensive list of what grains to add to the diet see this post.
Healthy Fat Foods
Fat is an essential nutrient. Unfortunately, all fat is not created equal. This means you want to stick with only healthy fat foods. These include monounsaturated (MUFAs) and polyunsaturated (PUFAs).
These healthy fats will reduce cholesterol and heart disease risk. MUFAs can lower the “bad” LDL cholesterol. PUFA’s are made up of omega-6 and omega-3 fats. These cannot be made by the body and must come from the diet.
Oils, nuts, seeds, avocado, low-sodium olives, and fish are foods that provide healthy fats and can be added to the stage 5 kidney disease diet.
Oils include olive oil, avocado oil, sesame oil, and flaxseed oils. Some healthy nuts and seeds are chia, hemp hearts, flax, walnuts, pecans, macadamia nuts, and peanut butter. Mackerel, herring, and trout are fishes that provide healthy fat.
Some fats may also fall into the category of your dietary restrictions. So be sure to ask your renal RD about choosing good fats that will not make you sick.
Food for Dialysis Patients
Many people with ESRD are on dialysis. As a result, when we talk about stage 5 kidney disease we also want to discuss food for dialysis patients. Below is a condensed dialysis food list
- Low sodium foods
- High-quality protein
- Low or high potassium foods, depending on labs and the type of dialysis
- Low phosphorus foods
- Healthy fats
- Possibly limit fluids
Please note this is not standard for everyone. If you are on dialysis you should talk to your dialysis dietitian and healthcare team to find out your specific nutrient needs.
Stage 5 Renal Diet Menu Plan
The renal diet meal plan for stage 5 kidney disease can be easy once you have a blueprint for what to add to your diet. Below is a sample renal diet menu that will help maintain kidney function even in the end-stage of renal disease.
Breakfast: Applesauce & Raisin cauli-oats with a coconut milk tea latte
Snack: Apple with cinnamon-coconut yogurt dip
Lunch: Kale & veggie salad with gluten-free bread
Snack: Sliced carrots & bell peppers with creamy pesto dip
Dinner: Roasted Red Pepper Pasta with sauteed broccoli
Snack: Sauteed peaches with whipped topping
Kidney Disease Stage 5 Life Expectancy
How long can you live with end-stage kidney failure may depend on whether or not you need dialysis. During stage 5 kidney disease the kidneys have failed. Consequently, this means you may need dialysis treatments for the rest of your life unless you get a kidney transplant.
Life Expectancy on Dialysis
A big question for those with ESRD is how long can you live with stage 5 kidney failure with dialysis? Here are the deets.
Stage 5 kidney disease life expectancy on dialysis is typically about 5 to 10 years. Additionally, there have been people who have lived well on dialysis for up to 20 and 30 years.
However, life expectancy will vary depending on other medical health concerns. Diabetes or high blood pressure control, for example.
One study found 20 to 50 percent of people with ESRD who have had early dialysis treatment will die within 2 years.
Speak with your healthcare team can help you learn how to keep yourself healthy on dialysis.
Life Expectancy without Dialysis
There are many factors to determine life expectancy for those who choose to not have dialysis with stage 5 kidney disease. People with kidney failure who forgo dialysis may survive for only a few days or weeks if they have significant symptoms and choose palliative care.
When looking at conservative management, patients have been seen to have an average life expectancy of 6 – 30 months after the decision to not start dialysis or pursue further actions in managing their health.
However, the life expectancy for those that choose to stay proactive in their care and still not start dialysis has not had significant research. This is where working with a dietitian can be extremely helpful.
Our dietitians at Plant-Powered Kidneys have helped many people in stage 5 stay symptom-free and off of dialysis. You can click here to learn more about our team and work with us privately.
Chronic kidney disease (CKD) is a serious issue that starts with slight damage to the kidneys. It can progress to stage 5 kidney disease. Known as end-stage renal disease, ESRD, is the last stage of this condition. Over 85% of kidney function is gone by this time.
Dialysis or a kidney transplant is discussed at this time as an option for alleviating symptoms of end-stage kidney failure. Dialysis or transplant can help when significant symptoms occur and cannot be managed with diet, medications, and lifestyle changes. While this phase of CKD seems bleak there is still the ability to preserve even the minimal kidney function that remains.
Many people with stage 5 kidney disease choose to stay off of dialysis by following a low protein diet and using ketoanalogues. Working with a renal dietitian can be extremely helpful in providing specific diet guidelines and supplement support.
The way to do this is through managing underlying conditions like heart disease, diabetes, and imbalanced nutrient levels.
While medical interventions are important, nutrition and lifestyle changes seem to have the biggest impact on improving quality of life even during stage 5 kidney disease. Incorporating the help of a renal dietitian can improve nutritional status and prevent further kidney damage.