@bobcr welcome to Mayo Clinic Connect. When I was in your shoes and at your stage (stage 4) I self referred to a dietician. My CKD is due to diabetes and hypertension. It helps to know the causes of your CKD so that you can customize the treatment. In my case I was already following dietary plans for diabetes. When I found a dietician I was blessed to find one who was diabetic herself and she knew about renal nutrition. What I learned from her is as follows:
Protein is hard on kidneys, particularly red meat. I mainly stick to poultry, fish /seafood, some pork, eggs & cheese for my protein. I limit red meat. The dietician recommended the amount I should have based on my size (height & weight) and gender. I’m female. Men have more muscle and generally require more protein.
Salt / sodium. I limit this due to my history of hypertension. Some salt substitutes contain potassium which brings me to the next category of things to learn about.
Kidney function labs. These are calcium, phosphorus, potassium, sometimes oxalates and one other that I can’t recall at the moment. My nephrologist believes in “eating for the labs”. He monitors the above substances in my lab work and advises if changes need to be made. For example my calcium was getting too high and I needed to cut it back. I also have osteoporosis. I take a calcium supplement for that and needed to reduce the dose a bit for my kidneys. So you see it can get complicated, especially if you have co-morbidities. A lot of CKD patients have to watch potassium. Mine has been ok. But the dietician gave me lists of higher and lower potassium foods that has been helpful to refer to. There are other lists for the other substances too that can be helpful also.
Hydration. I asked both my nephrologist and the dietitian how much and what kind of fluids I should be consuming. The answer varies according to individual situations and differences. But your providers should be able to guide you.
This is a lot to take in. It is doable and so worth it. Your providers can help you prioritize where to start so you can break it down into smaller more manageable steps. That is what I did. In my case I was able to improve my CKD from stage 4 to stage 3. It didn’t happen overnight. It has been a long journey (a decade) but again is worth it!