Stage 3 chronic kidney disease (CKD): What specialists do I see?

Kamama94. As usual, job well done, Kamama. While I understand these are tough times generally for everyone, I'm having a particularly difficult time buying food from major grocery stores in my area. Although extremely high risk, I cannot avoid grocery shopping in person. When I tried delivery or pickup services, I frequently received fresh food on the brink of spoilage. Once, I was sent an out-of-date turkey breast. Also, many items on my list are frequently "out-of-stock," although I've no way of knowing that until I have received my order. So, with my limited diet, trying to cook for my husband, and arthritic fingers, I'm looking for suggestions on how to procure food. Does anyone know of a meal delivery service whose meals include diabetic/kidney friendly choices?

Kamama94. As usual, job well done, Kamama. While I understand these are tough times generally for everyone, I'm having a particularly difficult time buying food from major grocery stores in my area. Although extremely high risk, I cannot avoid grocery shopping in person. When I tried delivery or pickup services, I frequently received fresh food on the brink of spoilage. Once, I was sent an out-of-date turkey breast. Also, many items on my list are frequently "out-of-stock," although I've no way of knowing that until I have received my order. So, with my limited diet, trying to cook for my husband, and arthritic fingers, I'm looking for suggestions on how to procure food. Does anyone know of a meal delivery service whose meals include diabetic/kidney friendly choices?

Welcome, @gladiator14! These are great groups. Like you, I had little dietary guidance even after seeing a neph so, like you, had to do some research on my own. Below is an excerpt from a recipe collection I gathered for renal patients citing NIH and ADA guidelines. This is not medical advice in any way, it's just what I was able to find out at the time and may no longer be the norm.

Two and a half years ago this home cook received the devastating news that one kidney had atrophied and there remained about 27% function in the other.
One of the first considerations that came to mind was diet. The result of researching kidney-friendly foods was a collection of recipes for kidney patients, DIABETIC AND RENAL FRIENDLY VEGETARIAN-ALMOST-VEGAN RECIPES with approximate nutrient values for each dish.

For several reasons, it might be wise to recheck values given there, valid at time of writing but perhaps no longer accurate.

First, nutrient amounts in that collection as well as in YES are approximate values; recipes calling for such ingredients and nutrient totals are suggestions only.
Second, since permission to include some companies’ brand names has not been obtained, generic descriptions of certain products have been given. When shopping for those items, comparing product label information to the nutritional values appearing here is strongly recommended.
Third, cooking sometimes modifies nutritional totals, some of which are increased while others decrease. Also, many USDA values are for raw foods, others are for cooked servings. Fourth, rinsing, draining then soaking and again rinsing and draining (and, if
possible, parboiling, rinsing and draining) can reduce some phosphorus, up to 40% (perhaps more) of the potassium, 33-89% sodium, depending on the product. Fifth, manufacturers sometimes change ingredients or amounts which then alters
values from what one previously might have read on product packages. Sixth, food producers are not required to list phosphorus content on labels and
most do not. (However, while some do not assay phosphorus, others do know how much a food has and usually will share that information with the consumer when asked.) Seventh, one brand of a product may contain different nutritional values from those in another similar, brand. Hy-Vee® store brands are among the preferred ingredients here but other brands can be substituted as long as recipe nutrient values are adjusted accordingly.

So, it behooves a CKD shopper to read labels, perhaps every time an item is purchased.

The NIH and the USDA are credible sources for nutrient values. It’s worth noting, however, that the USDA’s Global Branded Food Products Database includes values for some nutrients in branded and private label foods that appear on brand name product labels themselves, which are provided from the food producer’s own data.

Some USDA nutrient figures, including but not restricted to those confirmed by the manufacturers themselves, might lead the researcher to conclude that at
least a few common dietary recommendations/restrictions for renal patients in the past can be questioned, depending on type and stage of the disease process. Recommended amounts of nutrients, particularly protein and minerals such as phosphorus, potassium, and sodium, vary according to disease status/progression and vary according to whether a person is pre-dialysis or receiving dialysis; amounts recommended also vary from expert to expert.

Daily values for pre-dialysis stages 1-3 CKD recommended by the NIH are 800 to 1200 mg phosphorus, 1500 to 2700 mg potassium, 2000 to 3000 mg sodium, and 0.36 grams of protein per pound of body weight.

Phosphorus is a necessary part of any healthy diet but for CKD patients too much can cause itching, dry skin, bone density loss, and more. Some experts call for limiting phosphorus to 1,000 mg per day while others suggest 700-800 mg or less daily and still others say 500 mg is the best target amount.

Recommended potassium intake varies from group to group, too. At stage3b CKD, some dietitians or nephrologists limit potassium to 1500-<2000 mg daily.

The American Heart Association suggests using far less sodium,1500 mg or 1.5 grams a day instead of the common 2-gram daily restriction of the recent past. (Before deciding how much or how little sodium one should consume each day, it would be wise to consult one’s care team regarding sodium intake.)

Most experts favor less protein for persons with CKD (than the larger amounts healthier people can process,) sometimes 35 grams daily, perhaps lower.

Sources/Resources

American Diabetes Association
American Heart Association
Adventist Health Studies
American Journal Of Clinical Nutrition
American Kidney Fund
Cleveland Clinic
Daiya Foods
FDA
Follow Your Heart®
Go Veggie®
Hy-Vee® Stores, Inc/Hy-Vee® brands
La Preferida®
Mayo Clinic Community Support Groups
National Kidney Foundation
NIH
nutritiondata.self.com
Tofutti® Brands, Inc
University of Chicago
USDA

If you can, get your nephrologist to refer you to a renal dietitian. Also, if you're interested, my research and recipes are available in pdf format free of charge and I can post them to you here whenever you like.

Again, welcome to the group. Hope and love live here.

@trishanna, As a high risk individual, I have found a way to shop for groceries that is working well for me. I schedule my grocery pick-up for 8am (earliest one) and that order is for my heavy, stable products. I go early for my pickup when the store opens at 7am and pick out my veggies, fruits, meats etc. The store is almost empty, it is easy in/easy out before I drive around the building to get my pick-up order.

By any chance would you happen to have Whole Foods in your area? If yes, they will select and deliver your food. If you do not have Whole Foods perhaps an equivalent type of market that sells and delivers wholesome foods. Organic foods would be a big win.

@trishanna, a lot depends on which stores are available in a person's area. I can't name names other than my own Hy-Vee but there are three others in my town which do deliveries.

One is slightly more expensive than the so-called high-volume stores and I pay a few pennies more per item from my own store than I would a "cheaper" store. On a fixed income I have to adjust other expenses as a result but I'm willing to do that and glad I can.

One of the stores here I wouldn't buy anything from if I was starving. One time I ordered zucchini and they sent cucumbers and they sent terrible produce the rest of the time.

I eat no meat whatsoever so no issues there and I bake my own bread or buy white bread with no phosphates listed so no issues there. But until I found the right store for me I really struggled so I can relate to your difficulties.

If there's not a store in your area which can deliver good quality whole foods, pre-made meals certainly are an option. A friend is diabetic with cardiovascular issues, though no renal disease yet, and subscribes to a frozen-ingrdient dinner service on a diabetic plan and has lost 40 pounds and is now off all but one diabetic meds and has been able to go off a blood pressure med and a heart med. I just emailed my friend and asked for the name of the company he uses. It's BistroMD. http://www.bistromd.com. I think it's fairly expensive so he only uses one of the meals each day and "fills in" with oatmeal or cereal for breakfast and sandwiches and fruit for lunch.

@kamama94 Thanks so much for your help. I'm impressed by your friend's progress - good for him!! I shall check out bistromd immediately. Dinner is my main problem, and of course I have some menus that work, so I just need some help. Ha! Doctors are impressed with my weight loss, but it comes from not eating, period!!!

Wonder how you feel about vitamin/mineral supplements. I am very aware of doctors' opinions, but it's not always possible to get one's vitamin needs totally from our food, I think.

Hope your numbers are improving. Don't want you to have to go to dialysis!! You've worked so hard yourself and done so much to help others - keeping you in our thoughts.

Thank you so much, Kamama94. Your information is very helpful. I had found some of the recipes in YES but now find I cant relocate it. Are you able to provide a link for me for the recipe sites you mention. I did find a site tasty healthy heart recipes that has low sodium dishes of many types with nutrition facts that may be helpful to others. I would love your opinion of the site. Again, thank you for your response.

@gladiator14, oops, just posted those docs to trishanna instead of you. Sorry, just woke up from a nap. Here they are.