Sample Menus for Chronic Kidney Disease Patients

Jane H. Greene

MEAL PLANNING

No matter what stage of kidney disease, planning meals to meet nutritional requirements, prevent malnutrition, and maintain acceptable blood chemistries, blood pressure, and fluid status is a daunting task for any patient.

Most renal dietitians use the average calorie, protein, sodium, potassium, and phosphorus content for the food groups lists developed by the Renal Dietitians dietetic practice group of the American Dietetic Association when calculating a meal plan for a patient with chronic kidney disease (CKD). Steps involved to calculate a meal plan for any patient are as follows:

Determine the nutrition prescription.
Determine amount of high biological value (HBV) protein needed.
Determine the number of meat and milk choices needed to supply the HBV protein.
Distribute the remainder of protein between starch, milk substitute, fruit, and vegetable choices.
Provide for the remainder of caloric requirements with fat and high calorie choices (foods high in carbohydrates that contain only a trace of protein and minimal electrolytes).
Total each nutrient and adjust the diet to meet the previously established nutrition prescription.

The following sample menus and meal planning suggestions are a starting point for the health care team to assist patients and their caregivers. Each example will be based on the nutritional requirements of a 70-kg patient, using the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for the nutrition prescription.

CHRONIC KIDNEY DISEASE STAGES 3 AND 4

Nutrition Prescription: 0.6 g protein/kg body weight (42 g) and 30 calories/kg (2100 calories) < 2400 mg sodium, 800 mg phosphorus, < 2400 mg potassium.

Goals/Outcomes: prevent malnutrition, slow progression of kidney disease, decrease nitrogenous waste products, and prevent symptoms of uremia.

Meal Plan: 4 oz meat or meat substitute, 1 milk substitute, 5 starches, 3 vegetables, 1 fruit, 15 fats, and 4 high-calorie choices.

Day 1:
Breakfast:	½ cup liquid nondairy creamer, 1 cup Fruit Loops cereal, 1 medium powdered sugar donut, 1 cup Tang Breakfast drink,1 cup coffee with cream and sugar
Lunch:	Chicken salad on croissant (2 oz cooked chicken, 1 Tb mayonnaise, ½ tsp dried tarragon, 2 Tb chopped celery), wedge of iceberg lettuce with 1 Tb Catalina dressing, poached pear with 1 Tb brown sugar, 1/4 tsp nutmeg, 12 oz lemon-lime soda
Dinner:	2 oz fish and 2 hushpuppies fried in ½ cup olive oil, ½ cup green beans seasoned with onion, ½ cup coleslaw with 1 Tb mayonnaise, 12 oz lemonade
Snacks:	Fruit-flavored Popsicle and 8 oz cranberry juice cocktail
Nutritional Analysis: 2140 calories, 42.5 g protein, 1979 mg sodium, 803 mg phosphorus, and 1535 mg potassium.

Day 2:
Breakfast:	½ cup liquid nondairy creamer, ½ cup cream of wheat cereal, 1 Tb granulated sugar, 1 Tb unsalted tub margarine, 1 tsp cinnamon, 1 slice white bread, toasted and buttered, ½ cup red raspberries, 8 oz hot tea with 1 Tb honey
Lunch:	Chef’s salad (approximately 2 cups): 1 cup red leaf lettuce, 2 Tb chopped red and yellow pepper, 2 Tb grated carrot, 2 Tb diced celery, ½ cup cucumber slices, 4 cherry tomatoes, 1 boiled egg, diced, 3 Tb ranch dressing; 8 club crackers, 12 oz orange-flavored drink mix with sugar, ½ cup canned peaches
Dinner:	3 oz grilled pork tenderloin with rosemary and thyme, 1 cup fresh lemon rice, 6 small asparagus spears sautéed in 1 Tb olive oil, 12 oz sugar sweetened iced tea, 1 cup fruit sorbet
Snacks:	2 oz package Skittles, 1 Fruit Roll-Ups
Nutritional Analysis: 2122 calories, 41.8 gm protein, 1855 mg sodium, 1909 mg potassium, and 784 mg phosphorus.