Lack of Diet Awareness in Kidney Disease Patients: Potential Risks and Practical Solutions

One of the key factors in managing chronic kidney disease (CKD) is often overlooked: diet. While medications and medical monitoring play an important role, nutrition is the foundation for slowing disease progression, preventing dangerous complications, and improving quality of life.

In fact, many kidney failure patients still eat according to old habits, not knowing that seemingly healthy foods - such as bananas, sweet potatoes, and sea fish - can be harmful if potassium and phosphate levels are not controlled.

An alarming situation

According to statistics from the American Society of Nephrology (ASN), up to 70% of stage 3–4 CKD patients do not receive adequate nutrition counseling. In Vietnam, an internal survey at a number of provincial hospitals showed that only 1 in 5 kidney failure patients met with a nutritionist before starting treatment.

A doctor shared:

“I once treated a patient with stage 3 kidney failure, but his condition deteriorated rapidly because he ate too many foods rich in potassium and phosphate without knowing it. Nutritional education for kidney patients is still very limited.”

Dangerous complications from incorrect diet

When the kidney function is impaired, the ability to excrete electrolytes such as potassium and phosphate is affected. If not controlled through diet, the patient may experience serious complications.

Hyperkalemia is one of the most common complications, often occurring when patients eat too many potassium-rich foods such as bananas, sweet potatoes, coconut water or tomatoes. When the potassium concentration in the blood exceeds 5.5 mmol/L, the risk of arrhythmia and cardiac arrest increases. A 58-year-old female patient in Hanoi was hospitalized for arrhythmia after eating 3 bananas a day for two weeks. Tests showed that her blood potassium was up to 6.8 mmol/L - a dangerous level that can cause death if not treated promptly.

Hyperphosphatemia is also a common complication, especially in patients who eat a lot of sea fish, organs, milk and processed products. When phosphate accumulates in the blood, patients can experience severe itching, bone damage, and calcification of blood vessels - increasing the risk of stroke and cardiovascular disease.

In addition, eating too much animal protein also causes high blood urea levels, causing fatigue, nausea and even coma if not controlled.

Why are patients not fully advised?

There are many reasons for this situation. First of all, the health system in many places still lacks specialized nutritionists in nephrology. Short examination times make it difficult for doctors to give detailed advice on diet. In addition, many patients are not aware of the role of nutrition in treatment, and there are no easy-to-understand instructions to apply in daily life.

How to build a suitable menu for people with kidney disease

Here are some basic principles when building a diet for people with kidney failure:

First, it is necessary to reduce foods rich in potassium. Patients should limit foods such as bananas, sweet potatoes, coconut water, tomatoes and dark green vegetables. Instead, you can use apples, pears, watermelon, pumpkin or cabbage. A useful tip is to boil vegetables and then drain the water to significantly reduce the amount of potassium.

Second, it is necessary to reduce phosphate in the diet. Patients should avoid organs, sea fish, milk, cheese and carbonated soft drinks. Instead, you can use lean meat, eggs or plant milk without added phosphate. It is very important to read food labels carefully to avoid additives containing "phos".

Third, controlling protein intake is essential. Depending on the stage of the disease, the doctor will prescribe the appropriate amount of protein. Priority should be given to high-quality protein such as chicken, fish, eggs, and divided into small meals to avoid putting pressure on the kidneys.

The role of nutritionists

Nutritionists not only help build a suitable menu, but also clearly explain the food groups to avoid, guide how to prepare to reduce electrolytes, monitor weight and biochemical indexes to adjust the diet periodically. They can also personalize the menu according to the preferences and economic conditions of each patient, helping to increase compliance and treatment effectiveness.

Monitor electrolyte levels through testing

For effective control, patients need to periodically test indicators such as blood potassium (should be maintained between 3.5–5.0 mmol/L), blood phosphate (should be below 4.5 mg/dL), urea, creatinine and eGFR to assess kidney filtration function. In addition, calcium and parathyroid hormone (PTH) tests also help monitor bone complications due to phosphate disorders.

Solutions to overcome and limit the situation

To improve awareness and nutritional practices for kidney patients, it is necessary to integrate nutritional counseling into the medical examination process, train nutritionists specializing in nephrology, develop easy-to-understand, visually illustrated instruction materials, apply technology such as food tracking apps and test reminders, and organize regular nutrition classes for patients and their families.

Conclusion

Nutrition is not a sideline – it is a pillar in kidney disease treatment. Raising awareness, providing the right knowledge and supporting effective practices will help patients live healthier, longer and avoid dangerous complications.

If you or a loved one is being treated for kidney disease, be proactive in asking your doctor about your diet, requesting nutrition counseling, and monitoring your electrolyte levels regularly. Kidney health starts with the right meals every day.