Food plays an essential role in your child’s health. Not getting enough of the right foods can affect growth and development. It is important that your child eats a good balance of nutrition.

There are different nutritional needs depending on the stage of CKD.

Early CKD

Early CKD is often described as CKD stages 1-3a.

Most children in the earlier stages of CKD have kidneys that are still working well. Most children have a good appetite.

What is a healthy balanced diet?

In the early stages of CKD your child should follow a healthy balanced diet. This involves cooking with fresh ingredients, where possible.

Try to focus on reducing processed foods such as ready meals and pre-packaged foods. These can contain a lot of salt, unhealthy fats and phosphate additives.

A healthy diet should include:

Fruits, vegetables and fibre

For most people, a diet high in fibre is good for the heart. Looking after heart health is particularly important for people with a kidney condition.

Fibre comes from fruit, vegetables, wholegrains, and pulses (e.g. beans, and lentils). These foods also contain vitamins and minerals needed to keep your body healthy.

Your child should eat at least five portions of different fruits and vegetables per day. This advice applies to all stages of CKD.

The amount of fruit your child can hold in the palm of their hand is roughly one portion.

Probiotics and prebiotics

Studies have shown that people with kidney disease have more 'bad' and less ‘good’ gut bacteria. A healthy gut is related to better mental health, immunity, and heart health.

What you eat changes the balance of ‘good’ and ‘bad’ gut bacteria.

Foods containing fibre help to feed the ‘good’ bacteria. These are called ‘prebiotics’. Eating a variety of different fibre rich foods is best. These include: broccoli, garlic, onions, leeks, beans, lentils, apples, berries and wholegrain foods.

Some foods naturally contain ‘good’ bacteria. These are called ‘probiotics’.

Probiotics include:

● Cheeses (e.g. feta, cottage cheese, mozzarella, ricotta and blue cheese)

● Natural yoghurt and Kefir

● Fermented foods like kimchi, sauerkraut and tempeh

Starch carbohydrates

Our bodies need starchy-carbohydrates for energy. Bread, pasta, rice, noodles, pittas, potatoes are all starchy-carbohydrate foods. Choosing wholegrain varieties provides more fibre and vitamins.

Fluid

Your child should regularly drink non-sugary fluids to stay well and hydrated. Water is the ideal choice. Other options in moderation include milk and unsweetened squash.

Fats

There are different types of fats in our diet.

More detailed information can be found here: Facts about fat - NHS

It is recommended that we try to eat more ‘unsaturated fats’ such as those from oily fish, avocado, and nuts, and less trans fats which can be found in processed ready-made foods such as biscuits and cakes.

Protein

There are two types of protein: animal-based and plant-based.

Animal-based proteins include meat, fish, milk, cheese, yoghurt and eggs.

Plant-based proteins are found in beans, lentils, nuts, plant milks and yoghurts. This includes soya, coconut, oat, and almond.

Both animal and plant protein are important for good growth and to enable the body to heal after an injury. But studies now suggest more plant-based foods might be best for a person with kidney disease.

Processed and pre-prepared foods

A processed food is any food or drink that has been changed in some way during its preparation. This may be as simple as chopping, freezing, baking or canning foods. Therefore, not all processed foods are bad for you, and may not be that different from the original food.

Ultra processed foods (UPFs) are quite different from the original food. For example, a potato waffle is a UPF and is quite different from a fresh potato.

They often contain ingredients that you won’t normally find in your kitchen. These may be additives, preservatives, emulsifiers, sweeteners, colours and flavours.

Many UPFs are high in unhealthy fats, salt, and sugar, and low in fibre, vitamins and minerals. Eating lots of ultra processed foods is associated with poor health.

Phosphate

Phosphate is a natural mineral found in many healthy foods. Manufacturers sometimes add 'man-made' phosphate to food and drinks. This is to extend their shelf life, maintain colour and moisture, or enhance flavour.

This man-made phosphate is not healthy for our kidneys so try to limit it as much as possible. You can find it on the ingredients list with ‘phos’ in the word (e.g. see table below for examples of names or shown as an E number).

Salt

Salt increases blood pressure and the pressure on your kidneys.

There are lots of types of salt, such as table salt, Himalayan salt, and Kosher salt. These salts are all the same and no type holds any additional health benefits.

You may have seen some salts labelled as ‘low sodium’. We do not recommend these for patients with a kidney condition. This is because the sodium is often replaced with potassium. Some patients with CKD are not advised to have products with extra potassium added to them.

Children need very little salt. The easiest way to avoid giving your child too much salt is to cook most of their food from scratch.

More than 75% of the salt we eat comes from processed foods, pre-prepared foods and takeaways. A high salt food is one that contains more than 1.5g of salt per 100g. This information is always written on the back of the packet.

The following link has more information on salt and tools to help you find a healthier swap.

Reduce salt - Food facts - Healthier Families - NHS

Sugar

Sugar can be useful for those who have a poor appetite to make sure they get enough energy. It is also useful for those who do a lot of sport and are very active. However, most of us eat too much sugar.

There is more information on the recommended amount of sugar here: Sugar: the facts - NHS

Later stage CKD

This is often described as CKD stages 3b-5 and includes those on dialysis treatment.

Some children in the later stages of CKD have more symptoms. They also tend to have more nutritional problems including:

• not getting enough nutrition and/or poor growth
• too much waste product in the blood (urea)
• anaemia
• low vitamin D
• fluid overload
• imbalances of minerals in the blood

Not getting enough nutrition

Some children do not feel very hungry. They may also feel nauseated or vomit. Some children also feel full due to changes in the hunger hormones. This makes it difficult for them to eat enough nutrition, and they need extra help with this.

This could be prescribed nutrition drinks, vitamin supplements and in some cases, a feeding tube.

Nutritional supplements and vitamins

The dietitian may suggest a nutrition supplement drink if your child is not eating well. Your child may also need a kidney friendly multivitamin.

Do not start any drinks or vitamins without speaking to your kidney dietitian. These may not contain the right mix for your child.

Feeding devices

If your baby or child is unable to eat and drink enough, they may need the support of a feeding device.

This is often called tube feeding. It is different from oral feeding, which is by mouth.

Read more about feeding devices

Reduced growth

CKD may affect your child’s growth. It can be due to nutrition related reasons like poor appetite and vomiting. Sometimes even with good nutrition a child with a kidney disease may still struggle to grow. This can be due to hormonal reasons.

If this is the case for your child, they may be referred to a paediatric endocrinologist. This is a doctor who specialises in growth hormones. Some children with later stage CKD may need a growth hormone injection. Your kidney team will provide you more details if needed.

High blood urea

During the late stages of CKD, the kidneys are less able to get rid of waste products (including urea) from the body into the urine. High blood urea levels can cause taste changes, nausea, reduced appetite and tiredness.

There are a few reasons for high levels of urea in the blood, including:

• Not enough fluid
• Too few energy-rich foods
• Too many protein-rich foods

Your doctor will tell you how much your child should be drinking.

Your dietitian will support you if you need to make changes to your child’s diet.

Anaemia

There are different types of anaemia.

We cannot treat anaemia related to CKD by dietary changes alone. Your child’s doctor may prescribe folate and/or iron supplements. Some children need an injection called erythropoietin (EPO) or darbepoetin.

Low vitamin D

We get most of our vitamin D from sunlight on the skin. It is also found in some foods such as oily fish, eggs and breakfast cereal and yoghurts that have added vitamin D.

The kidneys convert vitamin D into a different form that the body can use, but in CKD this is more difficult. Your child's doctor will prescribe the right vitamin D for them.

Fluid overload

Sometimes as kidney disease progresses, urine output can reduce, and your child may be advised to limit how much they drink in a day. This can be difficult. Your dietitian will be able to support you with tips for managing this.

Imbalances of minerals: Phosphate

In the later stages of CKD the kidneys become less able to remove any extra phosphate the body doesn’t need. If blood phosphate remains high over a long period of time, this can affect bone and heart health.

Your child’s dietitian will help you to adjust their diet to reduce the blood phosphate. Your child's doctor may prescribe a phosphate binder. This medicine binds to the phosphate within the food and stops it from being absorbed into the blood.

Imbalances of minerals: Potassium

In later stages of CKD the kidneys may become less able to remove any extra potassium the body does not need. This can lead to high levels of potassium in your child’s bloodstream, which can lead to abnormal heart rhythms.

Your child’s dietitian will help you to adjust their diet to reduce the blood potassium. They can help you adapt your normal family recipes. Only reduce the high potassium foods if your kidney team advises you to.

Summary

Food plays an essential part in your child’s kidney health. In the earlier stages of CKD it is important to aim for a healthy balanced diet. As your child's kidney disease progresses, they may have more nutritional issues. Your dietitian will help you through any nutritional challenges that may arise. Not all people with a kidney condition experience the same problems. Your child’s kidney team will adapt their treatment to suit their needs.

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