Renal diet for vegetarians: What about protein?

I have end-stage kidney disease but I’m not on dialysis. I follow a special renal diet and I’m a vegetarian. What are good sources of protein for someone like me who must also limit phosphorus and potassium?

Answer From Rachael Majorowicz, R.D.N., L.D.

The answer depends on what type of vegetarian you are. It also depends on your level of kidney function and how much you need to limit nutrients such as protein, phosphorus and potassium.

A kidney diet, also called a renal diet, is a key part of any treatment plan for chronic kidney disease. Today’s kidney diets let vegetarians enjoy more foods than ever. Those foods include fruits, vegetables and plant proteins such as whole grains. But there’s no one eating plan that works for every vegetarian with chronic kidney disease.

If you can, meet with a registered dietitian who’s been trained to help people with kidney disease. The dietitian can help you choose vegetarian foods in the right amounts. Medicare and certain other health insurance plans cover meetings with dietitians. Check with your health plan to make sure.

In general, a kidney diet limits protein, especially if you’re not on dialysis. Too much protein can cause damage to the kidneys. But you still need to eat some protein every day. Talk with a dietitian about your specific protein needs.

Here are some examples of foods that have plant-based proteins and might work for you:

• Soy products such as tofu, tempeh, seitan, and soy milk or yogurt.
• Eggs or egg whites.
• No-salt-added canned or cooked dried beans and peas.
• Unsalted peanuts, nuts, seeds and nut butters.
• Whole grains such as barley, bulgur, brown rice and whole-wheat bread.
• Dairy products such as milk, yogurt, kefir and cheese.
• Milk substitutes such as almond, rice, or oat milks or yogurts.

Limiting potassium and phosphorus

When the kidneys work right, they prevent too much potassium and phosphorus from building up in the blood. But with kidney disease, the kidneys may have trouble keeping these nutrients at healthy levels. So you might need to limit foods or drinks that have lots of potassium or phosphorous if your body’s level of either nutrient is too high.

Here’s some basic information on key nutrients to be aware of in a vegetarian kidney diet:

• Protein. High-quality protein sources for vegetarians include lentils, seeds, tofu and whole grains. Follow your dietitian’s or healthcare professional’s recommendations on protein choices and amounts.
• Phosphorus. If your body’s phosphorus level is high, it may help to take in fewer foods and drinks that have phosphorus added to them. Phosphorus is added to highly processed items such as soft drinks, frozen food, snacks and processed cheeses. Dairy foods also are a source of phosphorus in a typical diet. If needed, you can replace dairy products with rice, almond or soy versions that haven’t been enriched. Many nondairy plant-based milks and yogurt are enriched with phosphorus-containing additives, so read ingredient lists carefully.

• Potassium. If your potassium level is high, it’s helpful to work with a dietitian to spot sources of potassium within your diet. Just like phosphorus, potassium that is added to foods is better absorbed than is the potassium found in fruits and vegetables naturally. A dietitian can help prevent high potassium by focusing on other factors that can cause potassium in your blood to be high. This includes controlling diabetes, preventing constipation and spotting sources of potassium additives in your diet.

  Cooking foods in water, pressure cooking or cooking in the microwave can lower the potassium levels in foods. Be aware that many low-sodium foods contain added potassium chloride. So read labels carefully.

• Sodium. Limit sodium. Cut back on the salt you add during cooking and at the table. Also be sure to check food labels and choose the lower sodium items. Low sodium foods have no more than 140 milligrams of sodium per serving. Many ready-to-eat foods, vegan meats, and soy- and rice-based cheeses are high in sodium. Choose no-salt-added canned beans if using.

A registered dietitian can help you meet your needs for calories and other important nutrients.