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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Eating well with kidney disease and type 1 diabetes

This supports your care team; it never replaces it

Your nephrologist, diabetes team and renal dietitian set your real targets for potassium, phosphorus, sodium, protein, fluid and blood glucose from your own blood tests, urine output, medicines and insulin plan, and they change them as your labs change. KDIGO asks for renal dietitians to tailor these "to their individual needs" (KDIGO 2024, practice point 3.3.2). Nothing here changes an insulin dose. A food marked "avoid" can be fine for someone whose potassium is normal; a food marked "eat" can be wrong for someone on a fluid limit.

In short

Kidneys that are failing lose the ability to get rid of potassium, phosphorus, sodium, the waste from protein and, late on, water. The kidney diet keeps those five in a range your kidneys can still handle. The sixth number, carbohydrate, keeps doing what it always did in type 1 diabetes: it decides the insulin dose.

  • Portions, not bans. Most kidney-diet problems are size problems: ½ cup of fruit or vegetables, 3 oz of meat (a deck of cards), 1 oz of cheese. "A large amount of a low-potassium food can easily turn it into a high-potassium food" (NKF).
  • Fresh over packaged. More than 70 % of sodium comes from packaged and restaurant food, not the salt shaker (FDA), and the phosphate additives in processed food are absorbed almost completely while natural phosphorus is not (Kalantar-Zadeh 2010; Noori 2010).
  • Read the ingredient list for "PHOS" and "potassium chloride". Phosphorus is not required on the Nutrition Facts label (NKF; NKF label guide).
  • A low blood glucose is always treated first. Use glucose tablets or apple or cranberry juice when there is a choice, but if orange juice or cola is what is within reach, drink the measured 4 oz now, recheck in 15 minutes and log it. One rescue portion is a budgeting note; an untreated low is an emergency (ADA 2026 §5; ADA 2026 §6). See Treating a low.
  • Star fruit is never allowed at any stage of kidney disease (de Oliveira 2015; NKF).
  • Protein goes up, not down, when dialysis starts (to 1.0–1.2 g per kg), and fluid becomes limited (KDOQI 2020; KDIGO 2022).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

These are the app's starting targets ("Suggest targets" in your profile), worked out for an example adult of 70 kg. The app does the same sums for your own weight and height.

Stage Protein per kg (for 70 kg) Potassium mg ¹ Phosphorus mg ² Sodium mg Fluid mL Energy per kg (for 70 kg) Calcium mg ³
G1–G2 0.8–1.0 g/kg (56–70 g) ≤ 4,000 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G3a 0.8 g/kg (about 56 g) ≤ 4,000 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G3b 0.8 g/kg (about 56 g) ≤ 3,500 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G4 0.8 g/kg (about 56 g) ≤ 3,000 ≤ 1,000 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
G5, no dialysis 0.8 g/kg (about 56 g) ≤ 2,500 ≤ 900 < 2,000 no set limit 30 kcal/kg (about 2,100 kcal) ≤ 1,000
Hemodialysis 1.0–1.2 g/kg (70–84 g) ≤ 2,500 ≤ 1,000 < 2,000 1,500 ⁴ 30 kcal/kg (about 2,100 kcal) ≤ 1,000
Peritoneal dialysis 1.0–1.2 g/kg (70–84 g) ≤ 3,500 ≤ 1,000 < 2,000 2,000 ⁴ 30 kcal/kg (about 2,100 kcal) ≤ 1,000

¹ A review ceiling, not a prescription: only restrict potassium if your blood potassium is high; your care team sets the number. ² Used when blood phosphate runs high; phosphate additives count most (see the Phosphorus page). ³ Total from food, supplements and calcium-based binders. ⁴ Hemodialysis: 1,000 mL plus your measured urine output (1,500 mL assumes about 500 mL of urine). Peritoneal dialysis: set from your urine output and ultrafiltration.

Protein: with diabetes, never below 0.8 g/kg before dialysis (ADA 2026 Rec 11.3; KDIGO 2022 and 2024). Without diabetes, KDOQI 2020 allows 0.6–0.8 g/kg only under close clinical supervision. "Per kg" means per kg of a reference weight your team chooses; the 70 kg column is an example. Energy: KDOQI 2020 gives 25–35 kcal/kg; on peritoneal dialysis subtract the calories absorbed from the dialysis fluid (often 400 or more a day).

For a 70 kg adult with diabetes that means about 56 g of protein a day before dialysis (0.8 g/kg) and 70–84 g on dialysis, with 1,750–2,450 kcal of energy (25–35 kcal/kg) (KDOQI 2020; KDIGO 2024; ADA 2026 §11).

The guideline ranges behind these numbers (for you and your team)

The guidelines set one range for "CKD 3–5 not on dialysis" and another for dialysis; what changes with stage is how likely a limit is to be needed, which the labs decide (KDOQI 2020; KDIGO 2024). Potassium and phosphorus have no guideline milligram number: KDOQI says to adjust intake "to maintain serum potassium within the normal range" (6.4.1) and to keep serum phosphate normal (6.3.1). The figures below are the ranges renal dietitians use once a limit is ordered. "Per kg" means per kg of a reference weight your team chooses (KDOQI 2020 1.1.6).

Per day (adult) CKD 1–2 CKD 3a–4, no dialysis CKD 5, no dialysis Hemodialysis Peritoneal dialysis
Protein g/kg 0.8 (RDA); avoid > 1.3 (KDIGO 2024) 0.8 with diabetes: KDIGO 2024 Rec 3.3.1.1 (2C), KDIGO 2022 Rec 3.1.1, ADA 2026 Rec 11.3 (A), which says going below 0.8 "is not recommended" with diabetes. KDOQI 2020 3.0.2 allows 0.6–0.8 only "under close clinical supervision" (opinion) (KDOQI 2020; KDIGO 2022; ADA 2026 §11) as 3a–4 1.0–1.2 (KDOQI 2020 3.0.3–3.0.4; ADA 2026 Rec 11.3, B) 1.0–1.2, often the upper end (KDIGO 2022)
Energy kcal/kg 25–35 25–35 (KDOQI 2020 3.1.1, 1C) 25–35 25–35 25–35 minus about 400+ kcal absorbed from dialysis fluid (DaVita)
Sodium mg < 2,000–2,300 < 2,000 (KDIGO 2024 Rec 3.3.2.1, 2C); < 2,300 (KDOQI 6.5.1, 1B; NIDDK; ADA) (NIDDK) < 2,000–2,300 < 2,000–2,300 (NKF hemodialysis < 2,300) (NKF) < 2,000–2,300 by guideline; PD programs often allow 3,000–4,000 (DaVita)
Potassium mg > 4,000 (no limit) (AKF) No limit unless blood potassium is high; K/DOQI 2004 range 2,000–4,000; when limited 2,000–3,000 (AKF: aim for 2,500, no more than 3,000) (AKF; DaVita) < 3,000 (NEJM 2017); 2,000–3,000 when limited (AKF) 2,000–3,000 (expert opinion 2,700–3,000) (AKF; DaVita) 3,000–4,000 "liberal" (DaVita; AKF)
Phosphorus mg Informational Keep blood phosphate normal; 800–1,000 when phosphate > 4.6 mg/dL (K/DOQI 2003 4.1, opinion); avoid additives above all (K/DOQI 2003; KDIGO 2017) 800–1,000 when phosphate > 5.5 mg/dL (evidence) (K/DOQI 2003) 800–1,000 "adjusted for protein needs", with binders at meals (K/DOQI 2003; NKF) 800–1,000 adjusted for protein, with binders (K/DOQI 2003; DaVita)
Calcium mg (food + supplements + calcium binders) about 1,000 800–1,000 if not on active vitamin D (KDOQI 6.2.1, 2B) Avoid high calcium (6.2.2) As CKD 5; limit calcium binders (KDIGO 2017 4.1.6) (KDIGO 2017) As CKD 5
Fluid mL No limit No routine limit; set for you if you have swelling (AKF) Set for you (AKF) 1,000 mL + your 24-hour urine (AKF; DaVita); NKF 1–2 L (NKF) 2–3 L, set for you (DaVita)
Carbohydrate From your diabetes plan: 1 carb choice = 15 g; typically 3–6 choices per meal and 1–3 per snack, set by your dietitian (NKF); fiber ≥ 14 g per 1,000 kcal (ADA 2026 §5) same same same same, counting dialysis-fluid glucose (DaVita)

Which numbers count per day, and which per week

Not every number is judged the same way, and the app follows exactly this split (Targets and warnings):

  • Potassium, sodium and fluid act within the day. Blood potassium can rise within hours of a large load, and a low day does not "bank" against a high one: the goal is never to have a dangerous day (KDIGO 2024).
  • On hemodialysis those three build up until the next session, so they are also judged over the gap between sessions. The long weekend gap is the dangerous one: deaths on the day after it were 22.1 vs 18.0 per 100 patient-years, and hospital stays for heart-rhythm problems roughly doubled (Foley 2011). Weight gain between sessions above 3.5 % of body weight is linked to death (Cabrera 2015). See Dialysis days.
  • Phosphorus and protein are judged on the average over a week or so. Blood phosphate, PTH and nutrition reflect weeks of eating, not one meal; KDOQI itself assesses intake from food records over several days (KDOQI 2020; Noori 2010). One high-phosphorus dinner is balanced by lower days around it.
  • Carbohydrate is counted per meal and per day for insulin; its weekly average is just information.

Does age or sex change my numbers?

Mostly not. Age and sex change how much energy (calories) you need, and they are part of the eGFR calculation and the anemia thresholds. They do not change protein per kg, sodium, potassium or phosphorus: those depend on your kidney function, your blood tests and your treatment (design note 05). Calcium needs differ by age and sex only when kidney function is near normal. The app's "Suggest targets" shows which of your details it used (Targets and warnings; Lab results).

Why protein goes up on dialysis

Before dialysis, extra protein makes the kidneys work harder, and more than 1.3 g per kg a day is linked to faster loss of kidney function (KDIGO 2024). Too little protein is also harmful: it causes muscle loss and, with insulin, raises the risk of lows (KDOQI 2020; KDIGO 2022). Dialysis removes protein and the body's need rises, so the target goes up to 1.0–1.2 g per kg (KDIGO 2022; ADA 2026 §11). See Protein.

What to do

  • Ask your team which of the numbers above apply to you and write them in the app (Profile → targets).
  • Learn your portions: ½ cup of fruit or vegetables, 3 oz of meat, 1 oz of cheese (Portions).
  • Read every ingredient list for "phos" and "potassium chloride" (Reading labels).
  • Keep glucose tablets with you, always (Treating a low).
  • Try a sample menu for your stage, with the matching grocery list.

Topics

Topic What it covers
Potassium · leaching when to limit, per-serving cues, swaps, how to leach vegetables
Phosphorus · additives natural vs additive phosphorus, binders, the "PHOS" list
Sodium under 2,000 mg, labels, salt substitutes
Protein · Eating enough how much, which kinds, keeping weight on
Fluid what counts, thirst, lows on a fluid limit
Carb counting renal swaps and your insulin plan
Reading labels · Portions · Eating out everyday skills
Food lists eat, limit and avoid, with milligrams
Dialysis days eating around hemodialysis sessions
Sample menus · Grocery lists · Recipes ready-made weeks

Ask your care team

  1. Which of my labs mean I need to limit potassium or phosphorus right now?
  2. What protein target should I aim for, and which weight do you use for it?
  3. Do I have a fluid limit? How much, and does it change on hot days or sick days?
  4. Should my insulin-to-carb ratio change if I switch to more white bread and rice?
  5. Can I see a renal dietitian, and how often?

Get help now if…

  • You have a low you cannot treat yourself, chest pain, severe breathlessness, or sudden severe weakness: call 911 (or your local emergency number). See Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-05.