According to the latest statistics from the US Renal Data System, more than 730,000 Americans are diagnosed with end-stage renal disease (ESRD), otherwise known as kidney failure. In ESRD, kidneys lose their ability to filter the blood, and this causes dangerous levels of fluid, electrolytes, and wastes to build up in the body. Individuals with ESRD must undergo dialysis or a kidney transplant to survive.
RDs play a key role in caring for ESRD patients, as these individuals have several unique nutrition needs. Although nutrient requirements vary from patient to patient, potassium and phosphorus are minerals that can be particularly problematic. If these nutrients accumulate in the blood, they can lead to serious complications including heart attacks, bone breakdown, and even death.
In my practice, I’ve often found it challenging to educate ESRD patients about foods they should avoid that are high in potassium and phosphorus, since many of these foods are deemed healthful. For example, it’s important for ESRD patients to limit their intake of bananas, oranges, tomatoes, potatoes, dairy products, legumes, and whole grains due to their high potassium and/or phosphorus content. Rather, I’ve found it helpful to focus on teaching ESRD patients what they can eat instead of what they can’t. It’s a common misconception that those with ESRD can’t eat any fruits or vegetables, and that’s not the case.
There are plenty of fruits and vegetables ESRD patients can eat that will benefit their health without causing excess potassium and phosphorus intake. However, RDs still must teach ESRD patients about the importance of portion control even when they eat fruits and vegetables containing low to moderate amounts of potassium and phosphorus. Eating them in large quantities could cause them to exceed their allowance for these minerals. Appropriate portion sizes will differ from patient to patient, so RDs will need to customize each person’s eating plan. Furthermore, some ESRD patients have restrictions for other nutrients, such as calcium, and therefore require a dietitian’s guidance to determine what foods they can include and avoid in their diet.
That said, listed below are eight fruits and vegetables RDs can recommend ESRD patients eat, along with some of their key nutrients and health benefits.
• Apples. 1 medium apple: 195 mg potassium; 20 mg phosphorus
Apples provide a variety of vitamins and minerals, including vitamin C, vitamin K, and manganese. They’re a great source of fiber and low in calories, and thus may be helpful for weight management and blood sugar control in ESRD patients. Furthermore, apples contain phenolics, flavonoids, and carotenoids, which are antioxidants that have been studied for their potential role in reducing risk of chronic diseases.
• Grapes. 1 cup of grapes: 288 mg potassium; 30 mg phosphorus
Grapes are another great source of vitamin C and vitamin K. Low levels of these vitamins are common in ESRD, likely due to increased losses during dialysis. Grapes also are high in fiber and provide small amounts of several minerals, including copper, manganese, and magnesium.
• Cabbage. 1 cup of shredded cabbage: 119 mg potassium; 18 mg phosphorus
Cabbage also is a rich source of vitamin K and vitamin C, and it provides some B vitamins, including folate and thiamin. Furthermore, cabbage has a high content of many antioxidants, such as polyphenols and flavonoids, which are known for their anti-inflammatory properties.
• Cauliflower. 1 cup of chopped cauliflower: 320 mg potassium; 47 mg phosphorus
Cauliflower is known for being rich in antioxidants, such as polyphenols, carotenoids, and flavonoids. These may have a variety of health benefits for ESRD patients, including reduced risk of other chronic illnesses such as heart disease and cancer. Cauliflower also is an excellent source of vitamin C and vitamin K and a good source of folate, and contains some manganese and magnesium.
• Red bell peppers. 1 cup of chopped bell pepper: 314 mg potassium; 39 mg phosphorus
Red bell peppers are rich in vitamin C, providing more than 300% of the DV in a 1-cup serving. Moreover, red bell peppers provide lots of vitamin A, vitamin E, B vitamins, and manganese. They’re also low in calories, high in fiber, and an excellent source of carotenoid antioxidants.
• Blueberries. 1 cup of blueberries: 114 g potassium; 18 mg phosphorus
Similar to the other fruits and vegetables mentioned, blueberries are an excellent source of vitamin C and vitamin K. What really makes blueberries shine is their antioxidant content. They have been shown to be higher in certain antioxidants, such as flavonoids and anthocyanins, compared with other types of berries. Although human research is needed to prove their effects, blueberries have been shown to improve renal function in animals with kidney damage.
• Onions. 1 cup of sliced onion: 168 mg potassium; 33 mg phosphorus
Onions provide several vitamins and minerals, including vitamin C, B vitamins, magnesium, and manganese. In addition, they provide unique antioxidants, such as quercetin, which is known for its potential to help reduce inflammation and boost immune system health.
• Asparagus. 1 cup of asparagus: 271 mg potassium; 70 mg phosphorus
Asparagus is a nutrient-dense vegetable, providing some of almost every vitamin and mineral that humans need, in addition to fiber and antioxidants. It’s particularly high in iron, vitamin A, vitamin K, and B vitamins.
None of these foods will treat or cure ESRD, but it’s worth encouraging ESRD patients to include them in their diets. They’re rich in vitamins, minerals, fiber, and antioxidants that will promote overall health and potentially reduce risk of comorbidities associated with ESRD.
The extent of dietary restrictions ESRD patients have can be overwhelming. This list of fruits and vegetables is a great place for RDs to start when recommending meals and snacks for these individuals. We know that a diet rich in fruits and vegetables, even for those with ESRD, is essential for overall health and weight management. The nutrients and plant compounds they contain also may have the potential to slow progression of ESRD and prevent other diseases from developing.
— Brianna Elliott, MS, RD, LD, is a nutrition specialist for Open Arms of Minnesota, a nonprofit organization that delivers medically tailored meals to individuals with chronic illnesses. She also authors her food and lifestyle blog, Fresh Fit Flourish, and is a contributing writer to several nutrition websites including Authority Nutrition.