From the Guidelines
Yes, you can follow both a diabetic and renal diet simultaneously, as they share many compatible principles, focusing on controlling blood sugar while limiting sodium, potassium, phosphorus, and protein based on your kidney function level, as recommended by the 2020 KDIGO guideline 1. The combined approach emphasizes non-starchy vegetables, moderate portions of high-quality protein, and complex carbohydrates with fiber.
- Key components of the diet include:
- High intake of vegetables, fruits, whole grains, fiber, legumes, plant-based proteins, unsaturated fats, and nuts
- Lower intake of processed meats, refined carbohydrates, and sweetened beverages, as suggested by the KDIGO 2020 clinical practice guideline 1
- Maintaining a protein intake of 0.8 g protein/kg (weight)/day for those with diabetes and CKD not treated with dialysis, as recommended by the KDIGO guideline 1
- Limiting sodium intake to <2 g of sodium per day, as recommended by the KDIGO guideline 1
- It is essential to work with a registered dietitian who specializes in both conditions to create a personalized meal plan that addresses your specific lab values, medication regimen, and nutritional needs, as requirements vary based on your kidney function stage and diabetes management goals.
- Portion control is crucial for both conditions, and heart-healthy fats like olive oil and avocado should be chosen, while avoiding foods high in added sugars, salt, and unhealthy fats.
- The American Diabetes Association also recommends reduction of protein intake to 0.8 –1.0 g kg body wt-1 day-1 in individuals with diabetes and CKD, which may improve measures of renal function, as stated in their 2008 position statement 1.
From the Research
Diabetic and Renal Diet
- It is possible to follow a diabetic and renal diet at the same time, as both conditions require careful management of nutritional parameters to achieve optimum health outcomes 2.
- The dietary management of patients with diabetes and renal disease involves addressing the challenges and practicalities of treating both conditions simultaneously, and healthcare professionals must advise changes that positively impact both conditions 3.
Nutritional Parameters
- Multiple nutritional parameters need to be monitored, including energy balance, protein intake, mineral control, fluid requirements, and coordination of carbohydrates, to achieve glycemic control in diabetes mellitus and manage chronic kidney disease 2.
- The diet for patients with diabetic renal failure is typically limited in protein, sodium, fluid, potassium, and phosphorus content, and a diabetic meal plan is modified to meet the required nutrient restrictions 4.
Management of Type 2 Diabetes in Chronic Kidney Disease
- The management of patients with type 2 diabetes and chronic kidney disease encompasses lifestyle modifications, glycemic control with individualized HbA1c targets, and cardiovascular disease risk reduction 5.
- Metformin and sodium-glucose cotransporter-2 inhibitors are first-line agents, and glucagon-like peptide-1 receptor agonists are second-line agents, while the use of other antidiabetic agents should consider patient preferences, comorbidities, drug costs, and the risk of hypoglycemia 5.
Protein Source and Serum Potassium and Phosphate Levels
- Consumption of higher proportions of plant protein was not associated with higher serum potassium or phosphate levels, but was associated with higher fibre and diet quality in adults with stage 4-5 chronic kidney disease 6.
- Plant proteins may be restricted on low potassium/phosphorus diets, but the impact of protein source on serum potassium and phosphate levels in adults with advanced kidney disease is an important consideration in dietary management 6.