Phosphorus is a mineral found in your bones. Along with calcium, phosphorus is needed for building healthy strong bones, as well as keeping other parts of your body healthy.

Normal working kidneys can remove extra phosphorus in your blood. When you have Chronic Kidney Disease (CKD) your kidneys cannot remove phosphorus very well. High phosphorus levels can cause damage to your body. Extra phosphorus causes body changes that pull calcium out of your bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium deposits in blood vessels, lungs, eyes, and heart. Phosphorus and calcium control is very important for your overall health.

A normal phosphorus level is 3.5 to 5.5 mg/dL. Ask your doctor or dietitian what your last phosphorus level was and write it

here ________________________ .

Yes. Dialysis can remove some phosphorus from your blood. It is important for you to understand how to limit build up of phosphorus between your dialysis treatments.

You can keep you phosphorus level normal by understanding your diet and medications for phosphorus control. Your dietitian and doctor will help you with this. Below is a list of foods high in phosphorus.

HIGH PHOSPHORUS FOOD TO LIMIT OR AVOID

Beverages	ale	beer
	chocolate drinks	cocoa
	drinks made with milkcanned iced teas	dark colas
Dairy Products	cheese	cottage cheese
	custard	ice cream
	milk	pudding
	cream soups	yogurt
Protein	carp	crayfish
	beef liver	chicken liver
	fish roe	organ meats
	oysters	sardines
Vegetables	dried beans and peas:
	baked beans	black beans
	chick peas	garbanzo beans
	kidney beans	lentils
	limas	northern beans
	pork ’ n beans	split peas
	soy beans
Other foods	bran cereals	brewer’s yeast
	caramels	nuts
	seeds	wheat germ
	whole grain products

Your doctor may order a medicine called a phosphate binder for you to take with meals and snacks. This medicine will help control the amount of phosphorus your body absorbs from the foods you eat. There are many different kinds of phosphate binders. Pills, chewable tablets, and powders are available. Some types also contain calcium, while others do not. You should only take the phosphate binder that is ordered by your doctor or dietitian.

Write your phosphate binder here: ________________________ .

Directions: ________________________ .

When your phosphorus level is too high, think about your diet and substitute lower phosphorus foods for a while. Talk to your dietitian and doctor about making changes in your diet and ask about your phosphate binder prescription.

HIGH PHOSPHORUS FOODSINSTEAD OF			LOW PHOSPHORUS FOODSTRY
	Phosphorus (mg)			Phosphorus (mg)
8 ounce milk	230		8 ounce nondairy creamer  or 4 ounce milk	100115
8 ounce cream soup made with milk	275		8 ounce cream soup made with water	90
1 ounce hard cheese	145		1 ounce cream cheese	30
½ cup ice cream	80		½ cup sherbet  or 1 popsicle	0
12-ounce can cola	55		12 ounce can of Ginger Ale or lemon soda	3
½ cup lima or pinto beans	100		½ cup mixed vegetables  or green beans	35
½ cup custard or pudding made with milk	150		½ cup pudding or custard made with nondairy creamer	50
2 ounce peanuts	200		1 ½ cup light salt/low fat popcorn	35
1 ½ ounce chocolate bar	125		1 ½ ounce hard candy, fruit flavors or jelly beans	3
2/3 cup oatmeal	130		2/3 cup cream of wheat  or grits	40
½ cup bran cereal	140-260		½ cup nonbran cereal, shredded wheat, rice cereals, or corn flakes

More than 20 million Americans—one in nine adults—have chronic kidney disease and most don’t even know it. More than 20 million others are at increased risk. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases and increase the availability of all organs for transplantation. Through its 50 affiliates nationwide, the foundation conducts programs in research, professional education, patient and community services, public education and organ donation. The work of the National Kidney Foundation is funded by public donations.

Potassium is a mineral found in many of the foods you eat. It plays a role in keeping your heartbeat regular and your muscles working right. It is the job of healthy kidneys to keep the right amount of potassium in your body. However, when your kidneys are not healthy, you often need to limit certain foods that can increase the potassium in your blood to a dangerous level. You may feel some weakness, numbness and tingling if your potassium is at a high level. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack.

Ask your doctor or dietitian about your monthly blood potassium level and enter it here:

If it is 3.5-5.0………………………You are in the SAFE zone

If it is 5.1-6.0………………………You are in the CAUTION zone

If it is higher than 6.0……………..You are in the DANGER zone

You should limit foods that are high in potassium. Your renal dietitian will help you plan your diet so you are getting the right amount of potassium.

Eat a variety of foods but in moderation.

If you want to include some high potassium vegetable in your diet, leach them before using. Leaching is a process by which some potassium can be pulled out of the vegetable. Instructions for leaching selected high potassium vegetables can be found at the end of this fact sheet. Check with your dietitian on the amount of leached high potassium vegetables that can be safely included in your diet.

Do not drink or use the liquid from canned fruits and vegetables, or the juices from cooked meat.

Remember that almost all foods have some potassium. The size of the serving is very important. A large amount of a low potassium food can turn into a high- potassium food.

If you are on dialysis, be sure to get all the treatment or exchanges prescribed to you.

The following table lists foods that are high in potassium. The portion size is ½ cup unless otherwise stated. Please be sure to check portion sizes. While all the foods on this list are high in potassium, some are higher than others.

High-Potassium Foods

Fruits	Vegetables	Other Foods
Apricot , raw (2 medium) dried (5 halves)	Acorn Squash	Bran/Bran products
Avocado (¼ whole)	Artichoke	Chocolate (1.5-2 ounces)
Banana (½ whole)	Bamboo Shoots	Granola
Cantaloupe	Baked Beans	Milk, all types (1 cup)
Dates (5 whole)	Butternut Squash	Molasses (1 Tablespoon)
Dried fruits	Refried Beans	Nutritional Supplements:   Use only under the direction of your doctor or dietitian.
Figs, dried	Beets, fresh then boiled
Grapefruit Juice	Black Beans
Honeydew	Broccoli, cooked	Nuts and Seeds (1 ounce)
Kiwi (1 medium)	Brussels Sprouts	Peanut Butter (2 tbs.)
Mango(1 medium)	Chinese Cabbage	Salt Substitutes/Lite Salt
Nectarine(1 medium)	Carrots, raw	Salt Free Broth
Orange(1 medium)	Dried Beans and Peas	Yogurt
Orange Juice	Greens, except Kale	Snuff/Chewing Tobacco
Papaya (½ whole)	Hubbard Squash
Pomegranate (1 whole)	Kohlrabi
Pomegranate Juice	Lentils
Prunes	Legumes
Prune Juice	Mushrooms, canned
Raisins	Parsnips
	Potatoes, white and sweet
	Pumpkin
	Rutabagas
	Spinach, cooked
	Tomatoes/Tomato products
	Vegetable Juices

The following table lists foods that are high in potassium. The portion size is ½ cup unless otherwise stated. Please be sure to check portion sizes. While all the foods on this list are high in potassium, some are higher than others. 

The process of leaching will help pull potassium out of some high-potassium vegetables. It is important to remember that leaching will not pull all of the potassium out of the vegetable. You must still limit the amount of leached high-potassium vegetables you eat. Ask your dietitian about the amount of leached vegetables that you can safely have in your diet.

How to leach vegetables.

For potatoes, sweet potatoes, carrots, beets, and rutabagas:

1. Peel and place the vegetable in cold water so they won’t darken.

2. Slice vegetable 1/8 inch thick.

3. Rinse in warm water for a few seconds.

4. Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours.

5. Rinse under warm water again for a few seconds.

6. Cook vegetable with five times the amount of water to the amount of vegetable.

For squash, mushrooms, cauliflower, and frozen greens:

1. Allow frozen vegetable to thaw to room temperature and drain.

2. Rinse fresh or frozen vegetables in warm water for a few seconds.

3. Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours.

4. Rinse under warm water again for a few seconds.

5. Cook the usual way, but with five times the amount of water to the amount of vegetable.

References:

Bowes & Church Food Values of Portions Commonly Used, 17th Ed., Pennington, JA, Lippincott, 1998.

Diet Guide for Patients with Kidney Disease, Renal Interest Group-Kansas City Dietetic Association, 1990.

More than 20 million Americans—one in nine adults—have chronic kidney disease, and most don’t even know it. More than 20 million others are at increased risk. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. Through its 50 affiliates nationwide, the foundation conducts programs in research, professional education, patient and community services, public education and organ donation. The work of the National Kidney Foundation is funded by public donations.

Sodium is a mineral found naturally in foods and is the major part of table salt.

When your kidneys are not healthy, extra sodium and fluid build up in your body. This can cause swollen ankles, puffiness, a rise in blood pressure, shortness of breath, and/or fluid around your heart and lungs. See the following table for suggestions on how to reduce sodium in your diet.

LIMIT THE AMOUNT OF…	FOOD TO LIMIT BECAUSE OF THEIR HIGH SODIUM CONTENT	ACCEPTABLE SUBSITUTES
SALT & SALT SEASONINGS	Table salt Seasoning salt Garlic salt Onion salt Celery salt Lemon pepper Lite salt Meat tenderizer Bouillon cubes Flavor enhancers	Fresh garlic, fresh onion, garlic powder, onion powder, black pepper, lemon juice, low-sodium/salt-free seasoning blends, vinegar
SALTY FOODS	High Sodium Sauces such as: Barbecue sauce Steak Sauce Soy sauce Teryaki sauce Oyster sauce Salted Snacks such as: Crackers Potato chips Corn chips Pretzels Tortilla chips Nuts Popcorn Sunflower seeds	Homemade or low-sodium sauces and salad dressings; vinegar; dry mustard; unsalted popcorn, pretzels, tortilla or corn chips
CURED FOODS	Ham Salt pork Bacon Sauerkraut Pickles, pickle relish Lox & Herring Olives	Fresh beef, veal, pork, poultry, fish, eggs
LUNCHEON MEATS	Hot Dogs Cold cuts, deli meats Pastrami Sausage Corned beef Spam	Low-salt deli meats
PROCESSED FOODS	Buttermilk Cheese Canned: Soups Tomato products Vegetable juices Canned vegetables Convenience Foods such as: TV Dinners Canned raviolis Chili Macaroni & Cheese Spaghetti Commercial mixes Frozen prepared foods Fast foods	Natural cheese (1-2 oz per week) Homemade or low-sodium soups, canned food without added salt Homemade casseroles without added salt, made with fresh or raw vegetables, fresh meat, rice, pasta, or unsalted canned vegetables

Some salt or sodium is needed for body water balance. But when your kidneys lose the ability to control sodium and water balance, you may experience the following:

• thirst

• fluid gain

• high blood pressure

• discomfort during dialysis

By using less sodium in your diet, you can control these problems.

• Cook with herbs and spices instead of salt. (Refer to “Spice Up Your Cooking” section for further suggestions.)

• Read food labels and choose those foods low in sodium.

• Avoid salt substitutes and specialty low-sodium foods made with salt substitutes because they are high in potassium.

• When eating out, ask for meat or fish without salt. Ask for gravy or sauce on the side; these may contain large amounts of salt and should be used in small amounts.

• Limit use of canned, processed and frozen foods.

• Understanding the terms:

                    Sodium Free - Only a trivial amount of sodium per serving.

                    Very Low Sodium - 35 mg or less per serving.

                    Low Sodium - 140 mg or less per serving.

                    Reduced Sodium - Foods in which the level of sodium is reduced by 25%.

                    Light or Lite in Sodium - Foods in which the sodium is reduced by at least 50%.

• Simple rule of thumb: If salt is listed in the first five ingredients, the item is probably too high in sodium to use.

All food labels now have milligrams (mg) of sodium listed. Follow these steps when reading the sodium information on the label:

1.  Know how much sodium you are allowed each day. Remember that there are 1000 milligrams (mg) in 1 gram. For example, if your diet prescription is 2 grams of sodium, your limit is 2000 milligrams per day. Consider the sodium value or other food to be eaten during the day.

2.  Look at the package label. Check the serving size. Nutrition values are expressed per serving. How does this compare to your total daily allowance? If the sodium level is 500 mg or more per serving, the item is not a good choice.

3.  Compare labels of similar products. Select the lowest sodium level for the same serving size.

Giving up salt does not mean giving up flavor. Learn to season your food with herbs and spices. Be creative and experiment for a new and exciting flavor.

What kinds of spices and herbs should I use instead of salt to add flavor?

Try the following spices with the foods listed.

Allspice:

Use with beef, fish, beets, cabbage, carrots, peas, fruit.

Basil:

Use with beef, pork, most vegetables.

Bay Leaf:

Use with beef, pork, most vegetables.

Caraway:

Use with beef, pork, green beans, cauliflower, cabbage, beets, asparagus, and in dips and marinades.

Cardamom:

Use with fruit and in baked goods.

Curry:

Use with beef, chicken, pork, fish, green beans, carrots and in marinades.

Dill:

Use with beef, chicken, green beans, cabbage, carrots, peas and in dips.

Ginger:

Use with beef, chicken, pork, green beans, cauliflower and eggplant.

Marjoram:

Use with beef, chicken, pork, green beans, cauliflower and eggplant.

Rosemary:

Use with chicken, pork, cauliflower, peas and in marinades.

Thyme:

Use with beef, chicken, pork, fish, green beans, beets and carrots.

Sage:

Use with chicken, pork, eggplant and in dressing.

Tarragon:

Use with fish, chicken, asparagus, beets, cabbage, cauliflower and in marinades.

• Purchase spices and herbs in small amounts. When they sit on the shelf for years they lose their flavor.

• Use no more than ¼ teaspoon of dried spice (¾ of fresh) per pound of meat.

• Add ground spices to food about 15 minutes before the end of the cooking period.

• Add whole spices to food at least one hour before the end of the cooking period.

• Combine herbs with oil or butter, set for 30 minutes to bring out their flavor, then brush on foods while they cook, or brush meat with oil and sprinkle herbs one hour before cooking.

• Crush dried herbs before adding to foods.

Caution! If you are told to limit potassium in your diet, be very cautious about using salt substitutes because most of them contain some form of potassium. Check with your doctor or dietitian before using and salt substitute.

When using the following seasoning recipes, make sure to blend well. Place in a shaker. 

American Favorite Blend 5 tsp. onion powder (not onion salt) 1 Tbsp. garlic powder 1 Tbsp. paprika 1 Tbsp. dry mustard 1 tsp. thyme ½ tsp. white pepper ½ tsp. celery seeds Yield: about ¼ cup (Health Education Assc. Inc., Glenside, PA)	Savory Seasoning 1 ¼ tsp. celery seed 2 Tbsp. crushed marjoram 2 Tbsp. crushed savory 2 Tbsp. crushed thyme 1 Tbsp. crushed basil Yield: about ½ cup (Nutrition: The Art of Good Eating, Seattle, WA)
Spicy Seasoning 3 Tbsp. celery seed 1 Tbsp. onion powder 1 tsp. garlic powder 2 Tbsp. crushed oregano 1 Tbsp. crushed thyme 1 ½ tsp. ground bay leaf 1 ½ tsp. black pepper 1 ½ tsp. ground cloves Yield: about ½ cup (Nutrition: The Art of Good Eating, Seattle, WA)	Savory Seasoning Savory Blend 1 tsp. chili powder 2 tsp. ground oregano 2 tsp. black pepper 1 Tbsp. garlic powder 6 Tbsp. onion powder 2 Tbsp. dry mustard 3 Tbsp. paprika 3 Tbsp. poultry seasoning Yield: about ¾ cup (South Carolina Dept. of Health and Environmental Services)

Experiment and create your own seasoning containing those spices that you like.