The information and advice contained in this book are based upon the

research and the personal and professional experiences of the author. They
are not intended as a substitute for consulting with a healthcare
professional. The publisher and author are not responsible for any adverse
effects or consequences resulting from the use of any of the suggestions or
procedures discussed in this book. All matters pertaining to your physical
health should be supervised by a healthcare professional. It is a sign of
wisdom, not cowardice, to seek a second or third opinion.

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Library of Congress Cataloging-in-Publication Data

Kang, Mandip S.
The doctor’s kidney diets : a nutritional guide to managing and slowing
the progression of chronic kidney disease / Mandip S. Kang, MD, FASN.
pages cm
Includes
bibliographical references and index.
ISBN 978-0-7570-0373-8 (pbk.)
1.
Kidneys—Diseases. 2. Kidneys—Diseases—Nutritional aspects. 3. Kidneys
—Diseases—Diet therapy. 4. Self-care, Health. I. Title.
RC903.K36
2015
616.6’10654—dc23
2015018370
Copyright © 2015 by Mandip S. Kang
All rights reserved. No part of this publication may be reproduced, scanned,
uploaded, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the publisher.
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
 Contents
Acknowledgments
Foreword
Introduction
PART ONE Your Kidneys and Your Health
1. Understanding How Healthy Kidneys Function
2. Understanding Kidney Disease
3. Nutrition and Chronic Kidney Disease
4. Diets Used to Manage CKD
5. Important Steps to Maximizing Your Health
PART TWO Kidney-Friendly Recipes
Breakfast Dishes
Entrées
Side Dishes and Salads
Sauces and Salad Dressings
Sweet and Savory Snacks
Desserts and Sweet Treats
Conclusion
Glossary
Resources
A Guide to Foods Low and High in Potassium, Phosphorus, and Sodium
References
Index
 I dedicate this book to those who have a passion for helping others in the
face of adversity. Your kindness and courage to step forward truly sets you
apart from the rest of us.
 Acknowledgments
I am indebted to Rudy Shur, Publisher; Joanne Abrams, Executive Editor;
and other members of the talented Square One Publishers staff whose
skilled hands made this book a reality. Your patience, support, and belief in
my message were enormously helpful. Sincere thanks also go to Barbara
Albers Hill, whose gift for creating reader-friendly text will allow this book
to benefit kidney patients everywhere.
Thank you to Uhling Consulting’s registered dietitians: Aubrey Uhling,
RD, CDE; Christina Caple, RD; and Meghan Smith, RD, for helping to
create new recipes and evaluate dietary information. Appreciation also goes
to Jacquelyn Beyrami, MS, RD, CSR; Nancee Vanderpluym, MS, RD; and
Kara Abbas, MS, RD, CSR, for their input and analysis of many of the
recipes.
I am thankful for great minds that taught me the art and science of
kidney diseases at Wake Forest University School of Medicine, especially
John Burkart, MD, who trained me during my fellowship and was kind
enough to review this book. Many thanks to my former colleagues at the
University of Utah School of Medicine’s Nephrology Department. Special
thanks also go to my colleagues at the Southwest Kidney Institute, who
inspire and motivate me daily, and to my patients, whose many stories
taught me that making small changes can indeed make a big difference in
one’s health.
Finally, a heartfelt thank-you to my wonderful family: to my loving
wife, Manjit Kang, RN, for assisting with recipes and helping review the
book through professional eyes; to my insightful daughter, Amrita, for her
proofreading skills; and to my son, Aneel, for his invaluable computer
assistance, research expertise, and unconditional support. Lastly, thank you
to my brother for his gifts of confidence and encouragement. My family’s
love and generosity are truly the foundation of this book.
 Foreword
In 1953, Homer Smith, one of the “fathers” of nephrology (the study of
kidney disease), suggested that the kidney may have played an important
role in the evolution of many biological species, including mankind. Along
the course of these evolutionary processes, the kidney became responsible
for many processes needed to maintain health. These processes go way
beyond the obvious one of removing excess fluids from the body—in other
words, urine production. It is what is not so obvious—the toxins, chemicals,
salt and other minerals that are in that urine—that make the kidney the
important and complex organ that it is. Our kidneys work twenty-four hours
a day, seven days a week to prevent these chemicals and minerals from
accumulating so we can remain healthy. When our kidneys are diseased, our
health is threatened. One of the major sources of the chemicals and minerals
that may accumulate is dietary intake. It is not surprising, then, that dietary
choices are an important part of routine health maintenance, a significant
step in minimizing strain on the kidneys, and a vital part of the overall
treatment for patients with chronic kidney illness or kidney failure treated
with dialysis.
The Doctor’s Kidney Diets by Mandip Kang, MD, FASN, is an
invaluable guide to the dietary management and treatment of kidney
disease. It is exactly what both the patient and the doctor needed. Dietary
management of kidney disease does not have to be hard. In fact, with the
recipes included in this book, it can even be enjoyable. Dr. Kang has
combined his years of knowledge treating patients with kidney disease and
other illnesses with his passion for patient care. The book is very
informative and easy to read. He recognizes that there is more than “one”
kidney diet, and that we need to individualize therapy to get it right. The
goal is to make the dietary part of the treatment for a patient with kidney
disease—usually, a lifelong condition—manageable, meaningful, and
effective. In following this aspect of treatment, the reader should feel better
and enjoy a more active, longer, and more satisfying life. I believe this book
outlines a great way to do just that. It is my hope that you enjoy the book,
the recipes, and most of all, greater health.
 John Burkart, MD
Professor of Nephrology/Medicine
Wake Forest University Medical Center
Winston Salem, North Carolina
He that takes medicine and neglects diet, wastes the skills of the
physician.
Chinese Proverb
 Introduction
In the United States today, it has been estimated that 26 million adults
have chronic kidney disease, and millions of others are at increased risk due
to rising rates of the two most common causes of CKD—hypertension (high
blood pressure) and diabetes. It is not surprising, then, that kidney disease
has been classified as an epidemic. While people diagnosed with CKD need
to know that it is considered a lifelong condition, they also need to know
that this disorder is absolutely manageable. Underlying causes can be
addressed, and a healthier lifestyle can be adopted with an eye toward
slowing the progression of the disease. My years as a nephrologist (kidney
doctor) have shown me that, whether you’re treating CKD alone or juggling
the management of several health conditions, diet is a significant part of
your treatment plan. By following the diet that meets your needs, you can
keep your body’s fluid and chemical levels in better balance, improving the
chance of stabilizing your kidney function and enhancing your overall
health. That is why I wrote The Doctor’s Kidney Diets—to guide you in
understanding and following a kidney-friendly eating plan so that you can
enjoy the greatest health possible.
When someone is diagnosed with chronic kidney disease, kidney
specialists and nutritionists emphasize the importance of diet to prevent the
worsening of the disease, and to avoid the symptoms and complications that
can develop due to this lifelong problem. Too often, though, patients find
the information given to them inadequate or confusing, especially when
several different disorders are involved, each with its own dietary
limitations. The purpose of this book is to fill that information gap and
empower you to improve your health through the foods you eat and the
lifestyle changes you make. The facts and recommendations found in this
book have been culled from scientific studies, from the expertise of a panel
of nutritionists, and—perhaps most important—from years spent treating
thousands of people with kidney disease.
Part One of this book focuses on the kidneys—both their function and
their dysfunction—and on the importance of diet in the treatment of CKD.
It lays the groundwork of information you need to manage chronic kidney
disease.
Chapter 1 reviews the vital tasks performed by the kidneys. This
information is important because the goal of CKD treatment includes—
although it is not limited to—compensating for the tasks that your kidneys
can no longer perform. Understanding kidney function is basic to
understanding the management of kidney disease.
Once you’ve learned about the work performed by the kidneys, you’ll
be ready to learn what happens when the kidneys are less able to do their
job. Chapter 2 focuses on the nature, causes, and stages of chronic kidney
disease. It also introduces you to your essential role as a member of your
own healthcare team.
In Chapter 3, the spotlight is on nutrition. Which nutrients may have to
be limited in your diet, and why? Which foods can cause further kidney
damage, and which can actually help you safeguard kidney function?
Chapter 3 lays out the facts and also explores important topics such as using
vitamin-and-mineral supplements, choosing healthy beverages, dining out,
and more.
Many people think that there is only one “renal diet”—one eating plan
that is right for everyone with CKD. The truth is that, depending on the
stage of CKD, any concurrent medical conditions, and other factors, your
doctor may recommend one of several diets, or may combine two or more
diets to meet your special needs. Chapter 4 not only explains the diets that
are most commonly prescribed for people with CKD, but also provides
valuable tips for successfully using each plan to manage your health.
Dietary changes are of crucial importance to everyone with CKD, but
beyond diet, there is much you can do to manage your CKD. Chapter 5
focuses on the many healthy lifestyle changes you can make, from getting
regular exercise to limiting the use of alcohol and caffeine. Some of these
changes may be easy to implement, and some may prove more challenging,
but all can make a positive difference in the way you feel on a daily basis as
well as in your long-term health.
Although it’s important to understand the “why’s” of making smart
food choices, I know that dietary principles alone won’t help you feel better.
You need to put those principles into practice by making and enjoying
kidney-friendly dishes. That’s why Part Two of The Doctor’s Kidney Diets
offers over fifty dietitian-created recipes designed specifically for people
with CKD. From breakfasts to desserts, from side dishes to snacks, these
dishes are not only easy to follow but also easy to love. Each one starts by
listing the specific diets with which it is a good match and ends by listing
Nutritional Facts, including calories, protein, carbohydrates, fiber, total fat,
saturated fat, trans fat, cholesterol, phosphorus, potassium, and sodium.
You’ll even find the Diabetic Exchanges per portion. This takes the
guesswork out of finding appealing dishes that match your dietary needs
and restrictions. Keep in mind, though, that all dietary decisions should be
made under the guidance of your healthcare team. I urge you to share these
recipes with your doctor and dietitian so that you can determine together
how the dishes can be incorporated into your menu plan.
I’ve tried to make the information in this book easy to understand and to
keep my use of medical terminology to a minimum. But some special terms
are necessary to explain kidney function, kidney disease, and nutrition.
With this in mind, I’ve created a Glossary (page 171) that explains the
terms used in this book as well as the terms you’re likely to hear when
working with you healthcare team. Turn to it whenever you want to double-
check the meaning of a health-related word or phrase.
Throughout this book, I emphasize the importance of understanding
your condition and its treatment. My experience has been that knowledge
and active involvement in your healthcare plan are the keys to a good
outcome. This book provides a great start, but you’ll want to keep adding to
your knowledge. That’s why I have compiled a comprehensive Resources
list (see page 183), which guides you to solid sources of information on
kidney-friendly diets, specific foods and nutrients, laboratory tests, and
other aspects of CKD treatment, as well as treatment for related conditions
such as diabetes and heart disease. The websites and organizations listed in
the Resources section can provide you with the information you need to
begin the successful management of your condition and to face any new
challenges you may encounter along the way.
 In my practice, I have seen my patients reap the benefits of dietary and
lifestyle changes—as well as patient education regarding the disease
process—and these benefits have often been significant. In many
individuals, kidney function has stabilized; in others, the time from
diagnosis to dialysis has been greatly prolonged. It is my hope that, armed
with The Doctor’s Kidney Diets, you will be able to enhance your long-term
health and manage, slow, or even halt the course of chronic kidney disease.
 PART ONE
Your Kidneys and Your Health
If you’ve been diagnosed with chronic kidney disease (CKD) or have
learned that you are at risk of developing this condition, you may feel
that you have entered a whole new world. There is suddenly a great
deal to learn about why your kidneys aren’t working properly; what
this means to your overall health; and how you can help guard against
a further decline in kidney function. Your doctor will be your first
source of information, of course, and you can expect to have many
conversations about kidney function, lab test results, related medical
conditions, and the significant impact dietary choices can have on your
kidneys’ health. You may also discuss what you can do to improve
your general fitness level. The knowledge you gain during your office
visits will be a wonderful start to your understanding of CKD. But you
don’t want to stop learning the moment you leave your doctor’s office,
because the more you know about your condition and the importance
of kidney-friendly eating, the more you will be able to participate in
your own health care and feel truly in control. Part One can be a vital
part of this learning process.
Chapter 1 presents important background information about kidney
function. You may be surprised by the diverse tasks—from filtering
out wastes to safeguarding bones—that healthy kidneys perform to
maintain good health. It’s crucial to understand this, because one of the
purposes of a CKD diet is to help you preserve your health even when
your kidneys are unable to do their usual jobs.
Chapter 2 offers clear information about the nature, causes, and
progression of chronic kidney disease, which is the focus of this book.
It also begins to acquaint you with your role as a member of your
healthcare team.