Anatomy of a kidney for Chronic Kidney Disease (CKD) nutrition- Medical nutrition therapy

CKD & renal

Expert Chronic Kidney Disease (CKD) Dietitian

Protect your kidney function, manage blood pressure, and maintain your vitality with proactive, evidence-based medical nutrition therapy.

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What is Chronic Kidney Disease (CKD)?

Your kidneys are the master filtration system of your body. They work 24/7 to remove waste products, balance fluids, manage blood pressure, and produce hormones that keep your bones strong and your blood healthy.

Chronic Kidney Disease (CKD) is the gradual, permanent loss of kidney function over time. When your kidneys are damaged, they can no longer filter blood as effectively as they should.

This causes “waste” (toxins) and excess fluid to build up in your body, which can lead to other health complications like heart disease, heart attacks and stroke.

CKD stages- Stages of chronic kidney disease

– Aare Urocare

CKD is often described in Stages (1 through 5), based on your Glomerular Filtration Rate (GFR)—a measure of how well your kidneys are cleaning your blood.

  • Stages 1–2: Mild damage, but kidneys are still working well.

  • Stage 3: Moderate loss of function; symptoms may begin to appear.

  • Stages 4–5: Severe loss of function leading toward kidney failure, where dialysis or a transplant may be required.

The stages of CKD:

  • Stage 1: Minor kidney damage with normal or high GFR (GFR > 90 mL/min)
  • Stage 2: mild reduction in GFR (GFR 60-89 mL/min)
  • Stage 3: moderate decrease in GFR (GFR 30-59 mL/min)
  • Stage 4: severe decrease in GFR where symptoms can start to occur (GFR 15-29 mL/min)
  • Stage 5: kidney failure (GFR < 15 mL/min), also known as end-stage renal disease (ESRD)

What causes CKD?

  • Kidney disease is rarely a standalone condition; it is usually the result of other health issues causing “silent” damage to the delicate nephrons (filtering units) within the kidneys.

    The primary drivers of CKD include:

    • Diabetes (Type 1 and 2): High blood sugar levels act like “glass” in the small blood vessels of the kidneys, causing scarring and damage over years.

    • Hypertension (High Blood Pressure): Excessive pressure weakens and hardens the arteries around the kidneys, reducing their ability to filter blood.

    • Glomerulonephritis: Inflammation of the kidney’s filtering units, often due to immune system malfunctions.

    • Polycystic Kidney Disease (PKD): A genetic condition where cysts grow in the kidneys.

    • Prolonged Medication Use: Over-reliance on certain NSAIDs (like ibuprofen) or exposure to specific toxins can accelerate kidney decline.

What we can do

How is CKD diagnosed?

CKD is often called a “silent killer” because you can lose up to 90% of kidney function before feeling any physical symptoms. Accurate diagnosis is vital.

The Diagnostic Process:

  1. eGFR (Estimated Glomerular Filtration Rate): A blood test measuring creatinine levels to see how many millilitres of blood your kidneys filter per minute.

  2. Urine Albumin-to-Creatinine Ratio (UACR): A urine test to check for Albumin (protein). Healthy kidneys do not let protein leak into the urine; if protein is present, it is a hallmark sign of kidney damage.

  3. Blood Pressure Monitoring: Persistent high readings are both a cause and a symptom of kidney issues.

Common Diagnostic Mistakes:

  • Ignoring “High-Normal” Protein: Many patients are told their urine protein is “slightly elevated” but aren’t told this is an early warning sign of CKD. Early intervention is the only way to stop the progression.

  • Looking at Creatinine Alone: Creatinine levels can fluctuate based on muscle mass, diet, and hydration. A doctor must look at the trend of eGFR over at least three months to confirm a “chronic” condition rather than an acute injury.

  • Normalizing Fatigue: Early-stage CKD causes subtle fatigue and “brain fog.” These are often dismissed as stress or aging, delaying the blood tests that would catch kidney decline in Stage 2 or 3.

How common is CKD

CKD is an escalating public health challenge in Australia. It is estimated that 1 in 10 Australians over the age of 18 have at least one clinical sign of CKD.

Disturbingly, up to 90% of people with CKD do not know they have it. Because the kidneys are so good at compensating for damage, most people don’t seek help until the disease has reached an advanced stage.

In Australia, kidney disease contributes to approximately 1 in 6 deaths, making early detection and nutritional intervention a literal lifesaver.

How is CKD treated? (The REAL Nutrition Approach)

While you cannot “undo” scarring in the kidneys, you can significantly slow, or even halt, the progression of the disease through targeted Medical Nutrition Therapy (MNT).

At REAL Health & Nutrition, we move away from the “don’t eat anything” approach and focus on Renal Preservation.

1. Precision Protein Management

Nutrient dense protein foods to optimise protein intake, bone density, muscle mass, falls risk and kidney health

Historically, kidney patients were told to stop eating protein.

We now know that’s dangerous and leads to muscle wasting and reduced kidney health depending on the stage of CKD.

We help you find the “Goldilocks” amount of protein for your body, enough to maintain your muscle and immune system, but not so much that it overburdens your kidneys with nitrogenous waste.

2. Crushing Insulin Resistance & Refined Sugars

Sodium and salt, a key driver for acute spikes in blood pressure and excess kidney/ renal strain

Sodium is the enemy of kidney health because it forces the body to hold onto fluid, spiking blood pressure.

We teach you how to flavour food without the salt shaker, focusing on potassium-alkaline balance to protect your vascular health and renal health.

3. Electrolyte Balancing (Potassium & Phosphorus)

Potatoes, being a high source of potassium that people often do not think of. It's Importance for renal function throughout CKD

As CKD progresses, the kidneys struggle to excrete potassium and phosphorus.

High levels of these can lead to heart arrhythmias and bone disease. We provide tailored lists of “swaps” so you can still enjoy fruits and vegetables without hitting dangerous serum levels.

4. Metabolic Health & Diabetes Synergy

Image of BGL Lancet and measurement device

Since diabetes and CKD often go hand-in-hand, we implement strategies to stabilise blood sugar.

This reduces the “osmotic pressure” on your kidneys, effectively giving them a rest and preventing further scarring.

When should you see a Doctor?

You should consult your GP for a “Kidney Health Check” if you have any of the following high-risk factors:

  • You have Diabetes or High Blood Pressure.

  • You have a family history of kidney failure.

  • You are over the age of 60.

  • You are of Aboriginal or Torres Strait Islander descent (who have higher clinical risks for CKD).

Seek immediate medical attention if you notice:

  • Foamy or “fizzy” urine (a sign of heavy protein leakage).

  • New or worsening swelling (oedema) in your ankles, feet, or around your eyes.

  • Chest pain, dizzyness or shortness of breath

  • A significant decrease in urine output.

  • Persistent, unexplained itchy skin and metallic taste in the mouth.

Do not wait for symptoms. If you are in a high-risk group, request a blood and urine test today. Once you have your results, book a consultation with our renal dietitians to start your preservation strategy.

When should you see a Dietitian for CKD?

The exact moment you are diagnosed with Stage 1, 2, or 3 Chronic Kidney Disease (CKD), you should book an appointment with an Accredited Practising Dietitian.

Do not wait until your kidney function has significantly declined or you are facing the immediate prospect of dialysis.

We cut through the confusion of generic “renal diets” and unnecessarily restrictive “low-everything” protocols, which often lead to muscle wasting and malnutrition, to provide a realistic, science-backed roadmap that preserves your kidney function and protects your long-term health.

Why Choose REAL for Supporting Your Kidney Health?

At REAL Health & Nutrition, we believe protecting your kidney function shouldn’t mean a lifetime of bland, restrictive, or “cardboard” diets.

Our Accredited Practising Dietitians use evidence-based Medical Nutrition Therapy to help you navigate the complexities of Chronic Kidney Disease, giving you the tools to preserve your kidney function while safely enjoying a broad, flavorful, and nourishing diet.

Realistic nutrition solutions

REAL Health & Nutrition was founded in Melbourne by Matthew Rigoni alongside a passionate team that provides evidence-based nutrition strategies that fit into your life.

Our diverse clientele includes individuals seeking to manage chronic disease, enhance their energy, and those aiming to improve their healthspan and longevity through sustainable health and nutrition strategies.

Matthew Rigoni, expert Dietitian and sports dietitian- REAL Health & Nutrition

Practitioners

Meet the team

Highly skilled and qualified Dietitians and Sport Nutritionists

  • Matthew Rigoni Accredited Practising Dietitian (APD), sport Nutritionist, Accredited Sport Dietitian (ASD)

    Matthew Rigoni

    Head Dietitian (APD) & Sports Nutritionist

    Matthew Rigoni is an Accredited Practising Dietitian and Sports Nutritionist supporting clients across Eltham, Diamond Creek and Melbourne’s North-East. He specialises in weight management, chronic disease care, IBS/low-FODMAP nutrition, and sports-performance nutrition. His approach focuses on evidence-based, realistic strategies tailored to each client’s health goals. Matthew also brings experience in strength training and rehabilitation, helping clients build long-term, sustainable habits.

  • Max Dennehy Dietitian, body building coach

    Max Dennehy

    Dietitian and Bodybuilding Coach

    Max Dennehy is a qualified Dietitian with strong expertise in sports nutrition, weight loss, muscle gain and body recomposition. He has more than seven years of hands-on experience in bodybuilding and strength training, blending clinical nutrition with practical performance coaching. Max supports clients managing chronic conditions, improving metabolic health, and achieving body-composition goals. His coaching style is structured and supportive, helping clients stay consistent and confident.

  • Emma Westlake Accredited Sports Nutritionist

    Emma Westlake

    Accredited Sports Nutritionist

    Emma Westlake is a Nutritionist and Accredited Sports Nutritionist with experience in athletic performance, endurance nutrition, injury recovery and rehabilitation. She brings a strong background in Biomedical Science and works with clients to improve energy, health and long-term wellbeing. Emma has supported athletes across AFL/AFLW, triathlon and running communities, offering clear and practical guidance. Her passion lies in helping active individuals optimise performance through personalised, evidence-based nutrition.

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This commitment ensures you always receive the most current, evidence-based nutrition guidance available.

Extra reading

  • Kidney Health Australia. (2024). Chronic Kidney Disease (CKD) Management in Primary Care (5th Edition). A comprehensive guide for health professionals and patients on the early detection and management of CKD in the Australian healthcare system. https://kidney.org.au/health-professionals/ckd-management-in-primary-care

  • Ikizler, T. A., et al. (2020). KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. American Journal of Kidney Diseases, 76(3), S1–S107. The global “gold standard” for renal nutrition, outlining precise protein and electrolyte requirements for every stage of kidney disease. https://doi.org/10.1053/j.ajkd.2020.05.006

  • KHA-CARI Guidelines. (2023). Nutritional Management in Adult Kidney Disease. Evidence-based clinical guidelines specifically tailored for the Australian and New Zealand population, focusing on dietary interventions to delay dialysis. https://www.cariguidelines.org/guidelines/chronic-kidney-disease/

  • KDIGO (Kidney Disease: Improving Global Outcomes). (2024). Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. The definitive international criteria for diagnosing and staging kidney disease using eGFR and Albuminuria trends. https://kdigo.org/guidelines/

Frequently Asked CKD Questions

Common questions for kidney/ renal health.

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    Technically, once kidney tissue has scarred (fibrosis), it cannot be regrown or “reversed” to a perfectly healthy state.

    However, targeted medical nutrition therapy is incredibly effective at halting or significantly slowing the rate of decline. In many cases, patients can enter a “stable state” where their kidney function remains consistent for decades, effectively avoiding the need for dialysis.

    In some instances, we have seen a small increase in eGFR with specific interventions, followed by stabilisation

    Not necessarily, but the source of your protein matters.

    Animal proteins (meat, dairy, eggs) produce more nitrogenous waste, which can put more pressure on the kidneys.

    Plant-based proteins (tofu, beans, lentils) are often more “kidney-friendly.” We don’t believe in forced veganism; instead, we help you find a balance that includes the foods you love while prioritising choices that protect your filtration system.

    Absolutely not. This is a common and dangerous misconception.

    A diet for someone in Stage 2 CKD looks very different from someone in Stage 5. Early on (CKD stage 1-2), we might encourage more fibre and high-potassium fruits; later on, we may need to strictly manage those same minerals.

    Your nutrition must be precision-tailored to your current blood results (eGFR, Potassium, Phosphate, and Albumin).

    If you want to take the guesswork out of your health, we’re only a few clicks away

    Traditionally, these were restricted because they are high in phosphorus. However, we now know that the body only absorbs about 40-50% of the phosphorus found in plant foods, compared to 90-100% of the phosphorus additives found in processed meats and sodas.

    We focus on cutting out the “hidden” chemical phosphorus first, so you can keep nutrient-dense whole foods in your diet for as long as possible.

    In most cases, yes! Coffee and tea are generally safe for the kidneys in moderation. The main concerns are what you add to them, such as high-potassium milks or creamers, and your total fluid intake.

    If you are in an advanced stage where fluid retention (oedema) is an issue, we will work with you to find a daily fluid budget that includes your favorite morning brew.

    No! This is one of the most important things to know.

    Many “low sodium” salts replace sodium with potassium chloride.

    Since damaged kidneys cannot efficiently remove excess potassium, using these substitutes can lead to dangerously high blood potassium levels (hyperkalaemia), which can affect your heart rhythm and increase the risk of a heart attack.

    This completely depends on what stage of CKD you have as the earlier stages, it may actually be beneficial. We do not recommend introducing these salts unless you have spoken with your Doctor or Dietitian first

    Fatigue in kidney disease usually stems from two issues: the buildup of waste products (uremia) that makes you feel “foggy,” and a decrease in Erythropoietin (EPO), a hormone the kidneys produce to create red blood cells.

    Without enough EPO, you can become anaemic. Our nutritional strategies focus on reducing that waste buildup and ensuring you have the iron and B-vitamins necessary to support your energy levels.