Kidney Disease, Nutrition and Food Insecurity: The Making of the Renal Food Cupboard

Renal Food Cupboard
Morley Day, a dialysis patient at Thunder Bay Regional Health Sciences Centre, poses with Marisa Tamasi, Registered Dietitian, in front of the Renal Food Cupboard. This Food Cupboard was started by staff of Regional Renal Services at the Health Sciences Centre to help dialysis patients gain access to foods that are safe for them to eat, when they need it.

Despite the fact that every 1 in 10 Canadians has kidney disease,  many people do not know much about this disease or what it means for those who live with it. Living with and managing kidney disease is a time consuming and lifelong obligation to regular doctor’s appointments, and could include 4-hour dialysis appointments 3 times each week, changes to your regular routine, potentially relocating for treatment and significant changes to your diet.

“Kidneys do a lot for your body. Primarily, kidneys regulate bodily fluids, electrolytes and substances such as potassium, sodium and phosphorous. They also remove waste products from your blood, and produce hormones that are essential for blood pressure regulation, red cell production and calcium balance,” says Marisa Tamasi, Registered Dietitian with Regional Renal Services at Thunder Bay Regional Health Sciences Centre. “When kidney function decreases as the disease progresses, patients may have to change their diet to help regulate balance in the body. This may include restricting excessive intake of fluid, sodium, potassium and phosphorous.”

A restrictive diet is important, and life-saving, for dialysis patients because when the kidneys aren’t working well, blood isn’t being cleaned and fluids and waste, potassium and phosphorous build up. Therefore, fluids must be restricted; this includes fluids that one drinks and fluids from food like vegetables and fruits. The general rule for fluid intake is 1L of fluid per day in addition to the amount that is excreted in urine. In comparison, the Dietitians of Canada recommend that healthy individuals, ages 19 years and older, drink 12 cups (3L) of water (males) and 9 cups (2.2L) of water (females) each day.

“In addition to fluid restrictions, dietary potassium and phosphorus may need to be restricted because too much potassium in the blood can affect the heart and too much phosphorous can affect bone health. Sodium should also be limited because too much sodium in the body can lead to fluid retention and high blood pressure”, explains Tamasi. “Without getting into too much detail, it’s really easy to see how valuable your kidneys are, and how complicated a dialysis patient’s diet becomes.”

What does this mean to those of us who aren’t nutrition experts? It means that common, healthy food choices for the general public aren’t necessarily safe choices for dialysis patients. For example, foods like bananas, whole grains, granola, regular milk, oranges, potatoes, mangoes, fresh peaches, beets, cooked kale, some mushrooms, peas and whole or canned tomatoes have too much potassium, phosphorous and/or sodium in them for dialysis patients to consume.

“In addition to a steep dietary learning curve for many of our patients, there are a lot of other factors that influence their nutrition,” says Tamasi. “I have patients who tell me that it is hard for them to follow the diet restrictions because of the cost of food and availability. We do our best to provide education about safe and alternative food options while ensuring that patients meet their nutritional needs, but food needs and accessibility are complicated for many patients.”

For patients who experience food insecurity (e.g. they do not have reliable access to a sufficient quantity of affordable, nutritious food), accessing food banks isn’t easy because of their dietary restrictions. Canned tomatoes, beans, Kraft Dinner, pasta sauces, etc. are not part of their restricted diet, resulting a survival catch-22: you choose to eat foods that may cause harm or you can choose to not eat.

Leave it to the Renal Services Team at the Health Sciences Centre to go above and beyond to support their patients. Seeing the hardships that many patients face, staff on the unit started to bring in food items to help the patients. This was the unofficial beginning of the Renal Food Cupboard, which patients who are in need are able to access through their care team at the Health Sciences Centre.

With approximately 850 patients enrolled in the regional program, the cupboard is an extra onsite resource for those who are in the most need. Additionally, renal dietitians, like Tamasi, use the cupboard for educational purposes as well, “We can also use the cupboard to show patients how to read food labels, or to introduce them to new kidney-friendly foods that they can try at home.”

In addition to an annual Christmas Hamper full of kidney-friendly food items to help make the holidays healthier and happier, Renal Services has received food donations for their Food Cupboard to help patients year-round.

If you would like to make a food donation for the Renal Food Cupboard, you can drop items off at the main reception in the Renal Unit at the Health Sciences Centre. For more information on what types of foods are safe for kidney patients, visit

To learn more about kidney disease, visit