Renal Dietitian’s Guide: Sodium and Fluid for Kidney Disease
My name is Candace Mooney, and I’m a registered dietitian and a board-certified specialist in renal nutrition. I specialize in helping people with CKD learn how to prevent or slow their progression of kidney disease with nutrition.
This guide shows you practical sodium and fluid targets, easy label reading, hidden sources and brand recommendations, how to track fluid, and when to talk with your care team.
Let’s first discuss why kidney disease is important.
Sodium & Fluid Matter in Kidney Disease
Sodium keeps your fluid balance, blood pressure, muscles, and nerve signals on track (1).
When kidney function slows, your body holds onto sodium and water, which leads to fluid buildup (edema) and higher blood pressure.
Over time, that volume overload and hypertension strain your heart and kidneys. In your heart, it can cause left-ventricular thickening and heart failure. In your kidneys, it damages your blood vessels and filtering units, which causes scarring (glomerulosclerosis/fibrosis).
Lowering your sodium intake may improve your blood pressure and proteinuria (protein leakage in your urine) when you have chronic kidney disease. This can prevent or slow the progression of your kidney disease and improve your health outcomes!
Sodium Quick Targets
Sodium Goal: Less than 2,000-2300 mg/day sodium for people with CKD. (3, 4)
I typically recommend you aim for less than 2,300 mg of sodium per day with kidney disease, about 700–800 mg per meal, if you eat three meals per day with a snack.
Your exact target might shift if you have heart failure, hypertension, or fluid overload, so be sure to follow your care team’s guidance.
Now that you know your goals, let’s talk about how to make it happen for you.
Label Reading Made Easy
We’ve included a picture guide below. Here’s how to read it:
- Check the serving size first—sodium is listed per serving, not the whole package.
- Use the %DV (daily value) shortcut when scanning labels. It’s based on <2,300 mg/day (4). This can give you a quick picture of how much sodium you’ll be using of your daily limit when consuming this food.
- Watch for red flags: brined, cured, pickled, smoked, broth/bouillon, and a long lists of “sodium” ingredients like sodium bicarbonate or sodium benzoate.
Hidden Sodium Sources You Might Miss!
Watch out for sodium traps!
Foods high in sodium that can make it harder to hit your goals include:
seasoning mixes, canned soups, canned beans, instant noodles, frozen entrées, sauces (soy/teriyaki/BBQ), condiments (ketchup/ranch/salsa), deli meats, pickles/olives, breaded/marinated foods, restaurant meals, and even sports drinks.
Restaurant Meals
Did you know that over 70% of sodium comes from packaged and restaurant foods, not your salt shaker? (5). Recent NHANES data show about 26% comes from restaurant meals alone! Yikes! (6)
I usually recommend trying to eat out less than 1-2 times per week. I know eating out is very convenient and necessary for some people. Please check out my blog on Fast Foods that are okay for Kidney Disease for a ton of appropriate meals to eat out.
Quick Ordering Tips:
At restaurants, choose grilled, roasted, or steamed entrées and skip anything labeled “smoked,” “cured,” “au jus,” or “broth-based.” Swap fries or soup for a side salad or steamed veggies (no salted toppings), and check the restaurant’s nutrition page before you go so you can plan for a lower sodium meal.
Kidney-Friendly Food Swaps
Check out our table below, where we’ve picked appropriate options for you!
We’ve listed lower-sodium canned beans and soups, deli meats, frozen foods, and cereals.
| Canned Bean Swap Brands (1/2 cup) | Soup Swap Brands (1 cup) | Deli Meat Brand Swaps (per 2 oz) | Frozen Food Swap Brands (1 serving) | Cereal Swap Brands (¾ cup) |
| Simple Truth (Low Sodium) Tri-bean Blend, Great Northern, Black, Pinto, Dark Red Kidney, Cannellini, Garbanzo (105-120 mg) | Health Valley Organic (No Salt Added/Low Sodium) Vegetable, Minestrone, Chicken Noodle (45-130 mg) | Boar’s Head No Salt Added Turkey Breast (55 mg) | Amy’s Kitchen Pesto Tortellini, Frozen, Three Cheese Kale Bake, Organic Mushroom Risotto (590-780 mg) | Post Great Grains (140 mg) |
| Eden Organic Black, Pinto, Butter, Navy (15-40 mg) | Progresso Reduced Sodium, Heart Healthy Garden, Hearty Minestrone, Roasted Chicken Noodle, Creamy Tomato with Basil Soup, Gluten Free (450-580 mg) | Marketside Natural Sliced Oven Roasted Turkey, Roast Beef (340-410 mg) | Healthy Choice Simply Steamers Creamy Spinach & Tomato Linguini (490 mg) | Kroger Muesli Cereal (150 mg) |
| Food to Live Organic Red Kidney, Black, Cannellini (15 mg-40) | Pacific Foods Organic Chicken Noodle, Greek-Style Chicken Orzo, Butternut Squash (540-640 mg) | Boar’s Head Deluxe Low Sodium Roast Beef(80 mg) | Deep Indian Kitchen Spinach Paneer(490 mg) | Kashi GO (170 mg) |
| Good & Gather Low sodium, Great Northern Beans, Red Kidney, 3 Bean Blend, Black, Pinto (120-130 mg) | Amy’s Kitchen Organic Low Sodium, Lentil Vegetable, Chunky Tomato Bisque, Split Pea soup,(470-540 mg) | H-E-B’s Reserve Slow-Roasted Turkey Breast (370 mg) | Tasty BiteProtein Chickpea Masala(410 mg) | Arrowhead Mills Puffed Rice(0) |
| 365 by Whole Foods Market Navy, Dark Kidney, Pinto (5-105 mg) | Nature’s Promise Soup, Organic, Tomato Basil, Lentil Soup (610-730 mg) | Simple Truth Organic, Turkey Breast Oven Roasted, Honey Ham Uncured, Chicken Breast Oven Roasted (130-280 mg) | Smart Ones Sesame Noodles with Vegetables (400 mg) | Kellogg’s Special K (Original, Vanilla Almond (220 mg) |
Condiments, sauces, and dressings can add a lot of sodium, too. If you love condiments as much as I do. Here are some lower-sodium options for you that have less than 100 mg of sodium per serving:
- Sauces: Tabasco, Sprouts Organic Marinara Sauce No Salt Added, Rice Vinegar + Sesame Oil, Doc’s Salt Free BBQ sauce
- Condiments: Heinz Yellow Mustard, Hellmann’s Real Mayonnaise, Huy Fong Sriracha Hot Chili Sauce, Simple Truth Organic Ketchup Reduced Sugar & Sodium, Heinz Dill Relish
- Salad Dressings: Bragg Organic Apple Cider Vinegar Dressing, Panera Balsamic Vinaigrette, Brick House Creamy Garlic Herb, Brick House Classic Sweet Herb
Warning about Potassium:
If you’re watching potassium, be on the lookout and avoid foods using potassium chloride (KCl) in place of salt (sodium chloride). You can do this by checking the ingredients on the nutrition label.
If you need more information on potassium, review our guide here, Potassium with Kidney Disease.
Now with potassium handled, let’s dive into cooking and salt-free flavor strategies.
Cooking & Flavor Without the Salt
Quick Reality Check:1 teaspoon of table salt = 2,300 mg sodium. That’s your entire daily amount!
It’s best to avoid salt or reduce salt if possible. If you must use salt at home, add it at the table and not when cooking. You’ll get more bang for your buck in flavor if you do it this way, leading you to use less salt over all.
There are different ways to flavor your food without salt!
You can build flavor with acids (lemon/lime, vinegars), aromatics (garlic, onion), herbs/spices (paprika, cumin, rosemary), umami (mushrooms, tomato pastecheck sodium), and toasted spices. Check out more about that in our Spice Up Kidney Disease! Blog.
Seasoning Salt vs. Salt-Free
Swapping seasoning salt for salt-free herb blends, garlic/onion powder (not garlic salt), citrus zest, or smoked paprika can still give a big flavor with little sodium.
This table shows you great replacements for your high-sodium seasonings.
| High Sodium Seasoning | (1 tsp) | Low-Sodium Replacement | |
| Tony Chachere’s Original Creole Seasoning | 1,360 mg | Tony’s No Salt Seasoning | 0 mg of sodium |
| Tony Chachere’s Lite Creole Seasoning | 680 mg | Dash Salt-Free (Multiple Options) | 0 mg of sodium |
| Lawry’s Garlic Salt | 1,400 mg | Lawry’s Kosher Salt Free 17 | 0 mg of sodium |
| Magic Seasoning Blends | 400 mg – 540 mg | Magic Salt-Free Seasoning | 0 mg of sodium |
| Slap Ya Mama | 1,240 mg | Tabitha Brown All Purpose Seasoning | 0 mg of sodium |
Salt substitutes can help cut sodium, but many swap in potassium (KCl) for sodium (NaCl). I recommend you avoid those potassium-added options.
Here’s a quick guide for salt substitutes:
- Potassium-added: NoSalt, Nu-Salt, MySALT, Morton Salt Substitute
- Potassium-free:
- Dash (Mrs. Dash) blends
- Lawry’s Salt-Free 17
- Flavor God salt-free
- Trader Joe’s 21 Seasoning Salute
- Bragg Sprinkle Seasoning
- Flavor God salt-free blends
- Simply Organic “Spice Right” salt-free
- Penzey’s salt-free blends (label will say “no salt”)
- McCormick Perfect Pinch Salt Free blends
- Magic Seasoning Salt Free blends
- True Lemon / True Lime
Less salt means less thirst, but fluids still matter!
Fluids Targets: What Counts and How to Track
Earlier stages of chronic kidney disease may not require a fluid limit. Typically you will need to make sure you’re drinking enough fluid to protect your kidneys.
I typically recommend my patients with CKD 3-5 drink at least 48-64 ounces of fluid per day, with the majority of that being water and uncaffeinated beverages.
We’ve broken this down for you in terms of what that means for popular refillable water bottles below.
You’ll usually hit your target with 3 fills of a 20 oz, 2 fills of a 30–32 oz, or about 1½ fills of a 40 oz (top off as needed).
If you are wondering what drinks are best for you, check out our blog Best Drinks for Kidney Disease.
Fluid Restriction
Later stages of kidney disease (CKD5) may set a fluid limit based on your urine output, weight, blood pressure, and symptoms. If your provider has set a fluid restriction on you, please adhere to your doctor’s prescription.
What’s counted as fluid?
- Water, coffee/tea, milk, juice, soda
- soups/broth
- gelatin/ice cream
- popsicles
- ice (½ volume)
- High-water fruits such as watermelon, oranges, grapes, and berries
Track your intake with a measuring bottle, a tally app, or pre-portioned cups. If you notice rapid weight gain, swelling, shortness of breath, or rising blood pressure, contact your healthcare provider.
Simple Tricks for Thirst
When thirst kicks in and you’re on a fluid restriction, suck on lemon wedges or sugar-free sour candies and chew sugar-free gum. I also like the cold “mouthfeel” trick of ice chips or a few frozen grapes (remember to count them toward your fluids).
To keep thirst down, limit very salty foods since they spike your thirst. After you brush, you can swish, and spit, don’t drink.
Next, let’s bust some sodium and fluid myths with real evidence! You may already know some of these answers from reading this blog!
Myth vs. Evidence
Myth: You can sweat off fluid retention (saunas, sweat suits, ‘detox’ wraps).
Evidence: Sweating dehydrates; it doesn’t treat edema—manage volume with sodium restriction, diuretics, and when needed, ultrafiltration/dialysis, not saunas.Evidence for sauna in HF is limited, and it is not guideline therapy. (7)
Myth: Sea/Himalayan salt is healthier.
Evidence: By weight, sea, kosher, and table salt all deliver about the same sodium; your body treats them the same. (8)
Myth: Compression doesn’t help leg swelling.
Evidence: For venous edema/chronic venous disease, graduated compression (about 20–40 mmHg at the ankle) reduces edema and symptoms; it’s core therapy. (9)
Myth: Everyone with kidney disease needs strict fluid restriction.
Evidence: Fluid recommendations aren’t one-size-fits-all; they are individualized based on your clinical status. (7)
Myth: If my blood pressure is normal today, sodium isn’t a big deal.
Evidence: In kidney disease, we still aim for <2.3 g sodium/day to help control BP and volume over time. (4)
Myth: Drinking extra water flushes out salt.
Evidence: In CKD (and especially on dialysis), more fluid can worsen swelling and BP; we individualize fluids and focus on lower sodium to tame thirst. (10)
Myth: Most of my salt comes from the shaker.
Evidence: Most sodium comes from packaged and restaurant foods, not the salt you add at home. (11)
Myth: A teaspoon of salt isn’t much.
Evidence: 1 tablespoon salt ≈ 2,300 mg sodium; that’s a full day’s limit for many people. (10)
Now that we’ve separated fact from fiction, let’s look at how sodium and fluid goals shift with conditions like heart failure and hypertension.
Special Considerations: Heart Failure and Hypertension
Congestive Heart Failure
Having congestive heart failure (CHF) may lower your daily sodium recommendations to 1,500 mg a day or less. (3) It may also lower your fluid recommendations to 1.0–1.5 liters per day if your cardiology team prescribes it.
Speak with your cardiology or nephrology team to know your personal recommendations, and follow their guidance.
Hypertension
Hypertension with CKD may also lower your sodium recommendations to <2000 mg per day. (3) Follow the guidance of your health care team. Some cardiology plans use 1500-2300 mg per day, so it’s important to follow the target your team sets.
Summary
Here’s the big picture to remember about sodium and fluid in kidney disease:
You’re aiming for ~2000 mg of sodium per day. Talk with your care team if you have heart failure for more specific recommendations.
Sodium is still essential for your nerves and muscles, so don’t aim for zero-salt.
Most of your sodium intake is hidden sodium found in packaged foods or restaurants. Learning how to read labels and being aware of the sodium in your favorite restaurants can help you reduce your sodium intake.
Make sure you are staying hydrated. Fluid limits only come into play if your care team prescribes them.
If you’re unsure what your sodium or fluid targets should be, reach out to your healthcare team or reach out to me or another renal dietitian for one-on-one guidance.
With the right swaps and strategies, you can stay in control of sodium, fluids, and your kidney health!
Comment with your favorite low sodium swaps below!
This article was co-written by dietetic intern Keonte Hutchinson & reviewed, edited, and co-written by Candace Mooney, MS RDN CSR.
