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Which Fish Are Best to Eat with Kidney Disease?

Packed with heart-healthy fats and loads of vitamins and minerals, it’s no wonder dietitians recommend fish for people living with chronic kidney disease (CKD). There’s an almost endless bounty of options to choose from, but not all fish are equally nutritious so choosing which fish to eat with kidney disease is important. Fortunately, many fish are compatible with a kidney-friendly diet when prepared properly.

Why Add Fish to Your Kidney Diet?

Fish is famously dense with beneficial nutrients like iron, zinc, calcium, B vitamins, and much more. Most fish are a good source of protein and naturally low in sodium, regardless of whether it comes from fresh or salt water.

Best of all, fish is rich in heart-healthy omega-3 fatty acids. Omega-3s can help reduce the risk of cardiovascular disease, lower blood pressure, and raise good cholesterol (HDL).¹ Caring for your heart is especially important for people living with CKD, since there is a strong connection between high blood pressure and kidney disease.

Seafood is an excellent source of protein, which is important for helping you feel your best with CKD. Eating fish reduces the risk of albuminuria (that is, protein in the urine) and can help lessen kidney damage in people living with diabetes.²You may need to adjust your protein intake depending on your stage of kidney disease, so speak with your dietitian to find out how much is right for you.

Maximize nutritional value

Choosing the right fish to eat with kidney disease is essential to making the most of your meal. Commercially processed, fried, or frozen fish are often made with lower quality products, which means you’ll get less of a nutritional boost. Plus, pre-prepared or fast-food fish often has a high salt content and lots of phosphorus—two things people living with CKD should minimize.

Eating fresh fish is best, however, it’s a good idea to avoid raw fish and shellfish if you have end stage renal disease (ESRD). Cooking seafood thoroughly will reduce your risk of gastrointestinal infections that may cause health complications.³

Look out for mercury in fish

When choosing which fish to eat with kidney disease, mercury may be a concern. Studies suggest excessive mercury consumption impacts the nervous system, heart, and kidneys.⁴While research into mercury’s effects is still ongoing, it’s a good idea to minimize mercury intake—especially if you’re pregnant, nursing, or feeding young children. Choosing smaller fish is one easy way to limit exposure. This is because heavy metals like mercury build up through the food chain, meaning large fish that eat other fish accumulate mercury at a faster rate.

If you catch fish locally, check with your local Department of Natural Resources for food safety information.

Four Kidney-Friendly Fish (and Recipes)

1. Salmon

Salmon is one of the most popular fish on the menu, and it’s one of the richest in omega-3s, vitamins, and minerals. However, it’s also naturally high in potassium and phosphorus, so people living with CKD shouldn’t go overboard with portion sizes.

Suggested recipe: Smoky & Savory Salmon Dip

kidney friendly recipe sesame tuna salad

2. Tuna

All tuna is high in protein and omega-3 fatty acids. When it comes to canned tuna, minimize mercury levels by choosing fish marked low-sodium light tuna instead of white or albacore.

Suggested recipe: Sesame Tuna Salad

kidney friendly recipe spring salad with tarragon vinaigrette

3. Anchovies

Little fish like anchovies and sardines provide a big dose of good fats and healthy protein. Opt for fresh whenever possible, since preserved fish (including tinned sardines, lox, and pickled herring) can be very high in added sodium.

Suggested recipe: Spring Salad with Tarragon Vinaigrette

kidney friendly recipe lemon pasta with shrimp

4. Shellfish

Shellfish like shrimp, crab, and lobster are a great way to add variety to your seafood choices. Shellfish is packed with protein and beneficial minerals like magnesium, selenium, and zinc.

Suggested recipe: Creamy Lemon Pasta with Shrimp

Other smart seafood choices include black sea bass, mackerel, fresh herring, and trout. When choosing fish to eat when living with kidney disease, the hardest part will likely be deciding which recipe you want to try first! Search our library of kidney-friendly recipes for your new favorite.

Quick Tips for Preparing Fish

Dietitians generally recommend one to two servings of fish per week—and, of course, portion size is important. No matter what fish you choose to eat with kidney disease, one serving should be about three ounces. That’s about the size of a deck of playing cards.

Diagram depicting recommended serving sizes for fish — A divided plate ready to be filled with suggested serving sizes: 3-5 ounces protein (about the size of your palm), half cup fruits and veggies (size of cupped hand), 1 cup breads and grains (size of a closed fist), and fluid serving of 4 ounces.

Cook fish to a minimum internal temperature of 145° F or until the meat is opaque and flaky. Generally, this means baking, poaching, broiling, or grilling fish for about 10 minutes per inch of thickness. Double the cook time when cooking from frozen.

Cook Mouthwatering Kidney-Friendly Fish without Added Salt

When you’re living with CKD, it’s important to manage your blood pressure. You can support healthy blood pressure by avoiding adding salt to your food and instead use plenty of delicious herbs and spices to pump up the flavor. Most fish taste great with pepper, lemon, paprika, and fresh herbs like dill.

Remember, store-bought seasoning blends, mixes, and other prepared foods tend to have added sodium. Making your own blends is an easy way to take control and get creative in the kitchen.

Catch of the Day

It’s easy to see why fish is a popular and healthy choice. When choosing what fish to eat when living with kidney disease, remember to keep to one to two servings per week for the most health benefits. Limit phosphorus, potassium, and mercury, and enjoy this heart-healthy protein.

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References

¹“Omega-3 Fatty Acids — Fact Sheet for Consumers,” National Institutes of Health, last updated August 4, 2021 https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/.

²Lee CT, Adler AI, Forouhi NG, et al. Cross-sectional association between fish consumption and albuminuria: the European Prospective Investigation of Cancer-Norfolk Study. Am J Kidney Dis. 2008 Nov;52(5):876-86. doi: 10.1053/j.ajkd.2008.02.307.

³Gholami P, Lew SQ, Klontz KC. Raw shellfish consumption among renal disease patients. A risk factor for severe Vibrio vulnificus infection. Am J Prev Med. 1998 Oct;15(3):243-5. doi: 10.1016/s0749-3797(98)00051-8.

⁴“Mercury and Health,” World Health Organization, published March 31, 2017, https://www.who.int/news-room/fact-sheets/detail/mercury-and-health.

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