Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work as well as they should and it affects nearly more than 10% of the population worldwide. Patients with CKD may often experience urinary discomfort with the most common urinary symptoms being nocturia (wakeup during the night to pee), decreased urine output, hematuria (blood in urine), foamy urine (indicative of proteinuria), dysuria, urinary frequency, and urgency.
Dysuria is defined as a painful of burning sensation during urination. In CKD, dysuria is not usually a direct manifestation of CKD but may occur due to secondary mechanisms, including infections, irritation from waste products, or changes in urine concentration including an electrolyte imbalance. Antibiotics are indicated for infectious dysuria, with agent and dosing tailored to renal function, while non-infectious dysuria is managed by lifestyle changes including diet, hydration, and medications. Evaluation should focus on identifying and treating these underlying causes.
Some pathophysiological contributors to dysuria in CKD patients include:
• Dehydration and concentrated urine where CKD patients, especially those on diuretics or with poor fluid intake, may have concentrated urine, which in-turn irritate the urothelium and contribute to dysuria.
• Due to a combination of factors including build-up of uremic toxins, CKD is associated with weakened immunity and increased susceptibility to infections including urinary tract infections (UTIs,) which are a leading cause of dysuria in this population.
• Crystals (oxalates, uric acid): CKD alters urinary excretion of oxalate, uric acid, and other solutes, predisposing to Crystals and stones that can cause mechanical irritation and dysuria.
• Medications: Diuretics may increase urinary concentration or alter electrolyte excretion, potentially promoting crystalluria or mucosal irritation, though direct causation of dysuria is not frequently reported or established.
• Changes in urinary pH: CKD can alter urinary pH, which may contribute crystal formation and the risk of stone-related dysuria.
How can Nutrition help?
There is no evidence that dietary modifications alone will resolve dysuria in CKD. However, some general recommendations can potentially help reduce symptoms depending on underlying cause of dysuria (e.g., urinary tract infection, nephrolithiasis, or medication side effect). Nutrition can play a role in managing urinary symptoms in CKD by reducing inflammation, limiting waste buildup, and supporting kidney function.
Bladder-Irritating Foods to Limit
- Caffeinated and carbonated beverages
- Artificial sweeteners (including those in gum and candy)
- Highly Acidic foods (e.g., tomatoes, citrus fruits)
- Oxalate-rich foods (e.g., spinach, nuts, beets, nuts and seeds) – may increase risk of kidney stones in susceptible individuals
Other foods that were reported to exacerbate dysuria:
- Spicy foods (Chilies and hot sauces)
- Salad Dressing and condiments
Beneficial Foods to Include
- Anti-inflammatory, renal-friendly options:
- Berries (Blueberries, strawberries, Raspberries)
- Olive oil
- Fatty fish such as salmon (rich in omega-3s and polyphenols)
- Fiber-rich foods: Help prevent constipation, which can worsen urinary discomfort by putting pressure on the bladder.
- Diet higher in Plant-based foods (KDIGO recommends Consumption of diets higher in vegetables, fruits, whole grains, ber, legumes, plant-based proteins, unsaturated fats and lower in processed meats, and ultra-processed foods for CKD patients, since highly processed forms accentuates metabolic acidosis in patients with CKD)
It’s important to recognize that individual sensitivity can vary—what may be effective for one person might not work for another.
Hydration: A Critical Factor
Hydration is also an important aspect to consider. Fluid balance and Proper hydration helps keep urine diluted, reducing irritation or burning sensation during urination. However, CKD patients should follow fluid intake recommendations tailored to clinical status with attention to avoiding both dehydration and fluid overload.
There is no universal fluid intake target for all CKD patients. Instead, hydration needs in CKD require individualized assessment based on stage of CKD, comorbidities, and risk of volume overload or depletion.
- Moderate fluid intake is often recommended for non-dialysis CKD patients.
- In advanced stages (CKD 4–5), fluid restriction (<1.5L/day) may be necessary, especially with symptoms like fluid overload or oliguria.
Electrolyte Management Through Diet
CKD affects how your body handles minerals like sodium, potassium, and phosphorus. An imbalance in these electrolytes can indirectly contribute to dysuria.
– Sodium: Limit salt to less than 2,300 mg per day to help control blood pressure and reduce swelling. Avoid adding salt at the table and choose low-sodium products.
– Potassium: Some fruits and vegetables are high in potassium. Your healthcare team may advise you to limit or choose lower-potassium options, depending on your blood tests.
– Phosphorus: Limit foods like processed cheese, cola drinks, and packaged foods with phosphate additives. Phosphorus restriction is also dependent on your blood tests.
Practical Tips for CKD Patients
- Meal Planning: Choose alkaline-forming, low-acid foods like lean proteins, vegetables.
- Hydration: Follow a personalized hydration plan to ensure adequate fluid intake without overloading the kidneys.
- Consult a Dietitian: Work with a dietitian to create a plan tailored to individual needs
Contact your healthcare provider if you have:
– Persistent or severe burning with urination
– Blood in your urine
– Fever, chills, or back pain
– Trouble passing urine
To conclude, Urinary burning can be a distressing symptom for CKD patients, but certain dietary changes can help alleviate discomfort. By staying hydrated, managing pH levels, and avoiding irritating foods, CKD patients may reduce dysuria and improve their overall quality of life. Always consult a healthcare professional for personalized guidance on managing symptoms.
References :
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- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International. 2024;105(4S):S117-S314. doi:10.1016/j.kint.2023.10.018.
- Chronic Kidney Disease: Role of Diet for a Reduction in the Severity of the Disease. Naber T, Purohit S. Nutrients. 2021;13(9):3277. doi:10.3390/nu13093277.
- Mehta P, Leslie SW, Reddivari AKR. Dysuria. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549918/
- Nutritional Management of Chronic Kidney Disease. Kalantar-Zadeh K, Fouque D. The New England Journal of Medicine. 2017;377(18):1765-1776. doi:10.1056/NEJMra1700312.
- Plant-Based Diets to Manage the Risks and Complications of Chronic Kidney Disease. Carrero JJ, González-Ortiz A, Avesani CM, et al. Nature Reviews. Nephrology. 2020;16(9):525-542. doi:10.1038/s41581-020-0297-2.
This article was written By Fatema Naser Eldeen
