In Relationship to Chronic Kidney Disease

Source: National Institute of Health & U.S. National Library of Medicine

According to the National Institute of Health (NIH), if you have chronic kidney disease, you should make changes to your diet. Dietary changes can often include:

• Reducing the amount of fluids taken in*
• Your physician may recommend eating a low-protein diet*
• Restricting minerals such as salt, phosphorous, or potassium*
• Making sure you are getting enough calories so that you do not lose too much weight*
• Periodic changes in your diet made over time as your kidney disease gets better or worse, or if you need dialysis*

Kidney Diet Purpose

The purpose of a Kidney Diet is to ensure that an individual maintains a balance of minerals, fluids and electrolytes. Especially with dialysis, a special diet is important for individuals since dialysis alone does not effectively remove every waste product. Furthermore, waste products may also build up between each dialysis treatment.*

Since most dialysis patients do not urinate very much, if at all, fluid restriction between treatments can be very important. For those that do not urinate normally, fluid can build up in the body and lead to excess fluid in the body in areas of the heart, lungs, and ankles.*

Kidney Diet Recommendations from the NIH

The National Institute of Healthy recommends asking for a referral to a registered dietitian. A registered dietician is licensed to provide diet information about kidney disease. And, there are some dietitians that actually specialize in kidney diets. Your dietitian can work with you to design a personalized diet to fit your specific needs.*

The NIH recommends that a person’s daily calorie intake needs be high enough to keep a person healthy and prevent the breakdown of their bodily tissue. That is why it is important for a person’s doctor and/or dietitian to identify what their ideal weight should be.*

Specific NIH Recommendations for Carbohydrates, Fats, Proteins, Minerals Dairy and Fluids

1. CARBOHYDRATES

If a person is overweight or has diabetes, they may need to limit the amount of carbohydrates they eat. Always speak to your doctor or dietitian about this.*

Normally, carbohydrates are an excellent source of energy for the body. If an individual’s health care provider has recommended a low-protein diet and that individual is searching for foods to eat, they may replace calories from protein with foods such as:

• Vegetables, fruits, breads and grains.  These foods provide fiber, minerals, and vitamins as well as energy.*
• If needed, individuals can even eat desserts as long as they limit desserts made with dairy, chocolate, nuts, or bananas. If diabetes or blood sugar problems are present, then speaking with your doctor or dietician would be advisable before eating sugar or carbohydrate rich foods.*

2. FATS

Fats can be an excellent source of calories, but the NIH suggest that you make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) in order to protect your arteries. It is always recommended that you speak with your doctor, nurse, or dietitian about how cholesterol and fats can increase your risks for heart problems.*

3. PROTEIN

Low-protein diets may be beneficial before dialysis treatments. An individual’s doctor or dietitian may recommend a diet low in protein like 1 gram of protein per kilogram of body weight per day.*

Once an individual begins dialysis, they will need more protein. Doctors will often recommend their patients eat a diet high in protein from poultry, fish, eggs or pork.  This can help the person replace muscles and other tissues that they may have loss before dialysis.*

The NIH suggest that people on dialysis should eat at least 8 – 10 ounces of high-protein foods each day. Your doctor, dietitian, and/or nurse may suggest adding egg whites, egg white powder, or protein powder as well.*

 4. MINERALS

 A) Calcium and Phosphorous

Calcium and phosphorous are two very important minerals in the body and are monitored closely by a person’s kidney doctor. It is important to note that phosphorous levels in the blood can become too high even in the early stages of chronic renal disease and this can cause low calcium. Low calcium problems can cause the body to pull calcium from your bones to compensate which can make your bones weaker and prone to breaks.*

Some people may need to take calcium dietary supplements to prevent bone loss, bone disease, and use vitamin D to control the balance of calcium and phosphorous in the body. Ask your doctor, nurse, or dietitian for specific recommendations.*

As for Phosphorous, fruits and vegetables are often recommended since they contain only small amounts of phosphorous. If dietary changes to lower phosphorous are not enough, your doctor, dietician or nurse may recommend “phosphorous binders.”*

B) Sodium (or Salt)

Doctors will often recommend their patients reduce their sodium intake to not only help control high blood pressure, but also to prevent individuals from becoming thirsty as well as preventing the body from holding onto extra fluid.*

The NIH recommends choosing foods that contain these words on their food labels: low-sodium, sodium-free, sodium reduced, unsalted, or no salt added. It is also suggested to always check all labels to see what the level of sodium is contained in each food serving as well as avoiding foods that list salt near the top of the ingredient list. Consider products with less than 100mg of sodium per serving.*

Another recommendation is to not use salt when cooking and remove the salt shaker away from the table. Most other herbs are considered safe, and you can use them to flavor your food instead of sodium (salt).*

Since many salt substitutes contain potassium, they recommend that you do not use salt substitutes. Individuals with chronic kidney disease often need to limit their potassium intake.*

C) Potassium

Normal potassium levels in the blood are important for maintaining a steady heart beat. However, when kidney function is impaired, too much potassium can build in the body and Dangerous heart rhythms can result.*

The essential mineral “Potassium” can be found in many different food groups including fruits and vegetables. Since certain fruits and vegetables contain more or less potassium than others, it is important to know which ones are low in potassium.*

Fruits that contain lower amounts of potassium include berries, plums, apples, grapes, peaches, pineapple, watermelon and pears. Vegetables that contain low amounts include broccoli, carrots, cauliflower, celery, cucumber, peppers, watercress, zucchini and lettuce.*

Fruits and Vegetables that contain higher levels of potassium include bananas, raisins, kiwis, dried fruit, cantaloupe, prunes, oranges, nectarines, asparagus, potatoes, tomatoes, pumpkin, avocado and cooked spinach.*

D) Iron

Doctors will often educate their patients with advanced kidney failure to the fact they usually need extra iron.*

Food that contain higher levels of iron include beef, pork, chicken, liver,  kidney beans and any foods that have been fortified with iron like some cereals. Always speak to your doctor, dietician or nurse for your specific recommendations.*

5. DAIRY

The NIH recommends that an individual limits the amount of dairy foods that they eat like milk, ice cream, yogurt, butter and cheese due to higher levels of phosphorous in these foods. It is important to note that some dairy foods can contain lower phosphorous amounts such as butter, cream cheese, sherbet, ricotta cheese, and brie cheese.*

6. FLUIDS

 Most people do not have to limit the amount of fluids they drink in the early stages of chronic kidney disease. But, as a person’s kidney disease becomes worse or if they are on dialysis, they will need to limit the amount of fluids they drink since fluid can build up in the body in between dialysis treatments.*

An individual’s doctor and/or dialysis nurse will let them know just how much fluids should be consumed every day. Often times, foods that contain a lot of water are not recommended such as Jell-O, popsicles, ice cream, grapes, melons, lettuce, tomatoes, and celery.*

Effective tips that keep a person from becoming thirsty can include:

• Avoiding salty foods*
• Freezing juice in ice cube trays and eating them like popsicles*
• Staying cool on hot days*

Reference: http://www.nlm.nih.gov/medlineplus/ency/article/002442.htm