Chronic Kidney Disease
How to maintain a good diet for healthy kidneys?
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Our kidneys filter waste and excess fluids from the blood, which are then excreted in our urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body.
Around 10% of the population worldwide is affected by chronic kidney disease (CKD), this happens because the kidneys fail to remove waste products from the body the way they should. It is important to follow a kidney-friendly diet that helps decrease the amount of waste in the blood. This diet is often referred to as a renal diet.
As every patient’s case details are different and have different nutrition requirements, the dietary restrictions may vary. It is always advised to talk to a renal dietitian (an expert in diet and nutrition for patients with kidney diseases). This information should be used as a basic guide.
What is Chronic Kidney Disease?
Chronic kidney disease is a slow and progressive loss of kidney function over a period of several years. Eventually, a person will develop permanent kidney failure. Chronic kidney disease, also known as chronic renal failure, chronic renal disease, or chronic kidney failure, is much more widespread than people realize; it often goes undetected and undiagnosed until the disease is well advanced.
What are the Stages in Chronic Kidney Failure?
Kidneys are responsible to filter our blood, removing waste, toxins, and surplus fluids. Individuals with CKD have damaged kidneys and cannot filter blood as should and it can lead to a variety of serious health concerns.
There are five stages of Chronic Kidney Diseases
Stage 1: At the first stage of Chronic Kidney Disease, there is very mild damage allowing the kidney to keep performing at 90 percent or better.
Stage 2: A mild decline in kidney function is visible and it is advisable to get in touch with a kidney specialist.
Stage 3: A moderate decline in kidney function. Stage 3A means the kidney is functioning between 45 and 59 percent and Stage 3B means kidney function is between 30 and 44 percent.
Stage 4: A severe decline in kidney function and the functioning is between 15 and 29 percent, which may lead to building up more waste, toxins, and fluids in the body.
Stage 5: Kidney failure or end-stage renal disease (ESRD) requiring dialysis. The kidney functioning is at less than 15 percent capacity and can lead to kidney failure.
When that happens, the buildup of waste and toxins becomes life-threatening. This is end-stage renal disease.
What are the symptoms of Chronic Kidney Disease?
The symptoms of chronic kidney disease develop over time and progresses slowly. Witnessing the below symptoms can be a sign of serious Kidney problems and one must not delay it’s treatment.
- Nausea and Vomiting
- Loss of appetite and weight loss
- Fatigue and weakness
- Sleep problems
- Changes in urination
- Muscle twitches and cramps
- Swelling of feet and ankles – as a result of water retention
- Chest pain
- Shortness of breath
- Uncontrollable High blood pressure
It is crucial to catch a kidney disease early in order to prevent kidney failure. The signs and symptoms may not appear until irreversible damage has occurred. For treatment of chronic kidney disease, one will need dialysis or a kidney transplant to survive.
What is a Kidney Friendly Diet?
A kidney-friendly diet is vital for people with chronic kidney disease as it helps in balancing the body’s minerals, like salt and potassium, and other body’s fluids that make hormones affect other organs. One must limit certain foods and fluids to avoid other fluids and minerals like electrolytes to build up in your body. At the same time, one needs to choose one that gives you the right amounts of protein, calories, vitamins, and minerals each day.
CKD is well managed with a proper meal plan and physical activity and medication.
Nutrition and Chronic Kidney Disease
Although CKD is generally progressive and irreversible, there are steps providers and patients can take to slow progression with the help of diet.The purpose of this diet is to keep the levels of electrolytes, minerals, and fluid in your body balanced when you have CKD or are on dialysis.
Treatment strategies to slow progression and reduce cardiovascular risk are similar. They include:
- Nutritional management
- Lifestyle modifications
- Medical management to control blood pressure and blood glucose, and reduce albuminuria
Screening for CKD on Hemodialysis and Dietary Principles for dialysis
Stable and well-nourished haemodialysis patients should be interviewed by a qualified dietitian every 6–12 months or every 3 months if they are over 50 years of age or on haemodialysis for more than 5 years (Evidence level III). Malnourished haemodialysis patients should undergo at least a 24-h dietary recall more frequently until improved. Several important nutrients can be lost during an Hemodialysis session and this contributes to malnutrition .
Below are the Dietary Principles for Individuals with Dialysis:
- Recommendations is to restrict
- Salt to about 1-4grms/day : this can be achieved by taking salt substitutes so palatability and food intake in maintained
- Fluid restriction is equally important
- CKD fail to consume enough Fiber : Low potassium fruits and vegetables should be included
- KOQI guidelines state 50%of dietary protein HBW
- Vitamin D deficiency data suggest
- L.carnitine ( cofactor in energy metabolism and fatty acids ) rich foods
- Probiotic and prebiotic : slow down the progression of CKD
- Cholesterol restriction : CVD high in CKD
Energy : The recommended energy for individuals with CKD who are undergoing maintenance dialysis is 35 k cals /kg/day for 60 years and above individuals 30 k cal /kg/day we educate patient to have adequate proportions of carbohydrates from sources such as cereals millets and root vegetables etc . for dibetic CKd patients only whole grains and fiber rich grains are vegetables are advised and for non diabetic we allow to have simple carbohydrates boiled potatoes sweet potatoes etc to keep their energy levels.
The KDOQI guidelines state that 50% of dietary proteins should be of High biological value (HBV ) like eggs milk chicken alternatively they can have low biological values protein foods like legumes in combination with high biological protein foods. We restrict protein intake 0.6 -0.8 /kg/day for predialysis patients
And prescribe 1,2 grams / kg /IBW for dialysis or hemodialysis and 1.2 -1.3 / kg IBW for peritoneal dialysis patient
A diet which is high in sodium tends to increase blood pressure and fluid retention in many people , a daily allowance should be less than 2300mg- 1500mg each day foods which have 5% less of the daily value of sodium should be selected. Canned foods, processed foods, pickles, papads, chips should be avoided. Alternatively flavouring such as pepper chilli powder , garlic salt , onion salt , ginger garlic rosemary oregon etc species and herbs can be used to improve the taste
Low and medium potassium content vegetables can be taken in the diet , high potassium vegetables should be avoided like instant coffee, cocoa, tender coconut water , fruits like banana mango custard apple etc
When you have CKD, phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.
We limit dairy products such as milk (Maas, Amazi), milk products (custard, cheese), ice-cream and cheese, high phosphate meats and substitutes such as eggs, pilchards, bacon, and sardines. With regards to high phosphate containing meats, we advise our patients to exchange these for low phosphate meats.
Excess fluid can build up in your body and may cause swelling and weight gain between dialysis sessions changes in your blood pressure your heart to work harder, which can lead to serious heart trouble a buildup of fluid in your lungs, making it hard for you to breathe
Keep track of the liquids you drink and other foods you eat.sources of fluids in our diet has to be pointed out .like gravies, sambar rasam ,soups porridges etc.
CKD with diabetes :
The American Association ADA has recommended lesser intake of calories increased physical activity for promoting weight management and monitoring of carbohydrates intake help to maintain the ABCs ( A1c , Blood pressure , and Cholesterol ). A diet consisting of carbohydrates especially complex carbohydrates from fruits vegetables whole grains legumes and low fat milk is recommended . High fiber diet (25 to 30 grams ) per day helps to control hemoglobin A1c and blood glucose levels .
CKD and hypertension :
Blood pressure can be maintained by proper management of diet which helps in reducing blood pressure in people with essential hypertension as dietary management with moderate sodium restriction which plays one of the main prominent roles of cause among the major population. Canned foods pickles sauces processed foods fast foods should be avoided.
- NIDDK.NIH.GOV, Eating right for Chronic Kidney Diseases, https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition, Last accessed on, 13th April,2021.
- Kidney Fund, Kidney Diet and Foods, https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/kidney-friendly-diet-for-ckd.html Last accessed on, 13th April,2021.
- Webmd, Kidney Disease Diet, https://www.webmd.com/a-to-z-guides/diet-and-chronic-kidney-disease Last accessed on, 13th April,2021.
- Healthline, Stages of CKD https://www.healthline.com/health/ckd-stages Last accessed on, 13th April,2021.
- NHS, Treatment of CKD https://www.nhs.uk/conditions/kidney-disease/treatment/, 19th April, 2021.
- Mayoclinic, Symptoms of CKD, https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521 19th April 2021.