A Little Note On Renal Diet: What’s New, What’s Best?

Kidney problems can be diagnosed through the following tests -

•Blood test

•Urine test

•Kidney scans

•Kidney biopsy

•Chest X-ray - the aim here is to check for pulmonary edema (fluid retained in the lungs).

•Glomerular filtration rate (GFR) - GFR is a test that measures the glomerular filtration rate -it compares the levels of waste products in the patient's blood and urine. GFR measures how many milliliters of waste the kidneys can filter per minute

Symptoms of Kidney issues -

The most common signs and symptoms of chronic kidney disease include:

•Anemia

•Blood in urine

•Dark urine

•Decreased mental alertness

•Decreased urine output

•Edema - swollen feet, hands, and ankles (face if edema is severe)

•Fatigue (tiredness)

•Hypertension (high blood pressure)

•Insomnia

•Itchy skin, can become persistent

•Loss of appetite

•Male inability to get or maintain an erection (erectile dysfunction)

•More frequent urination, especially at night

•Muscle cramps

•Muscle twitches

•Nausea

•Pain on the side or mid to lower back

•Panting (shortness of breath)

•Protein in urine

•Sudden change in bodyweight

•Unexplained headaches

TYPE OF KIDNEY DISEASES

1. Glomerulonephritis

2. Nephrosis

3. Acute renal failure

4. Chronic renal failure

5. Renal transplant

6. Kidney stones or urinary calculi

DIETARY MODIFICATIONS for Kidney disease management -

A renal diet is one that is low in sodium, phosphorous, and protein. A renal diet also includes consumption of high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium. Every person’s body is different, and according to the stage and type of renal disease, the diet and nutrition may vary.

PROTEIN

Renal patients are recommended high quality easily digestible protein. The amount may vary from patient stage and condition. Neutral nitrogen balance is achieved in patients with nondialysis CKD with a minimum of 0.6 g/kg/d of high biological value protein in stable nonacidotic patients when adequate calories are given.

Kidney-Friendly Proteins

-Chicken
-Cottage cheese
-Egg omelet
-Egg whites
-Fish
-Yogurt

PHOSPHORUS

The National Kidney Foundation recommends that serum calcium-phosphorus product be maintained at

Phosphorus can be found in many foods. Therefore, patients with compromised kidney function should work with a renal dietitian to help manage phosphorus levels.

Lower-phosphorous foods include:

-Italian, French or sourdough bread
-Corn or rice cereals and cream of wheat
-Unsalted popcorn
-Some light-colored sodas and lemonade

Higher-phosphorous foods to be avoided:

-Whole-grain bread
-Bran cereals and oatmeal
-Nuts and sunflower seeds
-Dark-colored colas

SODIUM

Normally, dietary sodium intake is restricted to 2000-4000 mg/d for patients with CKD to control hypertension, and to avoid excessive thirst and fluid consumption in patients with oliguria or anuria. Salt substitutes frequently contain potassium chloride, and patients should be instructed to avoid salt substitutes as they can precipitate hyperkalemia. In most nondialyzed patients with advanced renal failure, a daily intake of 1000-3000 mg (40-130 mEq) of sodium and 1500-3000 mL of fluid will maintain sodium and water balance. The requirement for sodium and water varies markedly, and each patient must be managed on an individual basis.

Too much sodium can be harmful for people with kidney disease because their kidneys are unable to eliminate excess sodium and fluid from the body. As sodium and fluid build up in the tissues and bloodstream, they may cause:

-Increased thirst

-Edema: swelling in the legs, hands, and face

-High blood pressure

-Heart failure: excess fluid in the bloodstream can overwork your heart, making it enlarged and weak

-Shortness of breath: fluid can build up in the lungs, making it difficult to breathe

How can patients monitor their sodium intake?

-Always read food labels. Sodium content is always listed.

-Pay close attention to serving sizes.

-Use fresh meats.

-Choose fresh fruits and vegetables

-Avoid processed and canned / tinned foods.

-Compare brands and use items that are lowest in sodium.

-Use spices that do not list “salt” in their title (choose garlic powder instead of garlic salt.)

-Cook at home and do NOT add lot of salt.

POTASSIUM

Dietary potassium is generally restricted to 2000-3000 mg/d for patients requiring hemodialysis and 3000-4000 mg/d for patients requiring peritoneal dialysis.

Why should kidney patients monitor their potassium intake?

When the kidneys fail, they can no longer remove excess potassium, so potassium levels build up in the body. High potassium in the blood is called hyperkalemia, which can cause:

-Muscle weakness
-An irregular heart beat
-Slow pulse
-Heart attacks
-Death

How can patients monitor their potassium intake?

When the kidneys can no longer regulate potassium, a patient must monitor the potassium intake to ensure that potassium level in your blood is within safe limits. For this, make sure to:

1. Limit foods that are high in potassium.

2. Limit milk and dairy products to 8 oz per day.

3. Choose fresh citrus fruits and vegetables.

4. Avoid salt substitutes & seasonings with potassium.

5. Read labels on packaged foods & avoid potassium chloride.

6. Pay close attention to serving size.

Fluids

Fluid control is important for patients in the later stages of Chronic Kidney Disease because normal fluid consumption may cause fluid retention in the body, which could become dangerous. People on dialysis often have decreased urine output, so increased fluid in the body can put unnecessary pressure on the person’s heart and lungs.

To control fluid intake, one should:

-Not drink more than what your doctor orders

-Room temperature melting foods are recommended

-Water used in cooking also should be controlled.

KIDNEY STONE-

A kidney stone is a hard mass that forms from crystals in the urine.

Dietary changes recommended to prevent stones

1.Drink plenty of fluid: 2-3 quarts/day

-This includes any type of fluid such as water, coffee and lemonade which have been known to have a beneficial effect with the exception of grapefruit juice and soda.

-This will help produce less concentrated urine and ensure a good urine volume of at least 2.5L/day

2. Limit foods with high oxalate content

-Spinach, many berries, chocolate, wheat bran, nuts, beets, tea and rhubarb should be eliminated from your diet intake

3. Eat enough dietary calcium

-Three servings of dairy per day will help lower the risk of calcium stone formation. Eat with meals.

4. Avoid extra calcium supplements

-Calcium supplements should be individualized by your physician and registered kidney dietician

5. Eat a moderate amount of protein

-High protein intakes will cause the kidneys to excrete more calcium which may cause more stones to form in the kidney

6. Avoid high salt intake

-High sodium intake increases calcium in the urine which further increases the chances of developing stones

-Low salt diet is also important to control blood pressure.

7. Avoid high doses of vitamin C supplements

-It is recommended to take 60mg/day of vitamin C based on the US Dietary Reference Intake

-Excess amounts of 1000mg/day or more may produce more oxalate in the body

Bipasha Das is a dietician and health coach, who has worked in multi-speciality hospitals, corporate firms as well in community nutrition camps. She specialises in modern urban lifestyle and diet planning