|Year : 2018 | Volume
| Issue : 2 | Page : 42-44
Dietary modification at different stages of chronic kidney disease
Dietician, Renal Nutrition, Mumbai, Maharashtra, India
|Date of Web Publication||6-Dec-2018|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sahigara S. Dietary modification at different stages of chronic kidney disease. J Renal Nutr Metab 2018;4:42-4
|How to cite this URL:|
Sahigara S. Dietary modification at different stages of chronic kidney disease. J Renal Nutr Metab [serial online] 2018 [cited 2018 Dec 17];4:42-4. Available from: http://www.jrnm.in/text.asp?2018/4/2/42/246999
| Introduction|| |
Chronic kidney disease (CKD), also known as chronic renal failure, is much more widespread than people realize; it often goes undetected and undiagnosed until the disease is well advanced. It is not unusual for people to realize they have chronic kidney failure only when their kidney function is down to 25 percent of normal. As kidney failure advances and the organ's function is severely impaired, dangerous levels of waste and fluid can rapidly build up in the body. Treatment is aimed at stopping or slowing down the progression of the disease-this is usually done by controlling its underlying cause.
| Indian Scenario|| |
SEEK (Screening and Early Evaluation of kidney disease) shows high prevalence of 17.4% of CKD.
Prevention: Screening is required for CKD as metabolic syndrome is increasing:
How to Screen:
- Age more than 60 yrs
- Cardiovascular disease (CVD) patients
- Family h/o CKD
- Tests for proteinuria or albuminuria
- Serum creatinine for eGFR.
It is estimated that only 10–20% of ESRD patients in India continue long-term RRT. Therefore, major emphasis should be on early detection of CKD and application of all possible measure to retard the progression of CKD. Nutritional modification is one important measure at early stages of CKD.
| Stages of Ckd|| |
Cockcroft-Gault formula for estimating creatinine clearance (GFR ml/min)
Crcl (ml/min) = (140-age) x lean body weight (kg)/72x serum creatinine x (0.85 if female):
- Weight has to be ideal body weight.
| Renal Nutrition|| |
The major concerns of a renal diet are:
- Low awareness of its importance amongst care givers
- Indian Diet is low in good quality protein and is rich in phosphate, minerals and salts
- Patients not screened for malnutrition, not provided adequate nutrition solution etc.
- Protein energy malnutrition is very common amongst kidney patients that is negatively impacting prognosis.
| Nutritional Care-Restrictions|| |
- Diet is an important part of the treatment plan
- Elements of renal diet:
- Getting right amount of calories and protein
- Getting favorable lipid profile as most CKD patients die of CVD
- Fluid restriction.
| Limiting Certain Nutrients|| |
Malnutrition rates in Chronic Kidney Disease (CKD) patients are high:
- 28% to 48% of predialysis patients
- 18% to 75% of dialysis patients.
Risk for malnutrition increases as CKD progresses.
Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is manifested by:
- Low serum levels of albumin or prealbumin
- Sarcopenia, and weight loss.
| Rationale for Dietary Protein Restriction in CKD|| |
- Ameliorate uremic syndrome
- Delay initiation of dialysis
- Decrease load on remaining nephrons
- Preserve residual renal function
- Improve proteinuria/albuminuria
- Preserve residual renal function
- Additive effect of ACE inhibitors
- Improve metabolic profile:
- Improve CV profile
- Improve insulin resistance, acidosis, and phosphate load.
- There is lack of objective reasons for not recommending low protein diet (LPD)
- Studies in animals have clearly shown restricting dietary proteins early during renal disease can minimize the adaptive changes and thereby retard the progressive deterioration of kidney disease
- The nutritional dilemma of CKD patients is, normal or high protein increases the nitrogenous waste and thus worsens the CKD. A very strict restriction of proteins causes malnutrition and malnutrition is a major risk factor for morbidity. It is very important to restrict the protein between 0.6-0.8/g/kg/bw depending on the stage of kidney disease and the nutritional status of the patient
- Fifty percent of the proteins should be of high biological value. Indian diets are predominantly low in proteins they just have to be modified and high biological value proteins must be introduced.
| Sodium|| |
The other most important modification in a renal diet is salt or sodium restriction.
Sodium is a mineral found in almost all foods. Too much sodium can make you thirsty, which can lead to swelling (oedema) and raise your blood pressure (hypertension). Hypertension is associated with proteinuria and more rapid progression of CKD.
One of the best things that you can do to stay healthy is to limit how much sodium you eat. To limit sodium in your meal plan:
- Restrict your dietary salt to 4g/day. Measuring 24-hour urinary sodium excretion may be helpful to quantify the actual intake of salt.
- Do not add salt to your food when cooking or eating. Try cooking with fresh herbs, lemon juice other salt substitutes and adjuncts.
- 1gm salt = 400mg of sodium, so all other high sodium foods should be restricted like papad, pickle, bakery products, cheese butter mayonnaise, canned foods, packaged foods.
| Potassium|| |
Not restricted unless serum potassium is high. (1500-2000mg/day). Potassium is a mineral found in almost all foods. Body needs some potassium to make muscles work, but too much potassium can be dangerous for a CKD patient. When kidneys are not working well, potassium level may be too high or too low. Having too much or too little potassium can cause muscle cramps, problems with the way your heart beats and muscle weakness.
Depending on the serum potassium and the stage of kidney disease the potassium restrictions are decided. The foods are divided into low moderate and high potassium foods depending on the potassium content.
- Low potassium-<100 mg/per serving
- Moderate potassium-101-200 mg/serving
- High potassium->200 mg/serving.
| Phosphorous|| |
Phosphorus is a mineral found in almost all foods. It works with calcium and vitamin D to keep bones healthy. Healthy kidneys keep the right amount of phosphorus in body. When kidneys are not working well, phosphorus can build up in your blood. Too much phosphorus in your blood can lead to weak bones that break easily.
Depending on your stage of kidney disease, a phosphate binder is prescribed. This helps to keep phosphorus from building up in your blood. A phosphate binder can be helpful, but despite the binder the phosphorous restrictions must be emphasized.
| Fluids|| |
Fluid restriction may be required to those patients who are oedematous or have a low urine output. It is very important to explain to the patients that fluids restriction does mean just restricting water everything that is fluid at room temperature is fluid.
| Benefits of Dietary Protein Restrictions|| |
- Dietary protein restriction has beneficial metabolic effects in CKD patients and helps delay initiating maintenance dialysis
- Evidence has not yet shown that metabolic benefits can slow CKD progression
- There is little or no evidence of harm from a protein-restricted diet
- Nevertheless, close supervision of patients following protein-restricted diets (with or without supplements) is of paramount importance to ensure that nutritional derangements do not occur.