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REVIEW ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 61-63

Importance of nutrition in prevention and treatment of chronic kidney disease


Director, Institute of Renal Sciences, Global Hospital, Mumbai, Maharashtra, India

Date of Web Publication23-Apr-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_1_19

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How to cite this article:
Shah BV. Importance of nutrition in prevention and treatment of chronic kidney disease. J Renal Nutr Metab 2018;4:61-3

How to cite this URL:
Shah BV. Importance of nutrition in prevention and treatment of chronic kidney disease. J Renal Nutr Metab [serial online] 2018 [cited 2019 May 19];4:61-3. Available from: http://www.jrnm.in/text.asp?2018/4/3/61/256811




  Introduction Top


The incidence and prevalence of chronic kidney disease (CKD) is increasing all over the world and has now reached epidemic proportions. This is likely to be even more true in developing countries such as India where there is a rising incidence of diabetes and hypertension. However, in the absence of national registry, it is difficult to get accurate data on kidney disease. There have been few population-based studies, but the definitions used and methodologies have been different, and therefore, data are variable and not likely to be accurate. An Indian CKD registry was set up by the Indian Society of Nephrology in 2005 with the aim to serve as a comprehensive nationwide data warehouse for studying various aspects of CKD. This registry, however, received data only from nephrologists who voluntarily submitted data. This means that data from many nephrologists who did not participate were not available to the registry. Moreover, many patients with CKD, particularly in rural areas, do not even reach a nephrologist. Therefore, there is no proper information about the burden of CKD in India. In the USA, the overall prevalence of CKD in the general population is approximately 14%. If it was similar if not more in India, about 180 million from a population of 1300 million are likely to have CKD. Poorly managed CKD which is likely in India where there are barely 1500 nephrologists carries a high risk of progression to end-stage kidney disease (ESKD).

Combining all the available literature, both published and unpublished, from various sources, Dr. Agarwal estimated the yearly incidence of ESKD in India to be approximately 150–200 pmp. This seems to be an underestimate since the incidence of end-stage renal disease in the USA is about 350 pmp (was reported to be 363 per million/year in 2013 and seems to have plateaued or declined since then). With the increasing incidence of diabetes and hypertension in our country, the incidence of ESKD is likely to be higher in India than in the USA. Even if one was to consider the incidence of ESKD to be like that in the USA, 455,000 develop ESKD in our country each year.

Available treatment options for ESKD include dialysis (hemodialysis and peritoneal dialysis) and kidney transplant (living and deceased donors). Both the treatment options are very expensive. The expense involved in dialysis treatment includes direct cost (approximately Rs. 25,000 per month for dialysis and medicines) and indirect cost (increased hospitalization, loss of income due to decreased working time and capacity and loss of time, and energy and money of person helping dialysis patient). The expense involved in kidney transplant involves an initial expense of about Rs. 1 million, followed by maintenance expense for immunosuppression and regular follow up. Consider this with the fact, that 69% live on less than US $2 (Rs. 140) a day and about 70% of our population live in rural areas where dialysis and transplant are not easily available.

Due to high cost and limited availability, barely 10% of new ESKD cases get renal replacement therapy (RRT). Even in those who get RRT, the quality of life is inferior and longevity curtailed. [Table 1] shows that at the age of 40 years, a healthy American is likely to live on an average another 39 years; a patient who goes on dialysis is likely to live on an average another 7.3 years while a patient who undergoes kidney transplant is likely to live another 22 years. Therefore, the main solution for a country like ours (and even for other countries because of the high cost of RRT, compromised quality of life and shortened survival) would be the prevention of CKD.
Table 1: Expected survival of patients with end-stage kidney disease

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  How to Prevent Chronic Kidney Disease? Top


To be able to prevent CKD, one must know what causes CKD. [Figure 1] shows the causes of CKD in India and [Figure 2] shows the causes in the United States. As shown in the figures, 50%–70% of cases of CKD are due to diabetes and hypertension. Preventing and controlling diabetes and hypertension itself can significantly reduce the incidence of CKD.
Figure 1: Observed causes of chronic kidney disease in India

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Figure 2: Reported causes of new cases of end-stage renal disease in the United States

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  Role of Nutrition in Prevention and Treatment of Diabetes Top


Type 2 diabetes epidemic can be attributed to urbanization with a change in work pattern from heavy labor to sedentary occupations and changes in food production and processing. Fast food restaurant establishments have experienced exponential global expansion in recent decades. This increased availability of fast foods has contributed to unhealthy diets with high-calorie content. Another key component in the food system transition has been an establishment of large chain supermarkets which displace fresh local food and farm shops and serve as a source of highly processed foods, high-energy snacks, and sugary beverages.

A high consumption of fruits, vegetables, low-fat dairy products, and whole grains and low consumption of fish, poultry, and red meat are associated with a significant reduction in the risk of developing type 2 diabetes and better control of blood sugar in those with diabetes. This, in turn, is associated with a lower risk of developing diabetic nephropathy.


  Role of Nutrition in Prevention and Treatment of Hypertension Top


A diet (rich in fruits, vegetables, low-fat dairy products, and whole grains) which is good for the prevention and treatment of diabetes is also good for the prevention and treatment of hypertension. In hypertensive patients, change to such diet can lower blood pressure by up to 11 mmHg. This eating plan is known as the Dietary Approaches to Stop Hypertension diet.

Even a small reduction in the sodium can reduce blood pressure by about 5–6 mmHg.

Weight loss by a combination of reducing calorie intake and daily exercise is one of the most effective ways of preventing and controlling blood pressure. In overweight or obese patients, losing even a small amount of weight can help reduce blood pressure. In general, one may reduce blood pressure by about 1 mmHg with each kilogram of weight loss.


  Role of Nutrition in Retarding Progression of Chronic Kidney Disease Top


In those with established CKD with reduction in the number of functioning nephrons, besides underlying etiologic factor, adaptive hemodynamic changes (afferent arteriolar vasodilatation and efferent arteriolar vasoconstriction) in the remnant nephrons [Figure 3] contribute over time to progressive deterioration in renal function [Figure 4]. Restricting dietary protein at an early stage of CKD can minimize the adaptive changes and thereby retard progressive deterioration in renal function. In addition, protein-restricted diet will decrease the generation of nitrogenous waste products and thereby delay the need for RRT.
Figure 3: Adaptive changes (dilatation of afferent arteriole and constriction of afferent arteriole)

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Figure 4: Adaptive hemodynamic changes lead to glomerulosclerosis

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  Conclusion Top


Nutrition plays an important role in the prevention and treatment of diabetes and hypertension which are leading causes of CKD. By preventing and controlling diabetes and hypertension with high consumption of diet comprising fruits, vegetables, low-fat dairy products, and whole grains and low consumption of fish, poultry, and red meat, the incidence of CKD can be significantly reduced. In those with established slowly progressive CKD, implementation of low-protein diet at an early stage can significantly delay the need for RRT.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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Introduction
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Role of Nutritio...
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