WHAT KIND OF A DIET SHOULD A PERSON WITH CHRONIC KIDNEY DISEASE FOLLOW?

The kidneys primary role is to purify the blood by removing waste products from it. The kidneys also are the primary organ which rid the body of excess water, minerals, and chemicals. They regulate the amounts of water and vital minerals in the body like: sodium, potassium, calcium, phosphorous, and bicarbonate as well.

Patients with chronic kidney disease often times experience dysfunctioning in terms of the regulation of fluid and electrolytes in their bodies because their kidneys are not functioning properly. They can experience severe imbalances in terms of the natural distribution of fluid and electrolytes in their body even if they only drink the recommended daily amounts of water for a normal person, or consume foods with the amount of salt of potassium needed for a normal person. They need to follow a modified diet as prescribed by their doctor or dietician for this reason.

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The diet that a person with chronic kidney disease should follow varies depending on his or her clinical status, the stage of his or her kidney failure, and other medical problems he or she may have. The diet of a person with chronic kidney disease may have to be modified periodically.

People with chronic kidney disease will be asked to follow a special diet to retard the progression of the disease, and to postpone the need for dialysis, to reduce the toxic effects of excess urea in the bloodstream, to ensure that the person is getting the daily nutrition he or she needs to live a healthy life, to prevent the person from losing too much weight, to reduce the risk of fluid and electrolyte disturbance in the body, and to reduce the risk of the person developing heart disease.

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People with chronic kidney disease will be advised to restrict daily protein consumption to .8gm/kg of their body mass, to consume an adequate amount of carbohydrates to maintain their energy levels, to ensure that they only consume a moderate amount of fats as this can intensify chronic kidney disease by resulting in decreased kidney function – this includes ghee, butter, and oil, to limit daily fluid and water consumption to minimize swelling, to restrict the amount of potassium, sodium, and phosphorous they consume in their daily diets, and to consume a high fiber diet that is rich in vitamins and trace elements.

Everyone needs to consume a certain amount of calories everyday to ensure that they can perform daily activities, maintain a certain normal temperature, body growth, and body weight. People get most of their calories from carbohydrates and fats. People with chronic kidney disease need more calories to maintain normal body functions. Doctors recommend that these people consume between 35-40 calories/kg of body weight daily.

If these people do not consume at least these many calories per day, their bodies will start to use their protein reserves for caloric energy, and this is bad because they can become malnourished, and/or produce more harmful waste products which can put even more strain on their kidneys. People with chronic kidney disease should be eating the daily amount of calories needed for their ideal, and not their actual body weight, because their actual body weight may be too low or high depending on their existing health conditions.

People with chronic kidney disease need to consume foods rich in complex carbohydrates because these supply the most amount of calories for the body. A wide variety of foods, including: wheat, cereals, rice, potatoes, fruits and vegetables, sugar, honey, cookies, cakes, sweets, and drink supply carbohydrates, but these are in the form of simple carbohydrates. A person with chronic kidney disease should consume the following foods because they are a good source of complex carbohydrates: whole wheat cereal, unrefined rice cereal, johar, bajra, ragi, and nachni – they are a good source of fiber as well. As a general rule, no more than 20% of the daily calories should come from simple carbohydrates, the rest should come from complex carbohydrates.

Fats are a good source of calories and contain twice the calories that carbohydrates and proteins do. People with chronic kidney disease should consume foods rich in unsaturated fats, and unsaturated fats themselves, including: olive oil, canola oil, sunflower oil, safflower oil, oil contained in fish (omega3), and nuts. They should avoid consuming foods rich in saturated fats including: red meat, poultry, whole milk, ghee, butter, cheese, coconuts, and lard because they can harden the arteries and cause heart problems.

Unsaturated fats can be divided into two categories: monounsaturated, and polyunsaturated. People with chronic kidney disease should not consume foods rich in omega 6 polyunsaturated fatty acids, and the ratio of omega 6/omega-3 should not be too high – the lower it is the better. People can consume low levels of omega 6 in relation to omega-3 by mixing vegetable oils together before cooking with them. People with chronic kidney disease should avoid eating foods high in trans fats as much as possible.

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While everyone needs protein in their diet because it is needed to help repair and maintain body tissues, heal wounds, and fight off disease and infections, too much protein can actually accelerate the rate of decline in kidney function. Therefore, people with chronic kidney disease should restrict protein consumption to some degree. People with chronic kidney disease often times dont feel like eating much as well, and this combined with strict protein restriction can have adverse effects on them, including: poor nutrition, weight loss, lethargy, and a lowered immune system, all of which can cause premature death, therefore proteins should be restricted only when absolutely necessary. People with advanced kidney disease should consume approximately .8gm/kg of protein a day. They should eat nutritious foods with high quality protein that have high biological value, including: milk products, refined soya bean powder, soya bean granules, soya chunks, egg whites, etc…fish should be consumed sparingly.

People with chronic kidney disease should also limit the amount of fluids they drink daily because any excess fluid consumed will result in excess swelling which puts extra pressure on their hearts and kidneys. The result can be high blood pressure, and death. People with a lot of extra water in their bodies are said to have fluid overload. Swelling, and swelling of the abdomen, shortness of breath, and rapid weight gain in a relatively short period of time are all signals of fluid overload. Patients must always follow their doctors recommendations in terms of daily fluid consumption. Because daily fluid consumption is calculated based on the patients urine output, and fluid status, it varies from patient to patient.

Patients with no apparent swelling or decreased urine output can drink as much fluid as they want. Patients with swelling and decreased urine output are advised to consume as much fluid as they urinated out the previous day plus 500/ml to account for fluid loss from sweating and breathing.

While everyone needs to consume salt because it contains sodium which helps maintain blood pressure, and blood volume, people with chronic kidney disease have kidneys that are not capable of removing extra sodium from their blood, therefore sodium and fluid accumulates in their bodies and results in increased thirst, swelling, shortness of breath, and higher blood pressure. People with chronic kidney disease should limit the sodium that they eat in food, and drink in beverages for this reason.

While salt and sodium are used interchangeably, they are different. Sodium chloride is commonly referred to as table salt and it contains 40% sodium, and while people get most of their sodium from salt, it is definitely the only source. Other sources include: sodium alginate which is used in ice cream and store bought chocolate milk, sodium bicarbonate which is found in baking powder and soda, sodium benzoate which is used as a preservative to make sauces last longer, sodium citrate which is used as a flavor enhancer for jello, desserts, and beverages, sodium nitrate which is used in preserving and coloring processed meat, sodium saccharide which is used as an artificial sweetner, and sodium sulfite which is used to preserve the color of dried fruits.

As a general rule, people with chronic kidney disease and lots of swelling should not consume more than 3 grams of sodium a day. They should limit or avoid certain foods which include: salted pickles, papad, salted chutney, sauce, chat masala, and sambhar powder. However the list does not end here. Foods that chronic kidney disease patients should avoid include: baked foods (cookies, cakes, pizzas, and breads), foods containing baking soda or powder (ganthiyas, pakodas, dholkas, handwas, samosas, ragdha patties, dahi vadas, etc), wafers, chips, popcorn, salted nuts, salted dry fruits, canned foods, and readymade snacks.

These people should also avoid salted butter and cheese, instant foods (noodles, spaghetti, cornflakes, macaroni, etc), cabbage, cauliflower, cabbage, beetroot, radishes, spinach, coriander leaves, salted lassi, masala soda, fresh lime juice, and coconut water, certain over the counter medicines (sodium bicarbonate medicine, antacid, and laxatives), meat, and body organs, seafood and most fish.

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People diagnosed with chronic kidney disease should buy unsalted food as much as possible, and add salt sparingly when cooking. They should not have seasoned flavorings or salt shakers at the dinner table, and they should not add salt to their food before eating it. They should read the labels of processed and packaged foods, being mindful of the amounts of salt and sodium present. They should buy low sodium and sodium free processed foods as much as possible. They should check the sodium content in over the counter medicines before taking them. They should boil vegetables with high sodium, and discard the excess water. They should add herbs and spices to foods low in salt while cooking them to make them tastier. People with chronic kidney disease should NEVER use salt substitutes because they contain lots of potassium which can raise blood pressure to dangerously high levels! They should not drink softened water, because the process replaces calcium with sodium. They should eat low sodium foods when eating out.

People with chronic kidney disease should also restrict the amounts of potassium they eat because while it is needed to ensure that muscles and nerves function properly, and the heart beats regularly, too much of it in the bloodstream can lead to hyperkalemia which can lead to severe muscular weakness, or irregular heart rhythms. Chronic kidney disease patients with hyperkalemia can even experience cardiac arrest (the heart stops functioning suddenly) which can lead to death.

The level of potassium found in a normal person is 3.5 mEq/1 to 5.0 mEq/1. Levels of potassium that are between 5.0 to 6.0 mEq/1 are considered high and need to be lowered. Levels that are higher than 6.0 mEq/1 are considered dangerous and needs to be lowered immediately. Levels that are higher than 7.0 mEq/1 are considered to be life threatening, and need immediate attention.0

Patients should always follow their doctors advice in terms eating a diet that is lower in potassium. Food can be classified into three different groups in terms of potassium content (high – more than 200 mg/100 grams of food, medium – 100-200 mg/100 grams of food, and low – less than 100 mg/100 grams of food).

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