Kidney Disease Diet

The kidney diet is also known as the renal diet. Kidney diseases have stages, and the kidney diet will be designed associated with the level of disease.
Controlling sodium, potassium, phosphorous, proteins, and fluid intakes will be done in the kidney diet.
Every kidney patient needs an exclusive diet that is quite different from the other patients.

Factors that are needed to arrange a proper and special diet for each person include:
♦ Being in the early or end stages of kidney failure.
♦ Suffering from kidney stones or subsequent treatments for kidney stones surgery.
♦ Receiving dialysis treatment and the type of it.
♦ Nutritional factors for nutritional assessments (like age, height, and weight).

Each kidney is made up of one million functional units called nephrons that purify the blood. The kidneys filter about 220 litres of blood every 24 hours, excreting only a small amount of it in the urine and returning the rest of the blood after filtration to the body. If a kidney does not work correctly, it may have been through a condition called kidney disease.

Kidney function

Kidney have very important roles in the body, include:
♦ Blood filtration
♦ Urine production and exertion of wastes products of the body
♦ Secretion of Erythropoietin stimulates the production of red blood cells in the bone marrow.
♦ Blood pressure regulation
♦ Maintenance of body electrolyte and fluids balance
♦ Vitamin D activation
♦ Maintenance of body minerals, including Calcium, Phosphorus, Sodium, and Potassium.

Type of kidney diseases

Common kidney disease are:
♦ Nephritic syndrome or acute glomerulonephritis
♦ Nephrotic syndrome or chronic kidney disease(CKD)
♦ ARF
♦ ESRD
♦ Kidney stones


The dietitians take measures to control and treat these conditions.
In acute kidney disease, they limit the protein and potassium intake to control uremia and hyperkalemia. The sodium intake will be restricted due to the HTN. Maintaining a good nutrition status will help the improvement of the health itself.

If you have signs of loss of appetite, nausea, fatigue, headache, shortness of breath, hyperkalemia, and weakness, you may suffer from ARF or Acute Renal Failure. In this condition, the kidney cannot excrete the daily metabolic wastes. This condition will take long, from a few days to several months, and you have to see a doctor.
The dietitians will calculate the energy needed to stop the weight loss due to control the appetite, elevate the fluids and electrolytes, and medical nutrition therapy for malnutrition, edema, hypertension, and uremia. We consider a high-calorie low protein diet for non-dialysis patients. Still, there are other medical nutrition therapies for dialysis patients. For more information, you can contact our nutritionists.

A nephrotic syndrome is a group of diseases that increase the exertion of protein from kidneys. This disease's symptoms are protein exertion, edema, high cholesterol, high levels of fats in the blood, and disorders in bone metabolism.
The dietitians will design a low protein diet as a kidney diet for this group of patients. A vegan diet and a low protein soy-based diet can help chronic kidney disease.

Stages of chronic kidney diseases(CKD):
Stage 1: Kidney damage, Normal or increase in function of the kidney
Stage 2: Mild decrease in kidney function
Stage 3: Moderate decrease in kidney function
Stage 4: Severe decrease in kidney function
Stage 5: kidney failure or End-Stage Renal Disease (ESRD)

The first and second stages do not need any Medical Nutrition therapy, but the nutritionist can do some nutrients management. The renal diet can be used for stages 3,4, and 5.
The dietitians reduce and restrict the protein intake in the kidney diet to stop the progress of renal failure. Hypertension can improve kidney failure, so it should be treated, and the management should be done in the kidney diet for the patient. Controlling Carbs (mainly glucose) should be done in the kidney diet to lower kidney failure.

In the end stage of renal disease (ESRD) patient suffers from a multifactor disease, not only on illness. Patients experience diabetes, glomerulonephritis, and hypertension at a time. If the signs of uremia syndrome appear, the patient may need a kidney transplant to cure the ESRD. Therefore, we need a diet designed for after transplantation, especially a high-protein diet besides moderate restriction of sodium.

What are the aims of nutrition therapy and kidney diet for ESRD?
Preventing nutritional deficiencies, especially for the children, provides nutrients needed for their growth by calculating the excellent protein, energy, vitamin, and mineral intake.
Control of edema or swelling in the lower part of the body
Maintenance of fluids and electrolytes such as Sodium, Potassium
Control of Calcium, Phosphorous, and Vitamin D intake.

What causes CKD?

The most important causes of chronic renal failure are diabetes, hypertension, glomerulonephritis, and polycystic kidney disease.
Besides medication and treatments, lifestyle changes and a proper kidney diet can help control the major causes of chronic kidney disease.

Due to the advanced medical science and increasing awareness of human health, the role of diet and healthy nutrition in our health becomes more apparent. The vital role of healthy nutrition in preventing and controlling diseases such as diabetes, hypertension, cardiovascular problems, lipid problems, cancers, and many other diseases has been proven today. Attention to the role of nutrition in maintaining health is increasing. It is increasing.
Most of the waste produced in the body comes from food. If the kidneys are healthy, we will not have a problem in purifying and filtration of the. If the kidneys are damaged, they lose their ability to respond to dietary changes and waste products and toxins accumulation in the patient's body.
Contrary to popular belief that nutrition is often considered simple and easy to change, diet control and adaptation are especially complex for patients. A nutritionist or renal dietitian must be available. The nutritionist uses special tools such as weight, height, test results, clinical evaluation of the patient, and consultation with the doctor to adjust the patient's diet and guide it according to his health. Many nutritional recommendations that may be appropriate for healthy people can be very inappropriate and harmful for certain people with certain diseases and conditions.
Nutrient intake is often inadequate in kidney patients, which can be attributed to a stringent kidney diet, nutritional restrictions imposed by the disease, and anorexia.
Inadequate nutritional awareness is critical in kidney and dialysis patients.

Potential causes in developing renal failure:
♦ Hypertension
♦ High-protein diet
♦ Diet rich in phosphorous
♦ High-fat diet and high in cholesterol
♦ High level of serum Oxalate
♦ High level of Uric acid in serum.

Managing nutrients and electrolytes in the kidney diet

Most kidney diets for kidney patients are low in salt, low in potassium, low in phosphorus, and limited fluid and protein intake. following is all thing that you should know about kidney diet:


Kidney diet Calorie and Energy:

Kidney patients do not need to limit energy intake, but management, modifying, assurance, and energy supply have a crucial role in designing the kidney diet.
Nutritionists and kidney dietitians can help patients to determine the proper energy needed for each person. Malnutrition is common among kidney patients, and it is associated with longevity, quality of life, and life expectancy. It should be noted that kidney patients' diet energy should not exceed the required amount because of being overweight. Obese are the main causes of high blood pressure, diabetes, and atherosclerosis, which are the underlying causes of kidney disease. In general, monitoring the nutritional status of kidney patients plays an important role in their health status because malnutrition in both forms (underweight and obesity and overweight) is dangerous for them.
The amount of energy depends on the kidney patient's nutritional status and stress level 25-40 kcal/kg of bodyweight. Dietitians consider less energy for transplant and Peritoneal Dialysis Patients.


Amount of Carbohydrates in kidney disease diet:

One of the primary sources in the diet of kidney patients is carbohydrates. You should pay attention to the type of carbohydrates and amount of them because the excessive consumption of simple carbs is harmful to diabetic patients. They are also a risk factor for people in the condition of prediabetes. So, it is better to consider more complex sources of Carbs such as cereals, starchy vegetables, and fruits.


How much proteins you should eat on kidney diet?

The major problem for kidney patients and the most crucial component in the kidney diet is proteins, due to the excretion of protein in the urine.
Most people think that a kidney patient should not eat protein. Still, it should be noted that inappropriate restriction of protein intake in kidney patients can lead to malnutrition. Incorrect restriction of protein intake in children, in addition to malnutrition, also leads to stunted growth. The amount of protein in the diet of kidney patients should be enough to meet the patient's daily needs for protein and at the same time not more than the daily requirement of the person to prevent increased pressure on the kidneys. Therefore, it is recommended that patients avoid the arbitrary restriction of protein sources and consult a nutritionist.
The important point in providing the protein required by the person in the kidney patient's diet is that this protein should be supplied from its appropriate sources according to other restrictions required by the patient.
At least 50% of protein intake should be from high biological value (HBV) proteins that our nutritionist will consider in the kidney diet.


Fats intake in kidney diet:

Fats are the source of energy. Most kidney patients have hyperlipidemia, which is one of the leading causes of atherosclerosis (stiffness of the arteries' walls). It is necessary to pay attention to the type of fat consumed in the diet of these patients.
Fat is an energy source in the diet of kidney patients. A deficient intake of fat has side effects similar to excessive intake. Content of fat in the kidney diet should be unsaturated fats, especially olive oil and canola oil.
It is necessary to pay attention to the cooking and food preparation methods to prepare food for kidney patients and the type of fat consumed. It is better to use often boiled and steamed foods in kidney patients' diets because fried foods include oxidants and toxins. Increased oxidants in the body are the main underlying factor in the occurrence of cardiovascular problems. One of the best ways to control toxins and oxidants' intake in the diet is to avoid fried foods.


Potassium (K):

The amount of K in the body depends on the amount of K in serum, urine, the number of dialysis sessions, and body size.
Excessive accumulation of potassium in these patients should be prevented. The best way to reduce potassium intake is through a kidney diet and dialysis. The most common reason for high potassium levels in kidney patients is high potassium foods, including oranges, orange juice, tomatoes, bananas, salt substitutes that contain potassium chloride, etc.
The high level of potassium in serum has some side effects; that the most important one is heart strokes. Therefore, the serum level of potassium in kidney patients is essential and should be controlled and monitored carefully.
If the K of serum is high, consuming foods low in K is recommended, and the daily intake should be restricted to 2000 mg.
A low potassium level can occur after diarrhea, vomiting, using laxatives, and loss of appetite.

5 recommendations to reduce potassium intake in the kidney diet:

♦ Avoid using salts containing potassium that hypertension patients use.
♦ Vegetables and fruits have a high potassium level, and it is better to use low-potassium levels.
♦ Legumes are rich in phosphorus and also potassium so, soaking them in water can reduce their content.
♦ The meat group is high in potassium. The kidney patients should receive the exact portions recommended by the nutritionist and avoid consuming these substances arbitrarily in the kidney diet.
♦ Refined cereals contain less potassium and phosphorus than whole grains.


Sodium (Na):

Sodium is a vital electrolyte for the body and interacts with the amount of potassium in the blood.
If the level of Sodium intake is high, it should be limited during the diet. If the level is very low, the excretion of sodium should be controlled. The kidneys have a crucial role in balancing the amount of sodium.
The main part of the sodium diet comes from salt's daily consumption, which is in the foods or added to them while providing meals. If the kidneys do not work correctly, excess sodium may stack up in the blood, and the patient becomes dehydrated.
if the amount of sodium is high, salty foods' consumption should be restricted and limited, and the fluids intake should be increased.
You can use 2-3 g/day (a normal diet without added salt).


5 recommendations to reduce sodium intake in the kidney diet:

♦ Reduction in salt intake in your kidney diet.
♦ Add lemon juice to foods bring flavours.
♦ Avoid broth for kidney patients in their kidney diet.
♦ Avoid processed foods, fast foods, canes, pickles, chips.
♦ Look for food labels on the products and check the amount of its content.


Phosphorous:

<17 mg/kg body weight/day
Phosphorus is one of the electrolytes that accumulates in the blood. Its level will rise when the kidneys are unable to filter the blood. An increase in the level of phosphorus in the blood is equivalent to a decrease in the level of calcium in the blood because they can affect each other. The decrease in the calcium level in the blood leads to the stimulation of the secretion of parathyroid hormone. This hormone accelerates the release of calcium from the bones, which can cause weakness of bones and eventually osteoporosis. Therefore, controlling the intake of phosphorus in the kidney diet is an essential point for kidney patients. As a result, the better the serum phosphorus level o patients is controlled, the less likely these complications are.
If the content was high, the restriction in dairy products is recommended.
Phosphorus-binding drugs are prescribed for almost all kidney patients by doctors to prevent an increase in phosphorus concentration in the blood. This supplement is taken with food and binds to the phosphorus to avoid dietary phosphorus absorption in the gastrointestinal tract.
These drugs prevent the absorption of dietary phosphorus in the gut and make calcium deficiency up to kidney patients. Milk and dairy products are significant dietary calcium sources because of the reduction in phosphorus; milk and dairy intake are limited. It should be noted that taking this drug supplement must along with main meals. Taking them alone or in between meals will make it useless or lower the drug's effect.
In cases where the level of phosphorus in the blood is higher than normal, calcium carbonate intake should be stopped to prevent calcium phosphate's deposition in the tissues under medical care.
The second way to control serum phosphorus levels is to control its intake through diet. The patient should consult a nutritionist and dietitian to establish a proper diet for kidney disease, become familiar with phosphorus's primary dietary sources, and avoid overeating.


Iron:

Due to the anemia, erythropoietin injection can adjust this condition.
Aluminum toxicity and severe constipation are very common in kidney patients, so some medications are needed.


Vitamins:

Kidney patients need different vitamins.
Restriction of P and K can cause folate, B2, B3, B6 deficiencies.
Some supplementation is required.
Vitamin E supplementation may be needed.


Fluids:

The human body can excrete water in many ways. Urine, sweating, feces, evaporation from the skin, and also through the respiratory system. The main way of excreting water through the kidney is through urine. If the kidneys do not do their jobs properly, the amount of water in the body rises. This condition has some complications such as swelling and edema in the lower part of the body, increased blood pressure and hypertension, water entrance and penetration to lungs, and shortness of breath.
There is no need to limit and restrict water intake in kidney patients until a decrease in urine excretion.

Recommendation to control fluid intake in kidney diet:

♦ Drink liquids cup without any rush.
♦ Eating cold fruits and veggies or in icy form can reduce thirst.
♦ All liquids milk, juices, soups, teas, coffee, liquid foods, etc., should be considered and calculated carefully by the renal dietitians.
♦ Salt intake should be monitored because high-sodium foods can increase water intake subsequently.

Diet for Kidney transplantation

Kidney transplantation is divided into two stages, acute and chronic.
The first two months after kidney transplantation surgery is called the Acute stage, and one or two months after that is the chronic state. Each stage requires its special diet. Based on the medical condition, the patient may not be able to eat immediately after surgery, so intravenous feeding or liquid diets may be used. In the acute phase after kidney transplant surgery, when the patient can use the everyday foods in his diet, the kidney diet will be designed. It is up to the nutritionist and dietitian to calculate each nutrient's amount and adjust how to receive it.
As long as the patient is hospitalized, the fluid intake needs to be calculated and consistent with the person's urine. When the patient is discharged, except in special cases, there is no need for fluid restriction, and the patient can respond to feelings.
There is another diet due to the chronic stage's condition, and the renal dietitians can change the diet.
The side effects of the used drugs should be controlled in both the kidney's acute and chronic phases. The first complication of taking these drugs is the weakness of the body's defences, so the patient should use healthy foods in the kidney diet as much as possible. These drugs also retain water and salt in the body. The accumulation of excess water and salt in the body raises blood pressure. High blood pressure itself is a major damaging factor to the kidneys.
These patients should control their salt intake through diet. Taking these medications may increase blood sugar and appetite, and the patient should also be aware of significant weight gain and loss. Lipid abnormalities and high levels of blood lipids (cholesterol and triglycerides) are common in patients undergoing transplantation.

Therefore, it is necessary and useful to pay attention to the following recommendations:
♦ The kidney diet should be regular and balanced.
♦ Paying attention to the type of fats in the diet.
♦ Avoid animal sources of fats
♦ The ways of preparing meals
♦ Weight control due to hospitalization and low activity.
♦ Using natural and unprocessed foods
♦ Controlling blood pressure and fluid and electrolyte intake.
♦ Avoid sour and salty foods

Let us know if you have any questions or comments.