Chronic Kidney Disease is characterised by progressive and irreversible loss of kidney function which occurs over a period of months or years. Ignoring chronic kidney disease leads to end-stage renal failure which requires dialysis or kidney transplantation. Adapting to a personalised diet for chronic kidney disease helps to prolong reaching end-stage renal failure through improvement in the patient’s nutritional status and compensation for the ongoing catabolic events.
Considerations ~ Diet for Chronic Kidney Disease
- Personalised Modifications for patients undergoing dialysis are recommended in the following dietary aspects: calories, protein, sodium, potassium, phosphorus, calcium, fluids, carbohydrates, and cholesterol (fat).
- Ideal Caloric Intake for adults undergoing dialysis = 35kcal/kg for individuals up to 60 years old; 30kcal/kg for individuals from 60 years old and for obese individuals.
- Blood serum levels should be checked every few months so any diet-related adjustments are made earlier on.
A Diet for Chronic Kidney Disease requires ongoing monitoring of the patient’s Lab Results, Oral Intake, Nutritional Supplements, Dietary Reviews and Changes based on patient’s needs and results & most importantly Compliance to Medication and Diet.
Proteins
Proteins provide energy and help fight infection whilst maintaining fluid balance within the blood.
Proteins with high biological value = meat, fish, eggs, poultry, tofu, soya milk & dairy (beef/red meat is better than chicken for patients with kidney failure).
Proteins with low biological value = bread, grains, vegetables, dried beans, peas & fruit.
Phosphorus
Phosphorus helps build strong healthy bones whilst maintaining health within other parts of the body. It is found in almost all foods. In chronic kidney disease, the balancing of phosphorus during the kidneys’ filtering process is impaired, leading to an increase of phosphorus in the blood.
In a diet for chronic renal disease, high-phosphorus foods which include dairy products, dried beans and peas, nuts, bran cereals, whole wheat bread, meats, peanut butter and food additives should be limited or avoided as much as possible. Dietary intake of phosphorus in patients with chronic kidney disease should not exceed 1.5g per day.
Potassium
Potassium has an important role in heartbeat regulation. Potassium level should be monitored so hyperkalemia is avoided as this may lead to a myocardial infarction a.k.a. heart attack.
In a diet for chronic kidney disease, the dietary goal for potassium is between 2-3g per day. High-Potassium foods such as prunes, oranges, bananas, potatoes, tomatoes, brussel sprouts, spinach, beets, dried foods and milk should be avoided.
Sodium
Sodium has an important role in nerve and muscle function, as well as promotes water and electrolyte balance within the body. However, too much sodium in the blood may lead to hypertension and congestive heart failure.
In patients with chronic kidney disease, special attention should be given in controlling sodium intake. Patients on haemodialysis should consume between 2-4g of sodium per day. It is good to keep in mind that 1 teaspoon of salt contains 2000mg of sodium, thus, foods that are high in sodium such as processed and deli meats, canned soups and salty snacks should be avoided.
Fluids
For a patient undergoing dialysis, fluid intake should be measured so the recommended intake amount is not exceeded. For patients undergoing haemodialysis, recommended fluid intake should take into consideration any fluid gains, blood pressure, and residual renal function. As for patients undergoing peritoneal dialysis, recommended fluid intake should be based on patient tolerance and minimum use of hypertonic solution for fluid balance maintenance.
Fluids include all drinks and foods that become liquid at room temperature, i.e. water, coffee and tea, soda, soups, juices, and jelly. Total intake of such fluids cannot exceed the individualised recommended amount which is usually between 1.5-2ltr per day.
Patients with kidney failure cannot get rid of extra fluid in their body, and so, the recommended daily intake shouldn’t be exceeded since extra fluid in patients with kidney failure results in oedema.
Calcium
Calcium in the body helps in building and maintaining strong bones, and has a role in the correct functioning of the nerves and muscles, including the heart.
Patients undergoing haemodialysis require balance, which is determined by the dietary calcium intake, vitamin D therapy, dialysate calcium levels, calcium supplements and calcium-based binders, as well as the monitoring of Parathormone or Parathyrin (hormone that regulates serum calcium concentration) by the physician.
Carbohydrates
Carbohydrates are nutrients which the body converts into glucose to produce energy for body function.
In patients with diabetes and chronic kidney disease, the ideal HgA1C is usually less than 7%.
Cholesterol
Cholesterol helps the body produce cell membranes, hormones and vitamin D. Too much cholesterol however may lead to cardiovascular disease, which incidentally is the most frequent cause of death in patients with kidney disease.
A diet for chronic kidney disease should take into consideration the individual’s metabolic profile, nutritional status, energy deficits, along with any other treatment goals.
Fast Foods, Italian & Asian foods
FAST FOODS
- Fast foods are high in sodium content as they are usually pre-salted;
- Fast food fries and baked potatoes are high in potassium – chronic kidney failure patients should ask for smaller and (if possible) unsalted servings;
- Sauces, condiments and dressings should be avoided as these are high in sodium;
- Balancing fast food with other food choices is recommended- ideally one should opt for healthier options in the day’s additional meals;
- Broiled, steamed and grilled items are better options when compared to deep fried foods;
- Larger-sized beverages should be avoided as these may lead to fluid overload
- Removing the skin from fast foods reduces the fat and sodium content
ITALIAN CUISINE
- The Italian cuisine has a lot of foods to offer for patients on a diet for chronic kidney disease;
- Red sauces contain potassium;
- White sauces contain a high amount of phosphorus;
- Pesto is made of garlic, basil and oil, making it an ideal choice;
- With salads or breads, one should ask for no olives and cheese, and request the dressing on the side;
- Pasta dishes like lasagna, cannelloni and ravioli should be avoided since these are high in sodium, high in potassium and high in phosphorus.
ASIAN CUISINE
- Asian cuisine typically contains a high amount of sodium. Asian soups and broth-cooked noodles should be avoided;
- Chinese foods typically contain a large amount of sauces and condiments which are high in sodium and MSG (Monosodium Glutamate – water, sodium and glutamate). Ideal Asian food choices in a diet for chronic kidney disease include egg rolls, steamed rice, and stir-fry vegetable dishes without sauces;
- Japanese foods typically contain more spices but less sodium. Ideal Japanese food choices in a diet for chronic kidney disease include sashimi and sushi (avoid california rolls with avocado), and grilled fish or chicken without sauces;
- Thai foods typically contain more spices but less sodium. Ideal Thai food choices in a diet for chronic kidney disease include spring rolls, steamed rice, and grilled fish and chicken dishes without sauces.
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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