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For Kidney Failure Patients

What you eat is as important as how much you eat and how you eat. If proper diet is essential for a healthy life it is mandatory for a sick person. The importance of nutrition for renal patient has grown, a need has arised for a dietary guide which is simple and concise to enable you to plan your diet and have variety in your diets.

DIETARY                                     MANAGEMENT

1. KIDNEY
2. PROTEIN
3. PHOSPHATE
4. CALCIUM
5. SODIUM
6. POTASSIUM

HOW TO MANAGE FLUID BALANCE

1. WHY DO I NEED TO CONTROL MY FLUIDS ?
2. HOW CAN I BALANCE MY FLUIDS ?
3. HOW DO I KNOW IF I HAVE TOO MUCH FLUID ?

 TIPS

DIET GUIDE

TABLE-1 : MINERALS, THEIR FUNCTIONS AND SOURCES
TABLE - 2 & 3 : DAILY DIETARY INTAKE FOR DIALYSIS PATIENT

DIETARY MANAGEMENT

1. Kidney

The food we eat is metabolised and utilised by the body and in the process waste products are produced. Kidney plays a major role in getting rid of these waste products. In addition, kidney has several other important functions such as maintaining an ideal internal environment, production of hormones etc.

Healthy kidney has enormous reserve and can cope with tremendous amount of work load. hence, we easy escape from most of the dietary indiscretions we indulge in. However, when the kidney fail, they cannot cope with even the normal workload. That is why patients with renal diseases are especially advised about their diet. By following such diet, the rate of progression of kidney failure can be decreased and several complications could be avoided. For example, excessive intake of protein may worsen kidney functions. extra salt intake will lead to high blood pressure or accumulation of water in the body.

For these reasons the nephrologists (Kidney specialist) advice special diet for their patients. How do we know what food preparation contains the forbidden items and how much of the common food items we could eat without developing complications? 

The main nutrients involved in the dietary management are protein, calcium, sodium, potassium and fluids.

2. Protein

The body requires protein for growth, maintenance and repair of body tissues. It is present in almost all the foods but the quantity and quality varies.

The proteins in the diet are digested and metabolized. The major end product of protein metabolism is urea, which is eliminated by the kidneys. In renal diseases the kidneys do not function effectively so that urea and other metabolic end products tend to accumulate in the blood. Controlling the amount and kind of protein in the diet helps to minimize the various symptoms, which arises due to accumulation of urea.

If you are on dialysis some protein is 'washed out' of your blood. You need to replace them by taking plenty of high protein foods.  

Good sources of protein are:
Meat – Chicken, Pork, Turkey, Lamb
Fish – White fish, e.g. cod and haddock, Tuna fish  
Cottage cheese – Natural or with chives or pineapple.

Eggs and milk are also rich in protein but must not be taken in excess as they are also high in phosphate. Cheese, another high protein food, should be avoided because it's high phosphate content.  

3. Phosphate

Phosphorus is a mineral that helps to maintain strong bones. the level of phosphorus is controlled by your kidneys in your bone. Over a period of time, extra phosphate in the blood can affect your bone, and make them more brittle and likely to break. Keeping a normal blood phosphorus level is important to prevent bone damage. High phosphorus levels can also cause calcium deposits, as it forms calcium phosphate and precipitate.  

If labs tests show that your phosphate is too high, you should limit the amount of food you eat that are rich in phosphate such as: milk based foods-yogurt, milk shakes, pudding. Meats, eggs, legumes and bran cereals also have high amounts of phosphorus.

Foods to avoid:
Salmon, fish roe and shellfish.  
Hard cheese, e.g Cheedar.  
Cheese spreads.  
Yoghurt, ice-cream, milk puddings (unless exchanged for an equal amount of milk)  
Nuts, Chocolate, Toffee and Fudge.  
Malted milk drinks, Drinking chocolate.  
Foods containing a lot of backing powder, e.g. scones.

Foods to restrict:  
Milk – 285 ml per day  
Eggs – 6 per week  
Egg whites, e.g. meringue, can be taken freely.

Your doctor may prescribe some medication to help keep you phosphate level down. These are called 'blinders'. It is important that you take your blinders everyday as directed by your doctor.

Over a long period of time your bones will slowly get weaker if you allow to much phosphate to build up in your body. This is because extra phosphate takes calcium out of bones. You probably will not notice your bones getting weaker right away, but as you get alder they can become brittle and break.

4. Calcium  

Calcium is one of the vital elements in your body. It is essential for bone formation, maintenance of muscle and skeletal system and several physiological activities at the cellular level. The total body content of calcium in a healthy person is about approximately 1 kg. About 99% of this is in the human skeleton (bone and teeth)  

In the renal patient due to excess of phosphorus in blood leads to precipitation of calcium. This in turn leads to resorption of calcium from bone and weakening of bones. Due to which it is also required that you should maintain proper phosphorus and calcium intake.  

5.Sodium

Sodium or salt, is used to hold water in the body. The kidneys normally help the body to keep just the right amount of sodium needed. the right amount of sodium keeps the right amount of water in the body. Your kidneys may no longer be able to remove any extra sodium from your body, so there may be too much sodium in your blood.

Too much sodium in the blood can cause the body to hold too much water. The extra water causes fluid weight gain, high blood pressure, puffy skin swelling in legs and ankles, and difficulty in breathing.  

Normally recommended salt intake is 3-4 gm daily. Remember that eating foods with lot of sodium (salt) will make you thirsty. When you are thirsty, it is difficult to control the amount of fluid you drink!

Never use a salt substitute – they usually contain potassium! (And you do not want to eat extra potassium) When you are cooking, try adding herbs and spices for flovour instead of salt. Avoid using salt at the table.

  Excessive salt intake leads to: 
  Excessive thirst 
   Retention of fluid in the body  
   Cardiac failur (heart failure)  
   Aggravation of hyertention

Foods with high sodium:  
The following foods are high in sodium content and should be avoided.  

Food with moderate sodium:  
Moderate amount of sodium are found in the following foods and should be taken in restricted quantities:

Milk and Curds  
Pulses and legumes – all varieties  
Vegetables (radish, cauliflower, lettuce, beet-root, coriander leaves, spinach, green mango, green tomato)

6.  Potassium

Potassium like sodium helps with nerve activity, muscle contractions and fluid balance. When kidney are not working, potassium levels will build up in the blood. This can be dangerous. Too much potassium can cause muscle weakness, since your heart is a muscle, high potassium levels could cause it to beat abnormally or to stop. There are no warning signs of having high potassium levels in the blood.

High Potassium foods:

Fruit – Apricots, Bananas, Dried Fruits, Kiwi Fruit, Oranges, Rhubarb, Grapefruit.  
Vegetables – Chips, Crisps, Jacket potatoes, roast potatoes, spinach, mushrooms.  
Drinks – Beer, Cider, Wine, Coffee, Fruit juices, Tomato juice, Bovril, Marmite.

Potassium can be controlled by the foods you eat. Potassium is found in almost all foods. Fats and sugars are the only potassium free foods. Milk, Bananas, potatoes, oranges, tomatoes and dried beans are high in potassium. Salt substitute and sodium free baking powder are also very high in potassium.  

The amount of potassium your body can handle depends on your level of kidney funtion. Your doctor will prescribe the amount that is right for you, and a dietitian will help you to plan changes in the food you eat.  

If your potassium is too low, you many need to eat more foods that are high in potassium.  

With a few changes to your normal diet, you can have a wide variety of healthy and tasty meals!

How to Manage Fluid Balance 

1. Why do I need to control my fluids?  

Healthy kidneys balance the amount of fluid in your body by removing the extra water from your blood. When your kidneys were healthy, if you drink a lot of fluid, your kidneys would produce more urine to get rid of it.  

Because your kidneys are no longer able to control the fluid in your body, you need to take control. Having too much or too little fluid inside you is not healthy and will make you feel sick. Peritoneal Dialysis will help remove the extra fluid in your body. But it is up to you to make sure that PD is removing the right amount of fluid. You have to help PD. You need to pay attention to how you are feeling and know how to manage your fluid balance.  

2.  How can I balance my fluids?  

a. Pay attention to your weight:  

One way of controlling or measuring the amount of fluid in your body is to weigh yourself. Your total weight is made up of two things: Body Weights and Fluid Weight.  

Body Weight is all the solids things in your body like bones, muscles, and fat. Body Weight is what goes up when you eat too much. Body Weight should stay almost the same every day unless you start eating too much and you gradually gain weight.  

Fluid Weight is the part of your body that is liquid, not solid. Your body tissues are actually full of fluids and your blood is fluid. When you weigh yourself on a scale, your total weight is partly Fluid Weight and partly Body Weight.

Fluid weight rises as you drink more. For example, say you put a jug of water on your scale and saw that it weight 2 kg. If you were able to drink all of that water and then stood on the scale, you would now weigh 2 kg more than you did before you drank the water.  

When kidneys are healthy, they turn extra water into urine and it passes out of the body. Another way some extra water leaves the body is by sweating. But now that your kidneys are not working properly you have to be careful not to add too much fluid weight. This is because your body cannot get rid of some extra fluid, but not as well as your kidneys used to.

a.   Body Weight vs. Fluid Weight  

If you stand on the scale and read your weight, how do you know how much is Body Weight and how much is Fluid Weight?  

Your total weight should remain about the same everyday. If your weight rises by a lot one day, that means too much Fluid Weight. Excess Fluid Weight can cause puffy ankles or puffy eyes and breathlessness. If your weight goes up a little bit each week, and you do not feel puffy or short to breath, you are probably adding Body Weight. If you have too much Body Weight you might want to go on a diet.  

Daily weight: In order to control your fluid Weight it is very important to weigh yourself everyday. Try to weigh yourself at the same time everyday, with clothing of a similar weight. You should record your weight everyday so that you can notice if it is changing very much. If your weight changes a lot one day, you will know that Fluid Weight has changed.  

b. Watch for puffy skin

Watching out puffy skin is a way of controlling your own fluid balance. As more fluids builds up inside you it may not stay in the blood vessels. Instead it moves into the tissues under your skin. This condition is called 'edema'. You will notice puffy skin means you have too much fluid in your weight.  

3. How do I know if I have too much fluid?

You may hear the term 'fluid overload' used. This means too much fluid in your body. You know some of the signs of extra fluid in the body are:  

Increased weight  
Puffy skin around eyes, ankles, fingers  
Higher than normal blood pressure 

If you do not get rid of the extra fluid it may lead to: 

Feeling short of breath 

If the amount of excess fluid in your body increases too much, your lungs can become filled up with water. This will cause you to feel short of breath, or like you can't get enough air. This is felt most at night when you lie down.

TIPS     

• Adequate calorie intake is very important.

• At least 50% of prescribed protein should be of high biological value and should be distributed in     all the meals for better utilization.

• Vegetables and Pulses should be taken after leaching potassium.

• Prescribed amounts of salts should be used for cooking or on the table.

• Intake of fluids should be restricted to the prescribed amount.

• Foods high in sodium and Potassium should be avoided.

  Note:  Direction for leaching Potassium. 'Wash [in warm water], peel and cut vegetables into small pieces. Soak in warm water for 2-3 hours. Discard water. Add large volume of fresh water and cook vegetables. Discard water.'

DIET GUIDE   

A Guide For Managing Your Diet 

Every month during your clinic visit, you will have lab tests taken to make sure your diet and dialysis (Hemodialysis / Peritoneal dialysis) are working properly to keep your body in balance. 

These are some things which your doctor will measure in your blood every month:  

Albumin: Normal Value - 3.5 - 5.3 g/dL

Complications: When albumin is too low it means you are not eating enough protein. You could become malnourished.

Foods high in protein:  Meat, eggs, fish, poultry etc.

Phosphate: Normal Value - 108 - 300 U/L

Complications: Too high can make your bones weak and break easily, can cause itchy skin, and mineral build up in        tissues. Too low can cause weak muscles and bones.  

Foods high in phosphate:   Milk, diary products, nuts, colas etc.  

Potassium: Normal Values - 3.5 - 5 MEq/L

Complications:   Too high or too low can cause irregular heart beats and other muscles weakness. 

Foods high in Potassium:   tomatoes, potatoes, bananas, broccoli, citrus fruit and juice etc.

Sodium: Normal Values - 135.0 - 148.0 MEq/L            

Complications: Sodium (salt) causes body to hold water. Too much sodium can cause fluid overload. Too little sodium can cause dehydration.

Foods high in sodium:             Bacon, ham, pretzels, potato chips, canned tuna, Chinese meals etc.

TABLE-1 : MINERALS, THEIR FUNCTIONS AND SOURCE