Patients who are diagnosed with CKD but not on dialysis need to be extremely careful about their diet. Remember, whatever one eats is adding up to the waste product which kidney is unable to filter out. Do consult a good dietitian to get a meal plan to ensure you have enough nutrition but at the same time the kidney is able to filter out the unwanted toxins from your body. Consuming more protein leads to overworked kidneys which can cause more damages. Therefore, eating less protein helps to preserve kidney function and prevent additional stress on the kidneys. Your dietitian or doctor will tell you how much of protein you need to consume a day.
High protein diet is a strict NO for pre dialysis CKD patients. Avoid red meat (mutton), yellow lentils (masoor daal) which are rich in protein. Table salt intake should be very low. Remember, sodium and potassium can play havoc to your body. So go slow on all such items which are difficult to digest. have satwik aahar. If doctor suggests avoiding milk, milk products, then follow the same strictly. Kidneys maintain electrolyte balance in the body which includes sodium, potassium, magnesium, chloride, bicarbonate, calcium and phosphate, to name a few. For this reason it is important to restrict electrolytes like sodium, potassium, phosphate, bicarbonate in dietary form. Please read electrolyte imbalance section to know more.
The following points are considered, along with test results and lifestyle:
- Protein in the diet
- The waste products from protein such as urea
- The calories needed from fat and carbohydrate. Too much and weight is put on. Not enough and the body may start to break down muscle for energy needs
- Amounts of minerals and salt eaten: both sodium salt (table salt) and potassium salt (salt substitutes)
- The management of calcium, phosphate and vitamin D taken in the diet, to prevent bone disease
- Fluid intake, so the body has enough, without suffering from fluid overload
- This becomes more important when urine output is reduced in the later stages of chronic kidney disease
The following information shall be more insightful.
Restricted Protein intake
Even though the impaired kidneys are able to function in the earlier stages of CKD, they still have a tough time to remove all waste products from the body. Consuming more protein leads to overworked kidneys which can cause more damages. Therefore, eating less protein helps to preserve kidney function and prevent additional stress on the kidneys. People of different ages and sizes, children, pregnant women and lactating mothers, malnourished, post surgery patients, ill patients, all have different protein requirement. A dietitian or doctor will tell how much of protein is required by a patient per day and whether diet should be sufficed with supplements to fulfill protein requirement. Suitable foods high in protein include: meat, fish, poultry, eggs, cheese, milk, milk products, nuts and pulses legumes (after discussion with the dietician).
The pros and cons of dietary protein restriction to alleviate symptoms of uraemia (high urea levels in the blood), before dialysis starts should be discussed with your doctor and renal dietitian. Monitoring of your nutritional intake is essential when a protein restricted diet is prescribed to prevent under nutrition. Sometimes a spontaneous reduction in protein intake will occur and needs to be corrected
Restricted Sodium intake
Salt (a major source of sodium) is commonly thought of as table salt, but ‘salts’ can include potassium as a ‘salt’ substitute. The recommended daily intake for salt is six grams. Reducing salt intake lowers high blood pressure and reduces the risk of a stroke or heart attack. Lowering blood pressure can also slow down decline in kidney function. Even if salt is not added during cooking, sodium is found in various food sources as it is naturally found in different types of foods, more commonly in packaged and processed foods. Sodium is like-hydrated sponge that absorbs fluid. It makes you feel thirsty. As a result, weight gain from fluid arises leading to increase in blood pressure. Sodium restriction in kidney disease helps to maintain normal fluid balance. In order to limit sodium in your diet,
- Limit the salt added to cooking
- Minimise the usage of preserved food.
- Use fresh herbs and whole spices in replace of salt in cooking
- Use fresh lime, lemon juice or vinegar to flavour food instead of spices
Note: Some low sodium/ substitutes are available in the market which is recommended for reducing sodium intake. However, such sodium substitutes are high in potassium, which is again an electrolyte and kidney patients may suffer hyperkalemia if potassium levels increase in the blood.
Restricted Potassium intake:
If potassium levels in the body are too high, hyperkalemia can result. Hyperkalemia is a potentially dangerous disturbance of the heart rhythm. Potassium requirement varies in different stages of CKD. Potassium is a mineral which is important for nerves and muscles function. Potassium in blood needs to be maintained at a safe level. Excessive potassium level in the blood can cause muscle weakness, abnormal heart rates and in extreme cases, heart failure. It is good to avoid food rich in high potassium. In general, glazy and shining texture food, fish, etc are high in potassium. Some high potassium food are corn flakes, muesli, biscuits, nuts, chocolate, cocoa, peanut butter, coconut, coconut milk, juices of fruits or vegetables, hilsa fish, tea, coffee, milk, wine, tomato ketchup, bottled and canned food, etc. Remember some food products which are advertised as low in sodium are actually very high in potassium. So be sure when you buy your groceries, check if low sodium is compromised with high potassium. Potassium can be reduced during the preparation of vegetables by leaching or soaking. Once leached, the potassium content will be lower than pre-preparation.
Restricted Phosphate intake
As the kidneys become less effective at filtering waste products, blood phosphate level rises. When it begins to build up in the blood, calcium is drawn from the bone. The calcium phosphate product forms hard deposits in patients’ tissues leading to skin itchiness, joint pain, eye irritation and hardening blood vessels. Overtime, patients’ bones become weak and brittle. This may lead to fractures and constant pain. CKD patients who do not require dialysis may need to restrict phosphate intake in their diet as their Glomerular Filtration Rate (GFR) decreases and blood tests show higher phosphate levels. Phosphorous rich food products should be avoided like sea food, dairy products, malt, soups, beans, etc.
Phosphate, Calcium and Vitamin D: Phosphate, calcium and vitamin D are important for bone formation. Healthy kidneys make vitamin D mainly from sunlight available and the food we eat (eggs, fish, animal protein, green vegetables, soy). Failing kidneys often cannot convert enough vitamin D. This is how renal bone disease and other abnormalities begin. Once levels of vitamin D are too low, calcium levels in the blood drop. Falling calcium levels prompt the parathyroid gland to make more parathyroid hormone, which removes more calcium from the bones. This disturbs the balance between calcium, phosphate and vitamin D. Calcium and phosphate then start to deposit in other parts of the body, like the blood vessels, heart, joints and skin. These changes begin early in chronic kidney disease. If such changes are identified, one must visit the doctor and make necessary dietary changes. It is during stages three to five of kidney failure that phosphate balance becomes much more important
Note: The best way is to strictly avoid all refined food products like refined oil, refined sugar, refined flour, refined rice, stored and canned products, pasteurized , processed, preservative based products and intake fresh food cooked in very low oil and spice in small quantities. Most foods have sodium, potassium and phosphorous. The only possible way to keep at bay is to decrease potion size and create diversity in meals. It is strongly recommended to consult a registered dietician and nutritionist to guide you and provide a proper meal plan.
Restricted diet for controlling lipid profile:
Kidney patients are always at a higher risk of cardiovascular disease (CVD). It is important to keep in check cholesterol, triglyceride levels in the blood to control blood pressure. High lipid levels in the bloodstream (hyperlipidemia) are common in kidney patients. Prevention of obesity, daily activities like exercise, walking, running, swimming, playing badminton, table tennis, aerobic exercises helps a lot in addition to healthy diet in controlling blood pressure. Highly unsaturated fats, like corn oil, sunflower oil and olive oil are better than highly saturated fats such as butter, cream, ghee, suet, coconut and fats from meat and poultry. Choose lean cuts of meat, remove fat and skin from meat and poultry. Avoid processed and fatty meat products like pates, sausages. Keep to small portions of foods containing butter, cream and full fat soft and hard cheeses. Avoid foods containing transfats (potato crisps, commercially prepared biscuits and cakes. Include two portions of fish a week as these are rich in Omega 3 fatty acids. Indian food like paratha, dosa, vadas, sweets made from ghee and refined sugar, fried chowmein, egg/ chicken/ mutton roll, mughlai, fried samosa, bhajiya, oil fried food, spicy food, junk food like pizza, pasta, should be completely avoided. In case of extreme craving, patient may have home cooked items of above nature which is not fermented, and not cooked with maida, butter, etc.
Say NO to Cigarettes, Drugs and Alcohol:
Smoking affects the lungs adversely over a long period of time. Lungs release an enzyme which plays a role in blood pressure control (read RAAS and ADH). Blood pressure worsens kidney disease and therefore one must QUIT SMOKING. Over the counter drugs like antacids, painkillers, antibiotics, etc, without a doctor’s prescription is extremely dangerous. Also, heroine, and similar drugs may lead to severe kidney damage. Alcohol has very high calorie but no calorific value. Alcohol has no nutritional value to the body and kidney exerts pressure to filter it out as a waste product from the body. It is recommended that kidney patients do not consume alcohol at all.
Healthy eating for kidney patients:-
Changes to diet in response to advice from medical professionals can make a difference to the progression of disease as well as helping to prevent complications. For those with stages three, four and five of chronic kidney disease (renal failure), professional guidance is needed for the renal specific changes needed to diet. The dietary guidance and treatment changes as renal impairment progresses, or if the form of dialysis changes and also following transplantation.
Fluids:
Healthy kidneys control the balance of fluid and sodium in the body. Too much salt in the diet creates thirst and kidney patients are more likely to retain fluids leading to swollen hand, foot, face and body. Dialysis patients with fluid restrictions will feel less thirsty if salt intake is reduced. Those on peritoneal dialysis will usually have a larger daily fluid allowance than those on haemodialysis. Diuretic treatments can reduce excess sodium and fluid in the body. This is often part of treatment to reduce high blood pressure during the early stages of chronic kidney disease.