Nutrition for Chronic Kidney Disease (CKD)

Causes:

Most common cause of chronic kidney disease is diabetes and the second most common cause is hypertension (high blood pressure), which cause permanent damage to the kidneys over time. Other causes are: autoimmune disease (lupus and IgA nephropathy), genetic diseases (polycystic kidney disease), nephrotic syndrome, glomerulonephritis, interstitial nephritis (inflammation of the tubules and surrounding structures), prolonged obstruction of the urinary tract from an enlarged prostate gland, kidney stones and some cancers, vesicoureteral reflux (condition that causes urine to back into the kidneys), recurrent kidney infection (pyelonephritis).

Risk Factors:

Diabetes and hypertension are numbers one and two. Also, cardiovascular disease, smoking, obesity, being African-American, Native American or Asian-American, family history of kidney disease, abnormal kidney structure, and older age.

Prevention:

Follow instructions on over-the-counter-pain relievers (aspirin, ibuprofen, and acetaminophen). Taking too many pain relievers could lead to kidney damage and generally should be avoided if you have kidney disease.

Maintain a healthy weight.

Don’t smoke.

Characteristics/Symptoms:

Chronic kidney disease usually gets worse slowly and symptoms may not appear until the kidneys are badly damaged. ESRD (end stage renal disease) symptoms are caused by waste and extra fluid building up in the body causing persistent itching, muscle twitches and cramps, nausea and vomiting, not feeling hungry, swelling in feet and ankles, too much or not enough urine, shortness of breath if fluid builds up in the lungs, chest pain if fluid builds up around the lining of the heart, trouble sleeping, fatigue and weakness, high blood pressure that is hard to control, decreased mental sharpness.

Treatments:

For ESRD (end stage renal disease), treatments include hemodialysis, peritoneal dialysis or kidney transplant.

Complications:

The kidneys do many jobs and cleaning the blood is only one job. They also control chemicals and fluids in your body, help control blood pressure, and help make red blood cells. Dialysis can do some, but not all of the jobs that healthy kidneys do. Complications of kidney disease include anemia, bone disease, hyperphosphatemia (high phosphorus levels in the blood), heart and blood vessel disease, hyperkalemia (high potassium levels in the blood), fluid retention (could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs-pulmonary edema), damage to the central nervous system, decreased immune response, pericarditis.

Monitoring:

Levels of urine albumin and the glomerular filtration rate are monitored. To assess the response to therapy and the progression of disease, UACR (albumin-to-creatinine ratio) is measured with >30mg/g being abnormal. Reducing urine albumin excretion to normal or near-normal may improve renal and cardiovascular prognoses. Changes in kidney function is monitored using eGFR (estimated glomerular filtration rate). In CKD, eGFR is less than 60ml/min/1.73m2.

Diet modifications, why the modifications are appropriate, sample one day (3 meals) meal plan:

People with chronic kidney disease should follow a diet that is low in phosphorus, potassium, sodium (salt), fluids, and protein. Kidneys may not be able to properly filter excess potassium and phosphorus, leading to hyperkalemia and hyperphosphatemia. Excess fluid and salt promote fluid retention which can lead to swelling in extremities and high blood pressure. If thirsty, one can suck on an ice cube or hard candy (sugar-free if diabetic).

Low phosphorus foods to eat: Italian, French and sourdough bread, corn or rice cereal and cream of wheat, unsalted popcorn, lemonade.

High phosphorus foods to avoid: whole grain bread, bran cereals, oatmeal, nuts,

sunflower seeds.

Low potassium foods to eat: apples, grapes, pineapple, strawberries, cauliflower, onions, pepper, radishes, summer squash, lettuce, pita, tortilla, beef, chicken, white rice.

High potassium foods to avoid: avocado, banana, melon, oranges, prunes, raisins,

artichokes, spinach, potatoes, tomatoes, bran products, granola, beans, brown rice.

Low sodium, salt (sodium chloride) foods to eat: fresh fruits and vegetables, unprocessed foods, no added table salt.

High sodium foods to avoid: processed foods, added table salt, condiments, sauces,

chips, soups.

Sample daily meals:

Breakfast: corn cereal, rice cereal, or cream of wheat with strawberries and milk

Lunch: chicken teriyaki pita sandwich (chicken, pita, lettuce, onion, olive oil) and pineapple or an apple

Snack: unsalted popcorn

Dinner: meatloaf (lean ground beef or chicken) or grilled shrimp, summer squash or cauliflower, green beans, apple bars for dessert