Delay the Need For Dialysis With Good Nutrition

By Maria Karalis, MBA, RD, LDN
 
People who have been diagnosed with decreased kidney function often find themselves confronted with many lifestyle changes, including their diet. But there are steps that can be taken to help prolong kidney function. Following the right diet is one way that you can help slow down the damage to the kidneys and delay the need for dialysis.
 
Nutrition Counseling
Research has been done on low protein diets and the progression of kidney disease, but the results are not conclusive. In some kinds of kidney disease, strict blood pressure and blood glucose control and a low protein diet have been shown to help. It is important to ask your nephrologist to refer you to a Registered Dietitian (RD) for individualized nutrition counseling.
 
The following is a list of guidelines to help you get on the right track to prolong kidney function. The primary goal of this pre-dialysis diet is to maintain optimal nutrition. There is no “one-size-fits-all” diet. It is individualized, based on your kidney function, other medical conditions, and nutritional status. The risk of following a pre-dialysis diet without seeking nutrition counseling by an RD is malnutrition. Therefore, it is critical to make an appointment with an RD to assess your individual needs. She will provide you with a meal plan that includes how many servings from each food group to eat each day. 
 
Protein
Protein is needed by the body to keep your tissues healthy and replace old or damaged tissue. Each day, protein must be included in your diet for you to stay healthy. When your kidneys no longer “filter” or clean your blood well enough, waste products build up from the foods you eat.
 
The amount of protein allowed will depend on your body size. The amount prescribed by the doctor is generally around 0.6-1.0 grams (g) of protein per kilogram desired body weight. Those at nutritional risk or diabetic will be prescribed a little bit more protein. For example, if you weigh 150 pounds, that is 68 kilograms. Therefore, you are allowed anywhere from 40 g of protein a day to 68 g per day (.6 x 68 and 1.0 x 68). 
 
Protein is found everywhere in the foods we eat (see Table 1). There are small amounts of protein in breads, fruits, and vegetables, but the majority of the protein is found in meats, chicken, fish, eggs, and dairy products. There are two kinds of protein:
(1) High quality (animal protein from meats, chicken, fish, eggs, and dairy products); and
(2) Low quality (plant protein from vegetables, breads, cereals). 
 
You need at least 50% protein from high quality sources. The RD can figure out your needs to include a mixture of these proteins.
 
The RD can tell you exactly how many ounces of meat, chicken, fish, or eggs you can have each day. Generally speaking, one ounce of meat, chicken or fish contains 7 g of protein. Meat or other protein should always be weighed without bone or shell after cooking:

                                       Table 1

                    Protein Content in Food Groups

Food Group

Amount of Protein per serving (grams)

Milk

4 grams per ½ cup

Meat, Fish or 

Chicken

7 grams per 1 ounce

Breads

2 grams per serving*

Vegetables

1 gram per serving*

Fruits

0.5 gram per serving*

Fats

No protein

*Servings vary depending on food item.

Calories
Calories are very important, too. In order for your body to use the proteins for growth and repair, sufficient calories are needed. 
 
Calories are necessary for energy and for maintaining your body weight. Just as fuel gives power to cars, calories fuel your body and give you energy. If you are underweight, the RD can give you suggestions on increasing calories in your diet.
 
Phosphorus
Research has shown that phosphorus tends to speed up the loss of kidney function. Phosphorus is found in almost all foods we eat but is especially high in protein foods. Other foods high in phosphorus include milk, cheese, nuts, seeds, bran, chocolate, colas, and legumes such as pinto beans and kidney beans. If the phosphorus level in your blood is high, you may be asked to take a medication known as a “phosphate binder.” This medication, when taken with meals, binds to phosphorus from the foods you eat.
 
Usually milk is limited in the pre-dialysis diet due to its high phosphorus content. If you are a milk drinker, don’t worry… there are substitutes on the market you can use. Some products include Coffee Rich, Mocha Mix, and Poly Rich.
 
Potassium
Potassium is a mineral important for regulating your heart. Limiting potassium is generally not necessary at this stage of kidney disease. 
 
The amount of potassium you may be allowed will be individualized based on the potassium level in your blood. If you are taking a “water pill” or diuretic such as Lasix, you may need to take a potassium supplement.
 
Fluid
Limiting your fluid intake is usually not needed at this stage in your kidney disease. However, keep in mind that, when your kidney function slows down, you make less urine and fluids build up in your body. 
 
When this occurs, you may experience edema (your hands, feet, or stomach may swell). You will gain water weight and may feel short of breath.
 
Sodium
How much sodium you are allowed depends on the type of renal disease you have, your blood pressure (BP), your fluid status and urine output, and the condition of your heart. Most likely, if you are reading this, you are already following a low sodium diet.
 
Vitamins
You may require a special vitamin to replace water-soluble vitamins. Ask your dietitian about this.
 
Sample Meal Plan
The following is a sample meal plan providing approximately 50 grams of protein, 1800 calories, and 1800 mg of sodium. This is just a sample. It is important to see a Registered Dietitian to determine your individual needs.

 
Breakfast (12.5 grams of protein)

  •     ¾ cup cornflakes;
  •     ½ cup nondairy creamer;
  •     1 banana;
  •     1 slice toast;
  •     1 soft-cooked egg;
  •     2 tsp. margarine; and
  •     Coffee with sugar or sugar substitute. 


Lunch (18.5 grams of protein:

  •     Roast beef sandwich (two ounces of roast beef, one tsp. mayonnaise, two slices of bread, and one small sliced tomato); 
  •     ½ cup fruit cocktail in heavy or light syrup; and
  •     Iced tea (regular or diet) with lemon.  


Dinner (15.5 grams of protein):

  •     2 ounces sautéed steak;
  •     ½ cup carrots;
  •      4 tsp. margarine;
  •     ½ cup applesauce or 1 medium apple; and  
  •     Lemonade. 


Snacks throughout the day or evening (4.5 grams of protein):

  •      ¾ ounce pretzels;
  •      3 graham crackers; and
  •      1 fresh pear or 1 medium apple.


Blood Pressure
High BP or hypertension damages the blood vessels in the kidneys. This decreases the blood supply to the kidneys. Normal BP is less than 130/85, and optimal pressure is less than 120/80, according to the new health advisory of the National Heart, Lung and Blood Institute (May 2000 issue of Hypertension). It is important to have regular checkups with your doctor to check for high BP.
 
Diabetes
Diabetes is currently the number one cause of renal failure. High blood sugar levels cause changes in the function of the blood vessels in the kidney. Over time, this causes destruction of the nephrons or “filters” of the kidneys. Work closely with your doctor and RD to keep your blood sugar levels under control.
 
Symptoms of Kidney Disease
Some people, but not all, experience signs and symptoms of kidney disease. If you experience worsening of the following symptoms, see your doctor right away:

  •     Change in how often you urinate;
  •     Edema or swelling of the face, feet, or stomach;
  •     High BP;
  •     Loss of appetite;
  •     Nausea or vomiting;
  •     “Metallic” taste in your mouth;
  •     Very tired or weak;
  •     Headaches; 
  •      Inability to concentrate; and
  •     Confusion.


Your Healthcare Team

The goal of your nephrologist, or kidney doctor, is to treat you properly to slow down the damage to your kidneys. This involves prescribing medications, a special diet, and certain blood and urine tests. Frequent visits with the RD are important to prevent malnutrition.
 
Conclusion
There is a lot you can do to slow down the damage to the kidneys and delay the need for dialysis.
If you have high BP::

  •     Keep your blood glucose under control if you are diabetic;
  •     Ask your doctor if following a low protein diet will be beneficial for you;
  •     If your doctor prescribes a special diet, see a Registered Dietitian; and


        Keep your appointments with your regular doctor and nephrologist. Ask a lot of questions when you are there. The more you know, the better you will do in the long run.
 

About the Author

Maria Karalis, MBA, RD, LDN, is a Nutrition Consultant and Writer and has worked in the nephrology field for over 17 years. She enjoys writing for healthcare professionals and people with chronic kidney disease (CKD) with one goal in mind:  helping CKD patients live their life to the fullest. This article was originally published on the iKidney.com website, supported by Watson Pharma, Inc. 

Article uploaded 10-1-2007