Nutrition and Early Kidney Disease - Litholink

Nutrition and Early Kidney Disease - Litholink

Why is good nutrition importantfor people with kidney disease?Eating healthy is important to us all, but itis even more important if you have chronickidney disease (CKD). Why? Because goodnutrition gives you energy to:n do your daily tasksn prevent infectionn build musclen help maintain a healthy weightn keep your kidney disease fromgetting worseWill I need to change my diet if Ihave kidney disease?There is no one diet that is right foreveryone with kidney disease. What youcan or cannot eat will change over time,depending on how much kidney functionyou have. Your doctor can refer you toa dietitian with special training who canteach you how to plan meals that are rightfor you.National Kidney Foundation 3

TIPIf you need help finding a dietitian whospecializes in kidney disease, you canask your doctor for a referral or contactthe American Dietetic Association at800.877.1600 ( are the basics of goodnutrition?Key nutrients are:n proteinn caloriesn vitaminsn mineralsYou will need a diet that gives you the rightamounts of protein, calories, vitamins andminerals each day. This will help to keepyou healthy and fit. It may also help to keepyour kidney disease from getting worse.4National Kidney Foundation

Why do I need protein?Protein is an important nutrient. Your bodyneeds protein to help build muscle, repairtissue and fight infection. But if you havekidney disease, you may need to eat lessprotein to prevent wastes from building upin your blood. This can help your kidneyswork longer. Your doctor will tell you if youneed to limit how much protein you eateach day.You get protein from:n red meatsn poultry (chicken and turkey)n fish and other seafoodn eggsn milk and cheesen vegetables and grainsYour dietitian can help you learn how tomaintain good nutrition while eating theright amount of protein.TIPThere are two kinds of proteins. “Higherquality” proteins are found in animalproducts like meat, poultry, fish, eggsand dairy products. They are the easiestproteins for your body to use. “Lowerquality” proteins are found in vegetablesand grains. A well-balanced diet forkidney patients should include bothkinds of proteins every day.National Kidney Foundation 5

Why do I need calories?Calories are like fuel – they provide yourbody with the energy you need to live.They are important because they:n help you stay at a healthy bodyweight.n give you energy to do your daily tasksand remain active.n help to keep the protein you eat frombeing wasted. (Without enough calories,your body will "waste" protein toprovide you with energy instead ofusing protein to build your musclesand tissues.)If you are not getting enough calories fromyour diet, you may need to eat extra sweetslike sugar, jam, jelly, hard candy, honeyand syrup. Other good sources of caloriescome from fats such as soft (tub) margarineand oils like canola or olive oil. It is importantto plan meals that give you enoughcalories each day. Otherwise your bodymay not have the energy you need to stayhealthy. Your dietitian can help you do this.TIPIf you have diabetes and kidney failure,ask your dietitian how to get theright amount of calories and keep yourblood sugar in control.6National Kidney Foundation

How do I get enough vitaminsand minerals?Do you know how most people getenough vitamins and minerals to stayhealthy? By eating a wide variety of foodseach day. However, if you have kidneydisease, you may need to limit some foodchoices that would normally give youimportant vitamins and minerals. If so, youmay need to take special vitamins or mineralsinstead. Be sure to:n take only the vitamins and mineralsyour doctor recommends, becausesome vitamins and minerals found instores may be harmful to people withchronic kidney disease.n check with your doctor before takingany herbal supplements or medicinesyou can buy at the store without adoctor’s prescription. Some may beharmful to people with kidney disease.n check with your doctor and dietitianbefore taking any vitamins or minerals.Your doctor and dietitian will tell youwhich ones are good choices for you.National Kidney Foundation 7

How will I know if I am gettingenough calories and nutrients?Your doctor will give you blood tests andurine tests. These will help show your doctorwhether or not you are getting enoughnutrients. You may also be asked to keepa food diary. Additionally, your dietitianmay interview you to find out about thefoods you eat. To learn more about thetests your doctor and dietitian will use tocheck your nutrition, see page 20.TIPn Ask your doctor or dietitian whichtests will be used to check yournutritional health.n Discuss the results with your doctoror dietitian.What should I do if I am notgetting enough nutrients?As a kidney patient, it may be difficultto get enough nutrients from food, especiallyif you are on a limited-protein diet.Many people with kidney disease alsofind it hard to eat enough calories eachday. Nutritional supplements can help youget the calories and nutrients you need.Supplements can come in the form ofliquid drinks, shakes, juices, bars, soups,cookies, puddings and more. There areeven some nutritional supplements that aremade just for people with early kidney disease,diabetes or kidney failure.8National Kidney Foundation

Some examples of supplements suitable forpeople with early kidney disease are:n Suplena ® with CarbSteadyn Resource ® Fruit Beverage (formerlycalled Resource Breeze)n Boost ® Fruit Flavoured BeverageSome examples of supplements suitable forpeople with diabetes are:n Glucerna ® Shakes or Barsn Resource ® Diabeticn Re/Gen ® “Low Sugar”Some examples of standard supplementsthat supply extra calories, protein andnutrients are:n Boost Plus ®n Carnation ® Instant Breakfast ® Juice orCarnation ® Instant Breakfast ® VHCn Resource ® Fruit Beverage (formerlycalled Resource Breeze)n Enlive ®n Ensure ® Hi Pron Boost ® High ProteinThese are just a few of the products available.Discuss with your doctor or dietitianwhich ones would be most beneficial foryou. Do not take any supplements withoutthe advice of your doctor or dietitian.National Kidney Foundation 9

How will I know if I need anutritional supplement?Your doctor and dietitian will tell you if youneed to take nutritional supplements. Useonly the supplements recommended byyour doctor or dietitian. Remember, not allpeople with kidney disease have the samedietary needs. Depending on what youeat, you may need less protein, but someoneelse might need extra protein. Or youmay need extra calories, but someone elsemight need less. Your dietitian will helpyou choose the right supplements for you.Will I need to control any othernutrients as well?You may need to balance other importantnutrients, too. They are:n sodiumn phosphorusn calciumn potassiumn fluid10National Kidney Foundation

SodiumSodium is a mineral found in most foods. Itaffects blood pressure and water balancein your body. Healthy kidneys can get ridof too much sodium in your body. But ifyour kidneys do not work well, sodium andfluid build up in your body. This can causehigh blood pressure and other problemslike swelling of your ankles, fingers or eyes.You may need to limit sodium in your diet.If so, your doctor or dietitian will tell you.Sodium is found in large amounts in tablesalt and in foods that have added tablesalt such as:n seasonings like soy sauce, teriyakisauce, garlic salt or onion saltn most canned foods and frozen dinners(unless they say low sodium)n processed meats like ham, bacon,sausage and cold cutsn salted snack foods like chips andcrackersn canned or dehydrated soups (likepackaged noodle soup)n most restaurant foods, take-out foodsand fast foodsTIPTry fresh or dried herbs and spicesinstead of table salt to enhance the flavorof foods. Salt is a flavor booster. Whenyou limit salt, you may have to use moreherbs and spices to get more flavor. Also,try adding a dash of hot pepper sauceor a squeeze of lemon juice for flavor.National Kidney Foundation 11

Your dietitian can teach you how tochoose foods that are lower in sodium.Learning how to read food labels can helpyou choose foods with less sodium. DoNOT use salt substitutes containing potassiumunless approved by your doctor.PhosphorusPhosphorus is a mineral found in mostfoods. Large amounts of phosphorus arefound in:n dairy products such as milk, cheese,yogurt, ice cream and puddingn nuts and peanut buttern dried beans and peas such as kidneybeans, split peas and lentilsn beverages such as cocoa, beer anddark cola drinksEating high-phosphorus foods can raisethe level of phosphorus in your blood. Yourkidneys may not be able to remove all ofthis extra phosphorus. What happens whenphosphorus builds up in your blood? Yourblood calcium levels drop and calciumis pulled from the bones. Over time, yourbones will become weak and break easily.A high level of phosphorus in your blood12National Kidney Foundation

may also cause calcium to build up in yourblood vessels, heart, joints, muscles andskin where it does not belong. This maycause serious problems such as:n damage to the heart and other organsn poor blood circulationn bone painn skin ulcersTo keep phosphorus at safe levels in yourblood, you may need to limit phosphorusrichfoods. You may also need to take atype of medicine called a phosphatebinder. These binders are taken with yourmeals and snacks. Your doctor will tell youif you need to limit high-phosphorus foodsor take phosphorus binders.TIPUsing non-dairy creamers andrecommended milk substitutes inplace of milk is one way to lower theamount of phosphorus in your diet.CalciumCalcium is a mineral that is important forbuilding strong bones. However, foodsthat are good sources of calcium arealso high in phosphorus. The best way toprevent loss of calcium from your bones isto limit high-phosphorus foods. You mayalso need to take phosphate binders andavoid eating calcium-fortified foods. Yourdoctor may have you take a special formNational Kidney Foundation 13

of vitamin D as well to help keep calciumand phosphorus levels in balance and toprevent bone disease. Do not take overthe-countervitamin D or calcium supplementsunless recommended by yourkidney doctor.PotassiumPotassium is another important mineralfound in most foods. Potassium helps yourmuscles and heart work properly. Largeamounts of potassium are found in:n certain fruits and vegetables (likebananas, melons, oranges, potatoes,tomatoes, dried fruits, nuts, avocados,deep colored and leafy green vegetablesand some juices)n milk and yogurtn dried beans and peasn most salt substitutesn protein-rich foods such as meat,poultry, pork and fishToo much or too little potassium in the bloodcan be dangerous. Not everyone needs thesame amount of potassium. Some peoplewith kidney disease need more; othersneed less. How much you need dependson how well your kidneys are working. Italso depends on whether or not you aretaking any medicine that changes the levelof potassium in your blood.14National Kidney Foundation

TIPHow do you know if your potassiumis normal? A simple blood test cancheck your potassium level. If it is notnormal, you may need to take:n potassium supplementsn special medicine to help get ridof too much potassiumTake only the supplements your doctorrecommends. Your dietitian can help youplan a diet that will give you the rightamount of potassium.FluidMost kidney patients do not need to limitthe amount of fluids they drink if they arein the earlier stages of kidney disease.(If you do not know your stage of kidneydisease, ask your doctor or contact theNational Kidney Foundation for additionalinformation.) If your kidney disease getsworse, your doctor will let you know if youneed to limit fluids and how much fluid isokay for you each day.National Kidney Foundation 15

What if I have diabetes?You may need to make only a fewchanges in your diabetic diet if you havekidney disease. If your doctor says thatyou should eat less protein, your diet mayneed to include more carbohydrates orhigh-quality fats to give you enough calories.Work with your dietitian to make ameal plan that is right for you. Ask yourdoctor how to test your blood sugar level.Check your levels often and try to keepyour levels under control. Your dosage ofinsulin or other medications may need tochange if your kidney disease gets worse.Contact your doctor if your levels are toohigh or too low.TIPn Learn to read food labels so youknow what you are eating. Readinglabels can help you shop for foodswith lower sodium and to check for“added” nutrients that may not bebest for you.n Herbs, spices, table wine and specialvinegar can be used instead of salt tomake your food flavorful. Try purchasingor growing fresh herbs. Try addinga dash of hot pepper sauce or asqueeze of lemon juice for flavor. Askyour dietitian for a list of herbs andspices that blend with different typesof foods.n Non-dairy creamers can be used inplace of milk in cereals, coffee andmany sauces. This is a good way tolower the amount of phosphorus inyour diet.16National Kidney Foundation

What if I’m a vegetarian?Most vegetarian diets are not rich inhigher quality protein. But eating a varietyof foods and getting enough caloriescan help. Without enough calories, yourbody will break down the protein youeat to create energy instead. If protein isbroken down, more waste products haveto be handled by your kidneys. Ask aboutways to check that the amount of proteinyou are eating is right for you. Talk withyour dietitian about the best sources ofvegetable protein with lower amounts ofpotassium and phosphorus. Your doctoror dietitian can check your blood to makesure you are getting the right amount ofprotein and calories.National Kidney Foundation 17

What if I need helpplanning meals?Your doctor can refer you to a registereddietitian with special training in kidney disease.This dietitian can:n help you plan meals that will give youthe right nutrients in the right amountsn explain why the diet changes you needto make are importantn answer your questionsTIPYou may be eligible for nutrition counselingwith a dietitian under Medicare orunder your health insurance plan.Where can I getmore information?You can speak to your doctor or othermembers of your health care team, or youcan call the National Kidney Foundationfor information. To learn more about kidneydisease, you may also want to read someof the free publications from the NationalKidney Foundation. (See page 19.)18National Kidney Foundation

Brochures:n About Chronic Kidney Disease: AGuide for Patients and their Families(11-50-0160)n Dining Out with Confidence: AGuide for Kidney Patients (11-10-0803)n GFR (Glomerular Filtration Rate): AKey to Understanding How Well YourKidneys Are Working (11-10-1813)n Your Kidneys: Master Chemists of theBody (11-10-0103)Fact Sheets:Fact sheets can be found online How to Increase Calories in YourCKD Dietn Phosphorus and Your CKD Dietn Potassium and Your CKD Dietn Sodium and Your CKD Diet: How toSpice Up Your Cookingn Vitamins and Minerals in KidneyDiseaseTo obtain a free copy of these publicationsor information about other National KidneyFoundation resources, contact your localNational Kidney Foundation affiliate, or callthe national toll-free number 800.622.9010.Also, visit the Web site of the NationalKidney Foundation’s Kidney Learning Systemat Kidney Foundation 19

How is my nutritionalhealth checked?You will be checked regularly by yourdoctor and dietitian to make sure you aregetting good nutrition. Some tests are:n Physical Nutrition ExamYour dietitian may give you an examto check your body for signs of nutritionproblems. This exam is called aSubjective Global Assessment (SGA).Your dietitian asks you questionsabout your food intake and looksat the fat and muscle stores in yourbody. The dietitian notes:n changes in your weightn changes in the tissues aroundyour face, arms, hands, shouldersand legsn your food intaken your activity and energy levelsn problems that might interferewith eatingn Dietary Interviews and Food DiariesYour dietitian will ask about yourdiet. You might also be asked tokeep a diary of everything you eateach day. These tests help your dietitiansee if you are eating the rightamount of protein, calories, vitaminsand minerals.(continued on next page)20National Kidney Foundation

(continued)How is my nutritionalhealth checked?n Serum AlbuminAlbumin is a type of protein in yourblood. It is checked by a blood test.If your albumin level is too low, itmay mean you are not eating enoughprotein or calories. Or, it may meanthat albumin is being lost in the urine,in which case eating more proteinwon’t help. If your albumin level continuesto be low, you have a greaterchance of getting an infection, nothealing properly, not feeling well,and being hospitalized. Your doctoror dietitian will tell you if you needextra protein.n nPNA (normalized protein equivalentof nitrogen appearance)Your nPNA estimates how much proteinyou are eating. It helps your doctorand dietitian check to see if youare eating the right amount of protein.The nPNA result comes from urine collectionand blood work.National Kidney Foundation 21

Notes22National Kidney Foundation

NotesNational Kidney Foundation 23

Litholink Corporation2250 West Campbell Park DriveChicago, Illinois 60612800 338 4333 Telephone312 243 3297 Facsimilewww.litholink.comMore than 26 million American adults and thousands ofAmerican children have chronic kidney disease. Most donot know they have this condition. Further, millions ofpeople with diabetes, hypertension, and other diseases donot realize they are at risk for developing kidney disease.The National Kidney Foundation, a major voluntary healthorganization, seeks to prevent kidney and urinary tractdiseases, improve the health and well-being of individualsand families affected by these diseases and increasethe availability of all organs for transplantation. Withmore than 50 local offices nationwide, the NKF providesearly detection screenings and other vital patient andcommunity services, conducts extensive public andprofessional education on kidney disease and organdonation, advocates for patients through legislative action,and supports kidney research to identify new treatments.A Curriculum for CKD Risk Reduction and CarePublic EducationKidney Learning System (KLS) TMAt RiskSTAGE 1Kidney Damage withNormal or Kidney FunctionSTAGE 2Kidney Damage withMild Kidney FunctionSTAGE 3ModerateKidney FunctionSTAGE 4SevereKidney FunctionSTAGE 5KidneyFailureT T T T T DGFR 130 90 60 30 15 0Green colored boxes indicate the scope of content in this KLS resource.GFR= Glomerular Filtration Rate; T= Kidney Transplant; D= DialysisFor more information, please visitwww.Kidney.orgwww.litholink.comP A R T N E R S I NE D U C A T I O N© 2009 National Kidney Foundation, Inc. All rights reserved. 11-10-1214_BAJ

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