Managing Chronic Kidney Disease with Good Nutrition

Good nutrition is a key component in preventing and managing chronic kidney disease (CKD). Making diet changes at the first signs of CKD can prevent further damage and slow the progression of the disease. Hypertension and diabetes are commonly associated with CKD. Controlling hypertension with a low sodium, healthy fat diet can reduce blood pressure which will help reduce stress on the kidneys. Managing diabetes and blood sugars with a balanced, consistent carbohydrate diet will decrease kidney damage. Fortunately, a healthy diet and physical activity can improve hypertension, diabetes, and CKD.  

There are several nutrition elements to consider when making diet changes for CKD. The first and possibly the most important nutrient to consider is sodium intake. Sodium causes fluid retention in the body and increases blood pressure which then puts extra strain on the kidneys. Sodium is found in all types of salt and used as a food preservative. Choose foods that are low in sodium. When looking at the food label, 200 mg of sodium per serving or less is a good option. Avoid foods that have more than 600 mg per serving. Limit total sodium intake to 1500 mg per day. One teaspoon of salt contains about 2300 mg of sodium. Consider putting the salt shaker away and try sodium free seasonings like Ms. Dash, no salt Tony Chachere's cajun seasoning, different types of peppers and herbs, garlic and onion powders, lemon juice, and other salt free seasonings. Look for low sodium canned good options, unsalted nuts and snack mixes, frozen or fresh vegetables without added salt, and fresh or frozen fruit. Making foods from scratch allows you to control the amount of salt that is added. Regular canned foods, frozen convenience products, broths and soups, boxed foods, snack foods (sweet and savory), cheese, processed and canned meats, and condiments/sauces all tend to be high in sodium. Check the labels on these foods and look for low sodium options. 

Protein is a macronutrient that is necessary for the body to preserve and repair bones, muscle, skin and hair; however, it should be limited in people with CKD to prevent further kidney damage. There are two types of protein - animal and plant-based sources. Reduce meat to 2-3 oz at meals. This would be about the size of a deck of cards. Good sources of animal protein include lean beef, skinless poultry, eggs, fish, lamb, pork loin, and wild game. Limit plant-based proteins to ½ cup or ¼ cup nuts. Plant-based protein sources usually contain carbohydrates which can affect blood sugar and can be high in potassium and phosphorus. Plant-based sources include beans, peas, lentils, nuts, nut butter, tofu and whole grains. 

Micronutrients like potassium and phosphorus levels in the body can be affected by kidney function. Potassium is used to control the muscles and nerves in the body including the heart. If the kidneys are unable to filter enough potassium out of the body, elevated potassium levels can cause the heart to not function properly. Avoid salt substitutes as they usually contain potassium chloride. Focus on fruits and vegetables that are low in potassium - apples, berries, grapes, peaches, pineapple, watermelon, asparagus, green beans, cabbage, carrots, cauliflower, corn, greens, and peppers. Avoid tomatoes, bananas, cantaloupe, orange juice, and dried fruit. Dry rice and pasta are good substitutes for potatoes. Drain and rinse canned vegetables and fruits. 

The kidneys control phosphorus build-up in the body. Elevated levels of phosphorus can cause calcium to leach out of bones which leads to brittle bones and fractures. Phosphorus is added to processed foods. These additives are more harmful to the kidneys than natural sources of phosphorus. Avoid foods with ingredients listed with phos (calcium phosphate, disodium phosphate, phosphoric acid, monopotassium phosphate). This includes dark colas, boxed foods, and many convenience foods.  Limit dairy to one serving per day. Rice milk is the best dairy substitute. 

People with CKD should talk with their doctor about fluid needs since fluid restrictions can be beneficial. Choose sugar-free beverages and avoid alcohol and drinks containing phos ingredients like colas and energy drinks. Focus on having more water than other liquids.

Controlling the intake of these nutrients will allow people suffering from CKD to feel better, control side effects, and delay CKD progression. 

If you have any questions about kidney disease, please log into your account and send us your question. We are here to help.

Libbi Calloway RD, CSOWM, LD

Kidney Disease – Part III

This week we will continue our discussion about kidney disease.  We will talk today about how to prevent chronic kidney disease (CKD).  We will also talk about treatment options and how you can help to manage CKD to prevent progression to kidney failure.

What can you do to keep your kidneys healthy?

We talked last week about some of the causes of CKD.  Just a reminder, you are more likely to develop CKD if you have one or more of the following conditions:

• Diabetes
• High blood pressure 
• A family history of kidney disease 
• Heart disease

If those conditions can increase your risk of CKD, preventing the development of these conditions can help prevent CKD.  If you already have these conditions, managing them well and keeping blood sugar and blood pressure readings within the normal range will help prevent CKD. 

Here are some things that you can do to help prevent or manage health conditions that cause kidney damage.

• Include physical activity as part of your daily routine - Try to be physically active for at least 30 minutes most days.
• Aim for a healthy weight - Talk with your doctor or dietician about a healthy weight-loss plan if you are overweight.
• Be sure to get enough sleep on a regular basis - Sleep deprivation causes an imbalance in many hormones and has many other negative health effects.  You should be getting 7-8 hours of sleep each night.
• Stop smoking - Smoking damages your blood vessels, increases your risk of kidney cancer, along with a myriad of other cancers and other health problems.  
• Pay attention to over-the-counter (OTC) medications - OTC pain-relieving medications can lead to kidney damage or worsen CKD.  Don't go over the dosing recommendations on the bottle without talking to your doctor.  If you already have CKD, don't take these medications.
• Manage diabetes, high blood pressure, and heart disease - The best way to keep these conditions from causing kidney damage is to keep your blood sugar and blood pressure under good control, take all of your medications as your doctor prescribes them, and maintain regular follow up visits with your doctor.
• Be an active participant in your health care -Take an active part in managing your chronic health conditions by asking your doctor about the things we have talked about.  
• Make healthy food choices - A healthy diet is important to help prevent CKD and the chronic health conditions that increase the risk of CKD.  If you already have CKD, talk with a dietician about a healthy meal plan to limit the amount of salt, potassium, and protein in your diet.

How is CKD treated?

If you already have CKD, there is no cure for it, but there are treatments that can slow or sometimes stop the progression.  There are also treatments to control the symptoms of CKD.  Here are some of the treatments your doctor might suggest:

• Treating the underlying cause - such as diabetes, high blood pressure, etc.
• Certain high blood pressure medications - Medications called ACE inhibitors can preserve kidney function, even if you do not have high blood pressure.
• Diuretics - can help to maintain the balance of fluids in your body.
• Medications to treat anemia - Can aid in the production of red blood cells.
• Medications to protect your bones - Calcium and vitamin D supplements may be recommended to prevent your bones from getting weaker.  
• Medications to bind phosphate -Phosphate binders lower phosphate levels in your blood (which can be too high in CKD).  This protects your blood vessels from damage.
• A lower protein diet - This can reduce the amount of work your kidneys must do.
• Regular monitoring - Your doctor will also want to test your kidney function at regular intervals to see if it is staying stable or progressing.

What if your CKD progresses to end-stage kidney (renal) disease (ESRD)?

If your kidneys cannot keep up with waste removal and fluid balance, this means you have developed ESRD or kidney failure.  At that point, you will need to have one of these two treatments:

• Dialysis - filters your blood and removes waste products and extra fluid.  There are two types.
  • Hemodialysis - A machine filters your blood to remove the extra waste and fluids. 
  • Peritoneal dialysis - Dialysis solution goes into the abdomen and absorbs waste and excess fluids then is drained from the body carrying the waste with it.
• Kidney Transplant - A healthy kidney from a donor is surgically placed into your body.  

Next week, we will have a guest Health Tip from one of our dieticians to discuss dietary considerations related to chronic kidney disease.  

If you want to read more about CKD, try these links below.  

Chronic kidney disease - Symptoms and causes - Mayo Clinic

Keeping Kidneys Safe: Smart Choices about Medicines | NIDDK (nih.gov)

Mineral & Bone Disorder in Chronic Kidney Disease | NIDDK (nih.gov)

If you have any questions about kidney disease, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Kidney Disease

March is National Kidney Month.  This is an opportunity for us to raise awareness about kidney disease.  I thought we could start this week with an overview of how your kidneys work and why they are so important.  Then we can talk about the different kidney diseases and what we can do about them.

Lets start with the basics.

The kidneys are bean-shaped organs, about the size of your fist.  There is one on either side of your spine at the lowest level of your rib cage.  The basic function of the kidney is to filter your blood, but they do more than that.  

Why are your kidneys so important?

Your kidneys remove wastes, toxins, and extra fluid from your body.  They remove acid that is produced during normal function of the body at the cellular level.  They maintain a healthy balance of water, salts, and minerals in your blood, including sodium, calcium, potassium, and phosphorus.  This healthy balance allows your nerves, muscles, and other tissues in your body to function normally.  Your kidneys also make some of your body's hormones.  

Here is a list of the most important functions performed by your kidneys...

• Remove waste products from the body, including acid produced by cellular functions
• Remove drugs from the body
• Maintain the body's healthy fluid balance
• Make hormones that control your blood pressure
• Control the production of red blood cells (which carry the oxygen in your blood)
• Produce an active form of vitamin D, which helps maintain strong, healthy bones

How do your kidneys work?

Your kidneys are made up of filtering units called nephrons, with about a million nephrons in each kidney.  Blood circulates through your kidneys many times each day.  As blood moves through the nephron, waste products and extra fluid are removed from the blood through a very complex process.  This extra fluid and waste becomes urine, which is stored in the bladder until it is removed from the body through urination.  

Healthy kidneys filter about a half cup of blood every minute, adding up to about 150 quarts of blood filtered each day!  Most of what is filtered is returned to your body, with only about 1-2 quarts of urine being made each day.

Let's talk about kidney disease.

There are different types of kidney disease.  

• Acute kidney failure - This happens when your kidneys suddenly become unable to filter waste products from your blood.  This acute issue develops rapidly, usually within a few days.  It is most common in people who are already in the hospital, especially people who are critically ill.  Acute kidney failure can be fatal and requires intensive treatment, and sometimes temporary dialysis.  The good news is that acute kidney failure can be reversible.  If you are otherwise in good health, you may recover completely normal kidney function once your acute illness that caused the kidney failure improves.  

• Chronic kidney disease (CKD) - CKD is defined as having some type of kidney abnormality, or "marker" such as protein in the urine AND having decreased kidney function for three months or longer.  There are many possible causes of CKD.  These causes include chronic diseases such as diabetes and high blood pressure, acute inflammatory conditions, inherited conditions, and many others.

Next week we will talk more about the causes of CKD, how it is diagnosed, and more.

If you have any questions about kidney disease, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor