Chronic Kidney Failure and Dietary Options

How do the kidneys work?

ArteryKidney

Ureter

Bladder

Urethra

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Vein

Wastes Out

Clean Blood to Body

Blood In

Structure of the Kidney

What do the kidneys do?

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Clean the blood and remove extra fluid

Filter out waste products

Keep your body chemicals in balance

Control blood pressure and red blood cells

What are the functions of the kidney?

1. Main function - acts as a ‘filter’ a) To remove toxic and waste products b) To remove excess water

2. Maintain internal balance of acid and base3. Maintain calcium and phosphate 4. To produce hormones

a) Erythropoeitin – in red cell productionb) Active Vitamin D – neccessary to maintain strong

healthy bones

What happens in kidney failure?

1. Retention of waste and toxic products and excess water

a. Increase in blood urea (generated during breakdown of proteins in body) may cause symptoms as tiredness, weakness, loss of appetite and vomiting

b. Increase in blood creatinine (breakdown of muscle). If level is > 10 mg/dl patient needs dialysis

c. Excess salt and water retention may result in high blood pressure, swelling of legs, face and abdomen and breathlessness

2. Upset in internal balance of acid and base leads to built up of acid in body

a. Blood calcium levels fall and phosphate levels increase because kidneys can no longer excrete phosphate

b. Results in bone disease and predispose patients to fracture

What happens in kidney failure?

3. Inadequate production of hormonesa. Anemia – lack of red blood cells as a

reduction of erythropoeitin

b. Bone disease – lack of vitamin D

What happens in kidney failure?

Symptoms of Kidney Failure

Unable to remove waste products and water

Nausea, vomiting, loss of appetite, tiredness, swellingOf feet and body, high blood pressure

Unable to maintain internal balance

Build up in acid Acidosis Lack of calcium Bone Disease

Lack of hormone

Lack of Vitamin D Bone Disease Lack of erythropoeitin Anemia

What are the early symptoms of kidney failure?

• Majority of patients no early symptoms• Small group of patients – swelling of face or

legs• Early kidney disease is usually detected by

routine examination of urine – Presence of blood and/ or protein

• High blood pressure

What causes kidney failure?

• Glomerulo-nephritis– IgA Nephropathy– SLE

• Diabetes Mellitus• Reflux Nephropathy – urine backflows leads

to infection and damage kidneys• Stone disease and obstructive uropathy• Inherited kidney diseases – polycystic kidney

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Why is diet important?

• Managing your diet can slow your renal disease

• The need for dialysis can be delayed

• Your diet affects how you feel

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Managing your diet

• Each person’s diet is individualized by the physician and dietitian

• Learn all you can about your diet

• Take an active role in planning your diet

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Controlling your diet

• The most important foods to control are those containing:– Protein– Potassium– Sodium– Phosphorous– Fluid

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Proteins• Proteins keep your body tissue healthy• Proteins must be eaten each day• High quality protein (animal protein)

– Dairy (milk, cheese)– Meat (steak, pork)– Poultry (chicken, turkey)– Eggs

• Low quality protein (plant protein)– Vegetables– Breads– Cereals

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• Potassium is a mineral that helps muscles and nerves work the right way

• Damaged kidneys can cause a build-up of potassium in your body

• Major sources of potassium include:– Milk– Potatoes– Bananas– Oranges– Dried Fruit

NutsLegumesSalt substituteChocolate

Potassium

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Sodium

• Sodium is a mineral that is important in controlling blood pressure

• Sodium is found in most processed foods, especially salt.

• Too much sodium can cause swelling, high blood pressure, weight gain and difficulty breathing

• Try using alternate food seasonings: lemon and limes, spices, seafood seasoning, Italian seasoning, vinegars, peppers

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Fluids

• Healthy kidneys remove fluids as urine

• As kidney function declines, you make less urine and fluids build up in your body

• Check for fluid and sodium retention

• You will need to restrict your fluid intake

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Phosphorus

• Phosphorus is a mineral which combines with calcium to keep bones and teeth strong

• Too little calcium and too much phosphorus

• You will need to control the phosphorus in your diet

• You may need to take a phosphate binder or a calcium supplement

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Do I need to limit calories?

• Calories are needed in your diet for energy and for maintaining your body weight

• It is important to eat enough calories every day

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What about vitamins?

• Your physician will prescribe your vitamins, which may include:– Folic acid– Iron supplements

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How will I know that my diet is working?

• The best indicators of how well you are following your diet are:– Weight loss or gain– Blood pressure– Swelling of hands and feet– Blood samples

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Dining out

• Once you understand your diet, you will be able to pick the correct foods to eat, whether you are at home or in a restaurant.

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Summary

• Like learning a new skill, time and practice are

needed to succeed in managing your renal diet

• Patience and good communication with your

physician and dietitian are important

• Remember, each person’s diet is set up for him or her,

because no two people are alike

• You have excellent support in your dialysis unit to

help you practice diet planning