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Diet in CKD (CHRONIC KIDNEY DISEASE) – Dr Umesh Khanna & Meera Shah



At every stage of kidney failure, diet plays a very important role in slowing of kidney disease,preventing complications,preventing malnutrition and keeping you healthy.The general principles of diet are as follows.

Calories :
Sufficient calorie requirement is very important in patients with chronic kidney disease. If the calorie requirement is not adequate, proteins of body are used as a source of energy. This will not only lead to malnutrition but also lead to production of greater amounts of waste products of protein breakdown.

Proteins :
Most patients with chronic kidney disease say ‘I have kidney problem and thus I should not be consuming food items that contain protein.’

But this is just a myth. Proteins are essential items.They  build, repair and maintain the body tissues. They also help the body fight infections and heal wounds. As the body breaks down protein foods, a waste product called urea is formed. If this is not eliminated, too much urea in the blood may cause tiredness, nausea, headaches and a bad taste in your mouth. But if you eat too little protein, muscle mass may be lost leading to fatigue and weight loss . Therefore, enough protein is required for the body, at the same time limiting the amount of urea formed. 

Foods like meat, fish, poultry, eggs, tofu, milk and milk products are high in protein.They are called first class proteins and can be had in moderation under the guidance of a dietician.The total protein intake is around 0.8 gm/kg body weight coming to around 40 to 50 gm/day half of which should be first class proteins.

Sodium :
The excretion of sodium decreases as renal failure progresses leading to increase in blood pressure and swelling.Hence In such cases, sodium has to be restricted. If the blood pressure is normal and there is absence of edema, in such cases sodium can be taken in moderation. Thus, sodium requirements should be totally indivualized. 

Most of the convenient and popular food items such as farsan, chips, biscuits, sandwiches, noodles, chinese, chaats, panipuri, pizzas, papads, pickles etc are all high in sodium, and hence should be avoided. 

The failing kidney cannot excrete potassium adequately. This increases the potassium concentration in the blood which may cause heart problems and sudden death. In such cases potassium has to be restricted. Leaching of vegetables and low potassium fruits should be encouraged. Fruit juices, coconut water, soups, dry fruits are high in potassium. However not all patients retain potassium and thus diet should be individualized based on the patients requirements.Also salt substitutes like ‘losalt or Lona or tata lite’ contain potassium and should be strictly avoided in kidney failure patients. 

Phosphorus :
Phosphorus is a mineral which helps keep bones strong and healthy. It may be referred to as phosphorus or phosphate. As kidney function declines, the blood phosphate level will rise, causing itchy skin, painful joints, and loss of calcium from bones. Therefore, the amount of phosphorus in the diet needs to be controlled. Phosphorus rich foods include milk and milk products, meat, fish and poultry. However, milk products and protein foods are also needed for overall good nutrition. Generally, foods with very high levels of phosphorus, such as seeds, nuts, dried peas, beans and bran cereals, are restricted in the daily eating plan.However it is the processed foods and colas.or soft drinks which contain totally avoidable phosphorus and should not be consumed at all. 

Read product labels carefully for hidden sources of phosphorus such as phosphoric acid and sodium phosphate. 

Calcium & Vitamin D :
Calcium and Vitamin D are needed for strong bones and are carefully regulated by healthy kidneys. Damaged kidneys may not be able to activate Vitamin D into a usable form. People with chronic kidney disease should only take calcium and Vitamin D as prescribed by their physician and monitor their levels regularly. Dairy products such as milk and milk products (curd, paneer) are good sources of calcium. 

Fluid : 
As kidney function decreases, the kidneys may not produce as much urine as before, and your body may become overloaded with fluid. In such cases, it is necessary to restrict the intake of fluids. Excessive fluid intake results in swelling, breathlessness and high blood pressure. In some cases where urine output is adequate and there is no swelling, fluid restriction may not be necessary. Fluids include any liquid at room temperature i.e. water, ice, milk, buttermilk, soup, juices, soft drinks, dal, ice creams etc.

Thus diet in kidney disease is individualized. based on their illness,blood reports and stage of kidney disease. You must consult your doctor or a qualified dietician and eat accordingly.

 

By - Dr. Umesh Khanna

Chairman, Mumbai kidney Foundation

Trustee, Sapiens Health Foundation

Secretary, Amar Gandhi Foundatio

  Lancelot Kidney & GI centre,D1/D2,Bharat baugh,Lancelot compound, SV Road Borivali West Mumbai 400092
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