Renal diet

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A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium. [1] Calories may also be supplemented if the individual is losing weight undesirably. [1]

Contents

The diet may help limit the buildup of waste products within the body and reduce strain on the kidneys, as well as reduce blood pressure and lower the risk of fluid build-up around the heart and lungs. [2] [3] [4] [5] Phosphorus restriction can help maintain bone health, as phosphorus buildup in the blood results in the leaching of calcium from bones and subsequently an increased fracture risk. [6] The evidence supporting uptake of a renal diet and a reduction in cardiovascular events and mortality is limited, but dietary interventions may increase health-related quality of life and estimated Glomerular Filtration Rate (eGFR) while lowering serum albumin and serum cholesterol levels. [4]

The restrictiveness of a renal diet depends on the severity of the patient's kidney disease, and the diet should be undertaken with the advice of a dietician. [5] [7] Patients with comorbid conditions like diabetes may need to further alter their diets to meet the needs of those conditions simultaneously. [7]

Who should be on a renal diet?

Diet modification is recommended in those diagnosed with CKD stage 3-5 or GFR <60 mL/min/1.732 that are NOT on dialysis. Those with eGFR greater than or equal to 60 mL/min/1.732 are recommended to follow the general population dietary recommendations (DASH diet). [8]

Sodium

Sodium restriction in CKD has been studied and recommended in individuals w/ coexisting hypertension, volume overload or proteinuria. Sodium restriction to <2 g/day (<5 g/day of salt) has shown improved blood pressure control, improved volume control and reduced proteinuria. [9] [10] [11] [12] High sodium intake of above 6g/day has been shown to increase rates of cardiovascular disease, stroke and overall mortality. [13] [14]

Avoid: High-sodium foods
  • Condiments
  • Canned vegetables/meats/fish/soups
  • Cured or smoked bacon, sausage, meats
  • Deli meats
  • Frozen dinners
  • Pickles
  • Pizza
  • Processed/packaged foods
  • Seasonings
  • Tomato sauces/marinades
Guide to reading sodium nutrition labels
Salt/sodium-freeLess than 5 mg of sodium per serving
Very low sodium35 mg or less of sodium per serving
Low sodium140 mg or less of sodium per serving
Reduced sodiumAt least 25% less sodium than the regular product
Light or lite in sodiumAt least 50% less sodium than the regular product
No salt added or unsaltedNo salt is added during processing, but these products may not be salt/sodium-free unless stated

Potassium

Potassium management for individuals with CKD is variable and dependent on various factors including CKD stage/eGFR, serum potassium levels and concomitant use of potassium altering medications such as ACE inhibitors/ARBs. Potassium regulation requires an individualized approach with the assistance of a dietician and physician.

Avoid: High-potassium food
FruitsVegetablesProteinsDairyOther
Bananas

Oranges

Raisins

Avocado

Cantaloupe

Coconut

Figs

Kiwi

Mango

Nectarines

Prunes

Artichokes

Baked beans

Beets

Brussels sprouts

Chard

Olives

Potatoes

Pickles

Pumpkin

Squash: acorn, butternut

Tomato

Beans (black/kidney/pinto)

Lobster

Salmon

Sardines

Scallops

Whitefish

Cheese

Ice cream

Milk Yogurt

Chocolate

Peanuts

Peanut butter

Sports drinks

Low-potassium foods
FruitsVegetablesProteinsGrainFluidsSnacks
Apples

Blueberries

Cherries

Dried fruits: apples, blueberries, cherries, coconut, cranberries

Grapes

Lychee

Pears

Persimmon

Pineapple

Plums

Raspberries

Strawberries

Tangerines

Watermelon

Asparagus

Bean sprouts

Broccoli

Cabbage

Carrots

Cauliflower

Celery

Cherry tomatoes

Corn

Cucumber

Eggplant

Green or wax beans

Greens: collard, mustard, turnip

Jicama

Kale

Leeks

Lettuce

Mushrooms

Okra

Onion

Peas: green, sugar snap, snow

Peppers: green, red, yellow, jalapeño

Radish

Spinach (raw)

Squash: spaghetti, yellow

Turnips

Water chestnuts

Beans

Beef

Chicken

Edamame

Eggs (whole or egg whites)

Fish

Lamb

Lentils

Pork

Tofu

Turkey

Veal

Wild game

Bagel

Bread loaf

Cereal

Corn tortilla

Couscous

English muffin

Oatmeal

Pasta

Pita

Quinoa

Rice

Rice cakes

Cream of Wheat

Grits

100% fruit juices: apple, cranberry, grape, pineapple

Fresh-brewed coffee

Fresh-brewed tea: black, herbal

Fresh-squeezed lemonade

Nectars: apricot, guava, mango, papaya, peach, pear

Sodas: club, lemon-lime

Water: sparkling, tap

All-natural fruit leather

Animal crackers

Applesauce

Frozen fruit bars

Fruit cocktail

Homemade desserts: fruit pie or cobbler

Italian ice

Rice Krispies Treats®

Sherbet

Unsalted snacks: crackers, pita chips, popcorn, pretzels, tortilla chips

Phosphorus and calcium

Increased serum phosphate levels in CKD is associated with poor bone health, increased risk of cardiovascular events and mortality. [15] [16] Although there isn't enough evidence that dietary restriction of phosphorus leads to decreased serum phosphorus, KDOQI recommends a maximum of 0.8 to 1 g/day intake restriction of dietary phosphorus. [17]

Serum phosphate levels in CKD are heavily influenced by calcium and parathyroid hormone levels. In CKD,  the kidneys are unable to make adequate amounts of vitamin D, resulting in decreased calcium absorption. Low calcium leads to parathyroid hormone release, which moves calcium and phosphorus out of bones and into the blood. Therefore calcium supplementation in CKD patients results in decreased PTH and decreased phosphorus levels. KDOQI recommends a calcium intake goal of 800 to 1000 mg/day (diet and medications combined). [17] Excessive calcium supplementation of 2000 mg/day for CKD patients may result in calcium deposition in other tissues leading to calcification. [18]

Avoid: High-phosphorus foods
ProteinGrainsDairyFluids
Pre-packaged or breaded meats and fish

Deli meats

Hot dogs

Processed meats

Biscuits

Muffins

Corn bread

Pancakes

Waffles

Cheese

Cheese sauces

Ice cream

Milk

Pudding

Yogurt

Beer

Hot cocoa

Canned soup

Some carbonated beverages, flavored waters and teas

Milk

Milkshakes

Some protein shakes

Low-phosphorus foods
ProteinGrainsDairyFruits
Fresh meats without breading or marinades

Turkey breast/thigh, skinless

Chicken breast/thigh skinless

Pork chop/roast

Salmon

Sea bass

Shrimp

Yellowfin

Flour tortillas: without baking powder

White pita bread

White bread

Sourdough bread

Almond milk

Sour cream

Soy milk

Egg whites

Cream cheese

Parmesan cheese

Apple

Cherries

Peaches

Pineapple

Strawberries

Protein

A low protein diet for individuals with non-dialysis CKD has shown to lower the rate of CKD progression and electrolyte balance. Low protein diets of <0.8 g/kg/day have shown improved CKD management with reduced serum phosphorus, serum urea nitrogen and reduced protein in the urine. [19] [20] [21] A very low protein diet (0.28 g/kg/day) is not recommended due to the possibility of malnutrition. The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a low protein diet of 0.55-0.6 g/kg/day but specific levels of protein intake varies for each individual and should be altered with the advice of a dietician and/or physician. [22] [23]

See also

References

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  2. Hershey, Kristen (December 2018). "Renal Diet". The Nursing Clinics of North America. 53 (4): 481–489. doi:10.1016/j.cnur.2018.05.005. ISSN   1558-1357. PMID   30388974. S2CID   53272380.
  3. Akchurin, Oleh M. (February 2019). "Chronic Kidney Disease and Dietary Measures to Improve Outcomes". Pediatric Clinics of North America. 66 (1): 247–267. doi:10.1016/j.pcl.2018.09.007. ISSN   1557-8240. PMC   6623973 . PMID   30454747.
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