Prevention is the best option

Healthy eating advice in chronic kidney disease

Consells nutricionals per malalts renals Vall d'Hebron

Healthy eating is the basis for good health. Patients with ESKD may need to change their diet. These changes may include limiting fluid intake, eating a diet low in protein, reducing consumption of salt, potassium, phosphorous and other electrolytes.

The patient should always think about changing diet if the kidney disease worsens or you have to go on dialysis.

Description

We recommend a varied and balanced diet, with the right amount of energy and all the nutrients required for each person’s needs depending on their age, sex, size and degree of physical activity.

With ESKD, the aim of the patient’s diet is to maintain a balance of electrolytes, minerals and fluids.

Patients undergoing dialysis need a special diet to reduce the accumulation of residual products in their body. It is very important to limit fluids as well as proteins, sodium, potassium and phosphorous.

Patients undergoing dialysis need a high intake of proteins to maintain sufficient nutrition. These patients can become malnourished, and that often leads to a poor prognosis.

Diet helps patients on dialysis to feel better. 

 

Dietary recommendations:

1. If there are no issues with consuming carbohydrates, these foods can be a good source of energy.  

2. Fats: They can be a good source of calories. It is important to ensure an intake of monounsaturated and polyunsaturated fats (olive oil). It is important to control cholesterol to avoid increasing cardiovascular risk. 

3. Protein: Patients with ESKD who are not on the renal replacement therapy (RRT) programme are advised to limit their intake of protein to delay the progress of kidney disease. This changes when patients start on dialysis, as they will need more protein (patients on peritoneal dialysis need an even greater protein intake, as they can lose a large amount of protein in the peritoneal fluid that is discarded).

For dialysis, a diet low in proteins is recommended based on weight, stage of the disease, amount of muscle that the person has and other factors.

During dialysis, intake of 1g per kilo per day of foods rich in proteins is advised. Egg whites or protein powders can be added to meals. 

4. Calcium and phosphorous: Levels of calcium and phosphorous should be monitored, as levels can often be too high during ESKD which can cause:

 -Low calcium: This causes the body to extract calcium from bones, making them weaker.

Itching

The amount of dairy products (milk, yoghurt, cheese) consumed should be controlled due to the large amount of phosphorus they contain. It is true that there are products that are low in phosphorous, such as margarine, butter, cream cheese, cream, and dairy-free shakes.

As a medical treatment, calcium supplements are incorporated to prevent osteoporosis and help fix phosphorus in food, so it is important to take these supplements/medication with food.

Vitamin D is also given to control the balance of calcium and phosphorus.

5. Sodium - salt: Reducing salt intake helps to control high blood pressure.

It also helps to control thirst (having to increase fluid intake) and stops the body from retaining fluids.

We advise looking out for the following food labels:

  • Low in sodium
  • No added salt
  • Salt free
  • No salt 

It is important to eat foods containing less than 100 mg of salt per portion.

DO NOT use salt in cooking, replace it with spices.

DO NOT use salt substitutes that contain a large amount of potassium. 

6. Potassium: Levels of potassium in the blood help to keep heart beat regular. If potassium is accumulated because the kidneys are not working properly, heart disease may occur.

Controlling potassium intake also helps to prevent high levels of calcium in the blood serum (hypercalcaemia).

Potassium is found in many food groups, including fruit and vegetables.

Recommended fruits:

  • Peaches, grapes, pears, cherries, apples, pineapple, watermelon.
  • Avoid oranges and/or orange juice, nectarines, melon, plums, bananas, raisins and kiwis.

Recommended vegetables:

  • Broccoli, cabbage, carrots, cauliflower, celery, cucumber, lettuce, courgette.
  • Avoid asparagus, avocado, potatoes, tomatoes and/or tomato sauce, spinach. 

We advise double cooking vegetables, boiling them first and then changing the water and cooking them again, as well as leaving (potatoes and green vegetables) to soak, changing the water several times. 

7. Iron: Patients with ESKD often have anaemia and often need extra iron intake.

Foods rich in iron: Liver, pork, chicken, cockles, spinach (warning: rich in potassium). 

8. Fluids: In the early stages of kidney failure, it is not necessary to limit the intake of liquids. As the disease worsens, however, it is important to be careful of liquid intake.

In ESKD, the amount of urine the body produces decreases and urine output usually stops completely after six months on haemodialysis RRT.

(Peritoneal dialysis patients usually maintain longer residual urine output over a longer period of time and have fewer restrictions on fluid, sodium and potassium intake because they have dialysis treatments every day).

Fluid intake is the insensitive losses per day plus residual diuresis retained. It is important to emphasise that foods also contain liquids.

Between dialysis sessions, fluid can accumulate in the body. This is why it is important to control the amount consumed to avoid complications (oedemas and breathing difficulty). 

We suggest the following:

  • DO NOT eat too many foods containing lots of water, such as soups, purées/creams, gelatin, lettuce, celery, tomatoes and melon.
  • DO USE smaller cups or glasses.
  • Avoiding eating salty foods.
  • Freeze and make cubes of iced water or juice to relieve thirst.

 

Professionals at Vall d’Hebron of particular note in this education/pathology:

Nursing team, RRT/Nephrology:

MªAngels Coyo Montero, DI

Carmen Martínez Rubio, DI

Laura Núñez Rodrigo, DI

Carmen López Queizan, TCAI

Teresa Eixarch Lanaspa, Supervisora d’Infermeria

   
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