VIEWS: 25 PAGES: 12 POSTED ON: 8/14/2011
Nutrition for Advanced Chronic Kidney Disease in Adults National Kidney and Urologic Diseases Information Clearinghouse Why is nutrition important phosphorus and potassium may rise to unsafe levels, causing heart and bone problems. for someone with advanced Anemia—low red blood cell count—can chronic kidney disease result from CKD because the kidneys stop U.S. Department of Health and (CKD)? making enough erythropoietin, a hormone Human Services A person may prevent or delay some health that causes bone marrow to make red blood problems from CKD by eating the right cells. After months or years, CKD may NATIONAL foods and avoiding foods high in sodium, progress to permanent kidney failure, which INSTITUTES potassium, and phosphorus. Learning requires a person to have a kidney transplant OF HEALTH about calories, fats, proteins, and fluids is or regular blood filtering treatments called important for a person with advanced CKD. dialysis. Protein foods such as meat and dairy prod- ucts break down into waste products that What is medical nutrition healthy kidneys remove from the blood. therapy (MNT)? As CKD progresses, nutritional needs MNT is the use of nutrition counseling by a change. A health care provider may recom- registered dietitian to help promote a medi- mend that a patient with reduced kidney cal or health goal. A health care provider function choose foods carefully. may refer a patient to a registered dietitian to help with the patient’s food plan. Many What do the kidneys do? insurance policies cover MNT when recom- mended by a health care provider. Anyone The kidneys remove wastes and extra water who qualifies for Medicare can receive a from the blood and make urine. To keep the benefit for MNT from a registered dietitian body working properly, the kidneys balance or nutrition professional when a health care the salts and minerals—such as calcium, provider provides a referral indicating that phosphorus, sodium, and potassium—that the person has diabetes or kidney disease. circulate in the blood. The kidneys also release hormones that help make red blood One way to locate a qualified dietitian is to cells, regulate blood pressure, and keep contact the American Dietetic Association bones strong. at www.eatright.org and click on “Find a Registered Dietitian.” Users can enter their address or ZIP code for a list of dietitians What are the effects of CKD? in their area. A person looking for dietary CKD usually takes a long time to develop advice to prevent kidney damage should and does not go away. In CKD, the kidneys click on “Renal (Kidney) Nutrition” in the continue to work—just not as well as they specialty field. Dietitians who specialize in should. Wastes may build up so gradu- helping people with CKD are called renal ally that the body becomes used to having dietitians. those wastes in the blood. Salts containing Why is knowing about What is the right meat calories important for portion size? someone with advanced Most people—with or without CKD—can CKD? get the daily protein they need by eating two 3-ounce servings of meat or meat substitute. As CKD progresses, people often lose their A 3-ounce serving of meat is about the size of appetites because they find that foods do not a deck of cards or the palm of a person’s hand. taste the same. As a result, they consume fewer calories—important units of energy in A renal dietitian can help people learn about food—and may lose too much weight. Renal the amount and sources of protein in their dietitians can help people with advanced diet. Animal protein in egg whites, cheese, CKD find healthy ways to add calories to chicken, fish, and red meats contain more of their diet if they are losing too much weight. the essential nutrients a body needs. With careful meal planning, a well-balanced vege- tarian diet can also provide these nutrients. A Why is knowing about renal dietitian can help people with advanced protein important for CKD make small adjustments in their eating someone with advanced habits that can result in significant protein CKD? reduction. For example, people can lower their protein intake by making sandwiches Protein is an essential part of any diet. using thinner slices of meat and adding let- Proteins help build and maintain muscle, tuce, cucumber slices, apple slices, and other bone, skin, connective tissue, internal organs, garnishes. The following table lists some high- and blood. They help fight disease and protein foods and suggestions for low-protein heal wounds. But proteins also break down alternatives that are better choices for people into waste products that must be removed with CKD trying to limit their protein intake. from the blood by the kidneys. Eating more protein than the body needs may put an extra burden on the kidneys and cause kidney function to decline faster. High- and Low-protein Foods � Health care providers recommend that Low-protein people with CKD eat moderate or reduced High-protein Foods Alternatives amounts of protein. However, restricting Ground beef Egg substitutes protein could lead to malnutrition, so people Halibut Shrimp with CKD need to be careful. The typical Salmon Tofu American diet contains more than enough protein. Learning about portion sizes can Tuna Imitation crab meat help people limit protein intake without Roasted turkey Roasted chicken endangering their health. Chili con carne Beef stew Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 22. USDA website. www.ars.usda. gov/SP2UserFiles/Place/12354500/Data/SR22/nutrlist/ sr22w203.pdf. Released September 2009. Accessed July 21, 2010. 2 Nutrition for Advanced Chronic Kidney Disease in Adults When kidney function declines to the point A dietitian can suggest healthy ways to where dialysis becomes necessary, patients include fat in the diet, especially if more cal- should include more protein in their diet ories are needed. Vegetable oils such as corn because dialysis removes large amounts of or safflower oil are healthier than animal fats protein from the blood. such as butter or lard. Hydrogenated vege- table oils should be avoided because they are Why is knowing about fat high in trans-fatty acids. Monounsaturated fats—olive, peanut, and canola oils—are important for someone with healthy alternatives to animal fats. The table advanced CKD? below shows the sources of fats, broken down Everyone should know about fat sources into three types of fats that should be eaten because eating the wrong kinds of fat and less often and good fats that can be eaten too much fat increases the risk of clogged more often. blood vessels and heart problems. Fat provides energy, helps produce hormonelike substances that regulate blood pressure and Sources of Fats other heart functions, and carries fat-soluble vitamins. Everyone needs dietary fat, but Eat Less Often Eat More Often some fats are healthier than others. People Saturated fats Monounsaturated fats with CKD are at higher risk of having a heart • red meat • corn oil attack or stroke. Therefore, people with • poultry • safflower oil CKD should be especially careful about how • whole milk • olive oil dietary fat affects their heart health. • butter • peanut oil People with advanced CKD should talk • lard • canola oil with a dietitian about healthy and unhealthy Trans-fatty acids sources of fat. Saturated fats and trans-fatty • commercially acids can raise blood cholesterol levels and baked goods clog blood vessels. Saturated fats are found • french fries in animal products such as red meat, poultry, • doughnuts whole milk, and butter. These fats are usu- ally solid at room temperature. Trans-fatty Hydrogenated vegetable oils acids are often found in commercially baked goods such as cookies and cakes and in fried • margarine foods like doughnuts and french fries. • shortening 3 Nutrition for Advanced Chronic Kidney Disease in Adults Why is knowing about Alternative seasonings such as lemon juice, salt-free seasoning mixes, and hot pepper sodium important for sauce can help people reduce their salt someone with advanced intake. People with advanced CKD should CKD? avoid salt substitutes that use potassium, such as AlsoSalt or Nu-Salt, because CKD Too much sodium in a person’s diet can be limits the body’s ability to eliminate potas- harmful because it causes blood to hold sium from the blood. The table below fluid. People with CKD need to be care- provides some high-sodium foods and sug- ful not to let too much fluid build up in gestions for low-sodium alternatives that are their bodies. The extra fluid raises blood healthier for people with any level of CKD pressure and puts a strain on the heart and who have high blood pressure. kidneys. A dietitian can help people find ways to reduce the amount of sodium in their diet. Nutrition labels provide informa- tion about the sodium content in food. The High- and Low-sodium Foods � U.S. Food and Drug Administration advises that healthy people should limit their daily Low-sodium High-sodium Foods sodium intake to no more than 2,300 milli- Alternatives grams (mg), the amount found in 1 teaspoon Salt Salt-free herb of table salt. People who are at risk for a Regular canned seasonings heart attack or stroke because of a condition vegetables Low-sodium canned such as high blood pressure or kidney disease Hot dogs and foods should limit their daily sodium intake to no canned meat Frozen vegetables more than 1,500 mg. Choosing sodium-free Packaged rice with without sauce or low-sodium food products will help them sauce Fresh, cooked meat reach that goal. Packaged noodles Plain rice without sauce with sauce Plain noodles without Sodium is found in ordinary table salt and Frozen vegetables sauce many salty seasonings such as soy sauce and with sauce Fresh vegetables teriyaki sauce. Canned foods, some frozen Frozen prepared without sauce foods, and most processed meats have large meals Homemade soup with amounts of salt. Snack foods such as chips Canned soup fresh ingredients and crackers are also high in salt. Regular tomato Reduced-sodium sauce tomato sauce Snack foods Unsalted pretzels Unsalted popcorn Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 22. USDA website. www.ars.usda. gov/SP2UserFiles/Place/12354500/Data/SR22/nutrlist/ sr22w307.pdf. Released September 2009. Accessed July 21, 2010. 4 Nutrition for Advanced Chronic Kidney Disease in Adults Why is knowing about potassium important for High- and Low-potassium Foods � someone with advanced High-potassium Low-potassium CKD? Foods Alternatives Keeping the proper level of potassium in Oranges and orange Apples and apple the blood is essential. Potassium keeps the juice juice heart beating regularly and muscles work- Melons Cranberries and ing right. Problems can occur when blood Apricots cranberry juice potassium levels are either too low or too Bananas Canned pears high. Damaged kidneys allow potassium to Potatoes Strawberries, build up in the blood, causing serious heart Tomatoes blueberries, problems. Potassium is found in many fruits raspberries Sweet potatoes and vegetables, such as bananas, potatoes, Pineapple Cooked spinach avocados, and melons. People with advanced Cabbage Cooked broccoli CKD may need to avoid some fruits and Boiled cauliflower Beans (baked, vegetables. Blood tests can indicate when kidney, lima, pinto) potassium levels have climbed above normal Source: United States Department of Agriculture range. A renal dietitian can help people with (USDA) National Nutrient Database for Standard advanced CKD find ways to limit the amount Reference, Release 22. USDA website. www.ars.usda. of potassium they eat. The potassium gov/SP2UserFiles/Place/12354500/Data/SR22/nutrlist/ content of potatoes and other vegetables sr22w306.pdf. Released September 2009. Accessed July 21, 2010. can be reduced by boiling them in water. The following table gives examples of some high-potassium foods and suggestions for low-potassium alternatives for people with advanced CKD. 5 Nutrition for Advanced Chronic Kidney Disease in Adults Why is knowing about The table below lists some high-phosphorus foods and suggestions for low-phosphorus phosphorus important for alternatives that are healthier for people with someone with advanced advanced CKD. CKD? Damaged kidneys allow phosphorus, a min- eral found in many foods, to build up in the High- and Low-phosphorus Foods � blood. Too much phosphorus in the blood pulls calcium from the bones, making the High-phosphorus Low-phosphorus bones weak and likely to break. Too much Foods Alternatives phosphorus may also make skin itch. Foods Dairy foods (milk, Liquid nondairy such as milk and cheese, dried beans, peas, cheese, yogurt) � creamer colas, canned iced teas and lemonade, nuts, Beans (baked, kidney, Sherbet � and peanut butter are high in phosphorus. A lima, pinto) � Cooked rice renal dietitian can help people with advanced Nuts and peanut butter Rice, wheat, and CKD learn how to limit phosphorus in their Processed meats (hot corn cereals � diet. dogs, canned meat) � Popcorn Cola Peas As CKD progresses, a person may need to Canned iced teas and Lemon-lime soda take a phosphate binder such as sevelamer lemonade Root beer hydrochloride (Renagel), lanthanum carbon- Bran cereals Powdered iced tea ate (Fosrenol), calcium acetate (PhosLo), Egg yolks and lemonade or calcium carbonate (Tums) to control the mixes phosphorus in the blood. These medications act like sponges to soak up, or bind, phos- Source: United States Department of Agriculture phorus while it is in the stomach. Because it (USDA) National Nutrient Database for Standard is bound, the phosphorus does not get into Reference, Release 22. USDA website. www.ars.usda. gov/SP2UserFiles/Place/12354500/Data/SR22/nutrlist/ the blood. Instead, it is removed from the sr22w305.pdf. Released September 2009. Accessed body in the stool. July 21, 2010. 6 Nutrition for Advanced Chronic Kidney Disease in Adults Why is regulating fluid Points to Remember intake important for • � A person may prevent or delay some someone with advanced health problems from chronic kidney disease (CKD) by eating the right foods CKD? and avoiding foods high in sodium, People with advanced CKD may need to potassium, and phosphorus. limit how much they drink because damaged • � The kidneys remove wastes and extra kidneys can’t remove extra fluid. The fluid water from the blood and make urine. builds up in the body and strains the heart. Patients should tell their health care provider • � Medical nutrition therapy (MNT) is the about any swelling around the eyes or in the use of counseling by a registered dieti- legs, arms, or abdomen. tian to help promote a medical or health goal. How can understanding • � Dietitians who specialize in helping peo- and keeping track of lab ple with CKD are called renal dietitians. reports help someone with • � People with advanced CKD often lose their appetites and consume fewer advanced CKD make healthy calories—important units of energy in food choices? food—and may lose too much weight. Learning how to read and understand lab • � Eating more protein than the body reports lets a person see how different foods needs may put an extra burden on the can affect the kidneys. A health care pro- kidneys and cause kidney function to vider should order regular blood tests for decline faster. Most people—with or people with CKD. Patients can ask their without CKD—can get the daily protein health care provider for copies of their lab they need by eating two 3-ounce serv- reports and ask to have them explained, ings of meat or meat substitute. noting any results out of the normal range. Keeping track of these lab results can help • � People with CKD are at higher risk of people see whether they are making progress having a heart attack or stroke. or getting worse. People with CKD should • � Everyone needs dietary fat, but some talk with their health care provider or dieti- fats are healthier than others. tian about how they can make healthier food choices. For example, if a test shows that a • � Too much sodium in a person’s diet can person with advanced CKD has a high potas- be harmful because it causes blood to sium level, that person should concentrate hold fluid. People with CKD need to be on reducing potassium in the diet by limiting careful not to let too much fluid build high-potassium foods. up in their bodies. 7 Nutrition for Advanced Chronic Kidney Disease in Adults • � People with advanced CKD should Hope through Research avoid salt substitutes that use potassium The National Institute of Diabetes and because CKD limits the body’s ability to Digestive and Kidney Diseases (NIDDK) has eliminate potassium from the blood. many research programs aimed at slowing • � Damaged kidneys allow potassium to the progression of CKD. For example, the build up in the blood, causing serious NIDDK is sponsoring the Chronic Renal heart problems. Potassium is found Insufficiency Cohort study to determine in many fruits and vegetables, such the risk factors for rapid decline in kidney as bananas, potatoes, avocados, and function and development of cardiovascular melons. disease. This study of about 3,000 patients • � Too much phosphorus in the blood pulls with chronic renal insufficiency, another way calcium from the bones, making the of describing CKD, will reflect the racial, bones weak and likely to break. ethnic, and gender composition of the people in the United States who have permanent • � People with advanced CKD may need to kidney failure. The data collected and speci- limit how much they drink because dam- mens obtained from people in this study will aged kidneys can’t remove extra fluid. serve as a national resource for investigat- • � Many patients find that keeping track ing CKD, as well as cardiovascular disease. of their test results helps them see how Establishing this group of patients and fol- their treatment is working. Patients can lowing them into the future will also provide ask their health care provider for cop- an opportunity to examine genetic, environ- ies of their lab reports and ask to have mental, behavioral, nutritional, quality-of- them explained, noting any results out life, and health resource use factors in this of the normal range. population. The main part of the study will consist of monitoring participants and fol- lowing up at regular clinic visits with kidney function measurements, cardiovascular stud- ies, and lab tests. In addition, participants will answer questionnaires to assess various demographic, nutritional, and quality-of-life factors. Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For infor- mation about current studies, visit www.ClinicalTrials.gov. 8 � Nutrition for Advanced Chronic Kidney Disease in Adults Additional Reading Kidney Beginnings: A Patient’s Guide to Living with Reduced Kidney Function The following fact sheets and brochures, as American Association of Kidney Patients well as other information, are available on 3505 East Frontage Road, Suite 315 request from the organizations listed. Most Tampa, FL 33607 of these resources can also be found online Phone: 1–800–749–2257 or 813–636–8100 at the web addresses given. Email: firstname.lastname@example.org Dining Out With Confidence: A Guide for Internet: www.aakp.org Patients With Kidney Disease What I need to know about Eating and Diabetes Nutrition and Chronic Kidney Disease National Diabetes Information National Kidney Foundation Clearinghouse 30 East 33rd Street 1 Information Way New York, NY 10016 Bethesda, MD 20892–3560 Phone: 1–800–622–9010 or 212–889–2210 Phone: 1–800–860–8747 Internet: www.kidney.org Email: email@example.com Facts About the DASH Eating Plan Internet: www.diabetes.niddk.nih.gov National Heart, Lung, and Blood Institute Eating Right for Kidney Health: Tips for People Information Center with Chronic Kidney Disease (CKD) (online P.O. Box 30105 only) Bethesda, MD 20824–0105 Your Kidney Test Results (online only) Phone: 301–592–8573 National Kidney Disease Education TTY: 240–629–3255 Program Fax: 301–592–8563 3 Kidney Information Way Email: firstname.lastname@example.org Bethesda, MD 20892 Internet: www.nhlbi.nih.gov Phone: 1–866–4–KIDNEY (1–866–454–3639) A Healthy Food Guide for People with TTY: 1–866–569–1162 Chronic Kidney Disease Fax: 301–402–8182 American Dietetic Association Email: email@example.com 120 South Riverside Plaza, Suite 2000 Internet: www.nkdep.nih.gov Chicago, IL 60606–6995 Internet: www.eatright.org 9 Nutrition for Advanced Chronic Kidney Disease in Adults For More Information About the Nutrition for American Kidney Fund Chronic Kidney Disease 6110 Executive Boulevard, Suite 1010 Series Rockville, MD 20852 Phone: 1–800–638–8299 or 1–866–300–2900 The NIDDK Nutrition for Chronic Kidney Fax: 301–881–0898 Disease Series includes three fact sheets: Email: firstname.lastname@example.org • � Nutrition for Early Chronic Kidney Internet: www.kidneyfund.org Disease in Adults � Food and Nutrition Information Center • � Nutrition for Advanced Chronic Kidney National Agricultural Library Disease in Adults 10301 Baltimore Avenue, Room 105 • � Nutrition for Chronic Kidney Disease in Beltsville, MD 20705–2351 Children Phone: 301–504–5414 Fax: 301–504–6409 For free, single, printed copies of this Email: email@example.com series, please contact the National Kidney Internet: www.nal.usda.gov/fnic and Urologic Diseases Information Clearinghouse. Life Options c/o Medical Education Institute, Inc. 414 D’Onofrio Drive, Suite 200 Acknowledgments Madison, WI 53719 Publications produced by the Clearinghouse Phone: 1–800–468–7777 are carefully reviewed by both NIDDK Fax: 608–833–8366 scientists and outside experts. This pub- Email: firstname.lastname@example.org lication was originally reviewed by Lisa Internet: www.lifeoptions.org Murphy-Gutekunst, M.S.Ed., R.D., C.S.R., Cleve-Hill Dialysis, Buffalo, NY, and Marcy The information in this fact sheet should Bushman, M.P.H., R.D., L.D.N., Sigma-Tau not be used in the nutritional counseling of Pharmaceuticals. infants, children, and adolescents with CKD. Families of pediatric patients with CKD should seek age-appropriate nutritional counseling from a pediatric renal dietitian. 10 Nutrition for Advanced Chronic Kidney Disease in Adults National Kidney Disease You may also find additional information about this Education Program topic by visiting MedlinePlus at www.medlineplus.gov. This publication may contain information about 3 Kidney Information Way � medications. When prepared, this publication Bethesda, MD 20892 � included the most current information available. For updates or for questions about any medications, Phone: 1–866–4–KIDNEY contact the U.S. Food and Drug Administration (1–866–454–3639) � toll-free at 1–888–INFO–FDA (1–888–463–6332) or TTY: 1–866–569–1162 � visit www.fda.gov. Consult your health care provider for more information. Fax: 301–402–8182 � Email: email@example.com � Internet: www.nkdep.nih.gov � The U.S. Government does not endorse or favor any The National Kidney Disease Education specific commercial product or company. Trade, Program (NKDEP) is an initiative of the proprietary, or company names appearing in this document are used only because they are considered National Institute of Diabetes and Digestive necessary in the context of the information provided. and Kidney Diseases, National Institutes If a product is not mentioned, the omission does not of Health, U.S. Department of Health and mean or imply that the product is unsatisfactory. Human Services. The NKDEP aims to raise awareness of the seriousness of kidney disease, the importance of testing those at high risk, and the availability of treatment to prevent or slow kidney disease. 11 Nutrition for Advanced Chronic Kidney Disease in Adults National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: firstname.lastname@example.org Internet: www.kidney.niddk.nih.gov The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at www.kidney.niddk.nih.gov. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 11–5572 April 2011 The NIDDK prints on recycled paper with bio-based ink.
Pages to are hidden for
"Nutrition for Advanced Chronic Kidney Disease in Adults"Please download to view full document