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Healthy kidneys help us to live healthy. So, we should maintain a proper diet. But if anyone suffering from kidney disease, he or she should strictly maintain a renal diet with medicines. Medicine is not the only way for preventing kidney disease from further damage. A good renal diet is also very important for the patients. So here some basic nutritional advices for chronic renal failure patients but they are not on dialysis.

Dietary management:

A kidney friendly diet is based on the patient’s age, sex, height, weight, physical activity and how many potassium, calcium, phosphorus, creatinine present in the blood.

First we have to know the role of calorie, protein, fat and carbohydrate in the diet.

calories:

Calories come from the proteins, carbohydrates and fats. Calories are very much important for your body for supplying energy. How many calories you need depends on your age, sex, activity level, height and weight. Carbohydrates and fats must supply non- protein kilocalories to spare protein for tissue protein synthesis.

The Harris-Benedict’s equation is used to estimate daily kilocalorie requirements.

For male: 66+ (13.8 X weight) + (5X height) –(6.8 X age) X 1.3

For female: 655.1+ ( 9.6 X weight) + ( 1.8 X height) –(4.7 X age) X 1.3

Here 1.3 is used for activity factor for malnutrition.

Proteins:

Protein is an essential nutrient in the diet for kidney patient. Protein helps to build muscle tissue and bone. It is necessary for skin. Most kidney patients are suffering from muscle wasting. So, requirement of protein is very much important but protein breakdowns into waste products which are removed from the blood by the kidneys. So, you take excess protein in the daily diet can cause kidney function more damage as kidney does not function properly in ESRD (End Stage Renal Disease). So, you should consult with a renal dietitian before taking protein in daily diet.

Low protein diets are advised during severe degree of renal failure. Protein should come 15% of total calories. On the basis of GFR (Glomerular Filtration Rate) and creatinine level in the blood protein is provided to the patients.

The patient is given 0.5 – 0.6 gm/ kg ideal body weight/ day protein as kidneys need to be given rest at this condition.

protein rich foods

Calculation of IBW

For male: inch of the height X1.9+52

For female: inch of the height X1.7+49

For example if someone’s height is 5’2”, his IBW is (2X 1.9+52)=55.8kg

Protein requirement is 55.8 X 0.6= 33gm/day

Requirement of protein is also based on the basis of GFR.

≥ 90 = Stage 1(1gm/kg IBW)

89-60 = Stage 2(0.9-0.8gm/kg IBW)

59-45 = Stage 3a (0.8-0.7gm/kg IBW)

45-30 = Stage 3b (0.8-0.7gm/kg IBW)

30-15 = Stage 4 (0.7-0.6 gm/kg IBW)

< 15 or dialysis = Stage 5 ( 0.6-0.5 gm/kg IBW)

Fats:

Fat should come 20% -25% of total calories. You should intake healthy fats. In this matter a dietitian can help you.

Fat provides energy and maintain heart functions. Unsaturated fatty acids help to produce hormone like substances that regulate blood pressure. Too much fat increases the cholesterol level in the blood. It can increase the risk of heart problems. It can also cause problems of digestion and vomiting. People with CKD are at higher risk of having heart disease. Therefore CKD patients should be careful about fat intake.

High fat diet

•  Oil intake-

You should not take extra oil. The requirement of oil should be 25 – 30 ml/day. Mixer of mustard oil and refined oil in 1:1 ratio will be beneficial for health. Avoid oily foods and nuts like cashew, almond , peanuts.

Carbohydrate:

Carbohydrates should come 60 % -65% of total calories. Carbohydrates are the main source of energy for muscular work. People with CKD are at risk of liver problem. So, carbohydrates are needed. The rate of oxidation of amino acids in liver is diminished if abundant supply of carbohydrates is available. Besides this, the main source of energy for central nervous system is glucose. Prolonged hypoglycemia (Deficiency of glucose) with CKD patients can lead to damage to the brain tissue. So, correct amount of carbohydrate is needed in your diet.

Carbohydrate rich foods

Sodium:

In chronic kidney disease salt is restricted 5gm/day. It may vary depending upon the presence of sodium in the blood. If patient needs more sodium, the requirement of sodium increases. Sodium is strictly restricted if hypertension, oedema are present because sodium has tendency to hold fluids in the blood and raises the blood pressure and thus puts a strain on the heart and kidneys. So, you should choose sodium free or low sodium foods to stay healthy. If people with CKD have high sodium in the blood , he or she should intake salt free foods.

• Tips for intake of salt-

Take some salt of total requirement of salt and sprinkle it on the whole food or you may dip a tooth pick in the salt and then touch it on your tongue. In this way intake of salt can be reduced. Don’t buy low potassium salt packets from market because they have high sodium level. So you should buy normal salt packets like TATA salt.



Table salt , baking soda, baking powder, aginamoto ( mono sodium glutamate), different types of sauces like oyster sauce, soya sauce etc. salami, smoked fish, cured meat and fish, cheese, pickle, different types of soups. Roasted and salted seeds and nuts, popcorns , chips , fast foods like egg roll, pizza, burger etc.

Potassium:

Potassium is essential for heart and also for muscular work. So, right amount of potassium should be taken through foods. The normal level of potassium in the blood is 3.5 – 5.0.If the level raises potassium intake should be restricted because too much potassium cannot be removed from the blood by the damaged kidneys. So, potassium builds up in the blood day by day causing heart attack and it can lead to death of the patient. Besides these, another symptom is observed such as mental confusion. Patient is recommended 0.5 – 0.6 gm/ IBW potassium. It may vary depending upon the potassium level in blood. There is a chance of increasing amount of potassium intake.
Here is the list of potassium  content foods.

Phosphorus:

In chronic renal failure patient there is a reduction of phosphate excretion. In this condition if you intake high phosphorus rich foods constantly, phosphate will be build up in the blood. Too much phosphorus in the blood pulls calcium from the bone, making the bones weak this leads to abnormalities in the metabolism of calcium, vitamin- D and high parathyroid hormone, finally leading to renal bone disease. Too much phosphorus is the cause of itchy skin.

The patient is recommended 800-1000 mg/day. You should intake some phosphorus binders with your diet. A nephrologist can help you in this matter. Before taking foods you should consult with a renal dietitian who can help you to learn about phosphorus rich foods how you intake it in the daily diet.



Phosphorus rich foods: (if serum phosphorus level is > 4.5 mg/dl, then restrict)

Atta, lentil, cholar dal, rajma, soyabean,carrot, almond, kaju, pista, mustard seed, sesame, fenugreek seed, popy seeds, milk & milk products.

Fish: bhetki, boal, koi, lata, parse, golda chingri.

Fluid intake:

Patients with CKD need to limit the fluids intake. Because damaged kidneys can’t remove the extra fluid. So, fluids build up in the body and it leads to heart problem. If you have oedema, take fluid as per your urine volume. Fluids include water, tea, milk, curry, soup etc. So, you should measure your daily urine volume in a urine pot. So, before drinking water you must consult with your nephrologist. In this case you have to write your daily urine volume in a page before visiting.

Uric acid:

In chronic renal failure, the patient needs to limit the intake of uric acid rich foods. Because damaged kidney cannot remove the extra uric acid from blood. Then uric acid levels in the blood become too high (condition known as hyperuricemia). If it continues for a long time in the body, crystals may form and cause gout. You should limit the intake of uric acid rich foods.

Foods that can raise uric acid level:

Yeast, bakery products, black gram, lentil, poppy seeds, shrimp(brown), raisin, soya bean(dry), animal organs like liver, fish egg, fish head, stomach, kidney etc.

Some dos and don’ts about foods Of chronic kidney disease: