Nutritional therapy for kidney disease patients.

Nutrition Therapy for Kidney Disease Patients

Proper nutrition control from the early stages of kidney disease can help slow the progression of kidney damage by consuming low protein diets. Low protein intake results in decreased urea levels and a reduced workload for the remaining functional parts of the kidneys.

Chronic kidney disease has 5 stages based on the glomerular filtration rate (GFR):

Stage 1: GFR > 90%

Stage 2: GFR = 60-89%

Stage 3: GFR = 30-59%

Stage 4: GFR = 15-29%

Stage 5: GFR < 15%

Protein intake is vital to the body, as it is used for energy and repair. However, excessive protein intake leads to the production of waste products, which are then excreted by the kidneys. This causes the kidneys to work harder, leading to faster deterioration. Consuming too little protein can also lead to malnutrition.

Choosing high-quality protein sources that contain all the necessary amino acids for the body is important. Good protein sources include fish, lean pork, skinless chicken breast, egg whites, low-fat dairy products, and nuts. Avoid consuming red meat, processed meat products such as ham, bacon, and cheese.

For patients with chronic kidney disease (pre-dialysis) or a GFR of less than 30ml/min/1.73m², a low protein diet is recommended, as prescribed by a healthcare provider.

To calculate the recommended daily protein intake, use the formula: Ideal body weight x (0.6-0.8) = daily protein requirement (grams/day)

For example, for an individual with an ideal body weight of 55kg:

Daily protein requirement = 55 x 0.8 = 44 grams/day

For patients with kidney disease in the end-stage (dialysis), a higher protein diet may be necessary, as prescribed by a healthcare provider.

To calculate the recommended daily protein intake, use the formula: Ideal body weight x 1.2 = daily protein requirement (grams/day).

Fats: Choose oils with lower saturated fat content such as rice bran oil, coconut oil, canola oil, and sunflower oil. Avoid high saturated fat oils such as lard, and palm oil.

Carbohydrates: For patients with chronic kidney disease before hemodialysis, choose protein-free carbohydrates such as glass noodles, potato starch noodles, sago, and plain white rice vermicelli.

Potassium: Limit intake to 2,000-3,000 mg per day. High levels of potassium affect muscle and heart function. When there is kidney dysfunction, potassium excretion is reduced. The level of potassium in the blood should be less than 5 mEq/L. If potassium levels in the blood are high, it can cause abnormal heartbeats or even stop the heart. Patients with a GFR level of 4-5 should avoid high-potassium foods.

Fruits: Fruits with high potassium include dragon fruit, cantaloupe, watermelon, melon, guava, orange, papaya, durian, sweet tamarind, dried longan, avocado, strawberry, and canned fruits.

Vegetables: Vegetables with high potassium include purple cauliflower, carrot, green beans, broccoli, tomato, banana blooms, Thai eggplants, Chinese squash, Chinese cabbage, mushroom, shallot, bamboo shoot, water chestnut, taro, sweet potato, pumpkin, and lotus root.

Green leafy vegetables can be boiled or blanched to reduce their potassium content. If potassium levels are above 5.5, avoid eating all kinds of fruits.

Phosphorus can negatively effect the strength of bones. Having high levels of phosphorus in the blood can result in the bones losing calcium, which can cause them to weaken. Bones become brittle and phosphorus binds with calcium in the blood, leading to the formation of plaque in the blood vessels, which increases the risk of heart disease. Phosphorus levels need to be controlled when the kidneys reach stage 3 deterioration. Foods that are high in phosphorus include milk, drinking yogurt, yogurt, butter, cookies, bread, ice cream, instant coffee, peanuts, red beans, Milo, Ovaltine, cocoa, Pepsi, mineral water, sunflower seeds, pumpkin seeds, corn, sesame, egg yolk, various insects, plant seeds, crispy fish, dried shrimp, tofu, soy milk, and canned fish.

Sodium should be limited to no more than 2,000 mg per day. Consuming salty foods can cause swelling in patients with chronic kidney disease. Controlling food intake involves cooking with less salt, avoiding processed foods, reducing the use of fish sauce, soy sauce, and salt, and using low-sodium seasoning. Other foods that are high in sodium include sausages, ham, pork floss, salted fish, canned food, pickled food, fermented fish, shrimp paste, pickled vegetables, crispy snacks, French fries, and baking powder.

The amount of clean water that should be consumed can be calculated from the volume of urine per day plus 500 ml of water. Avoid drinking herbal drinks such as boiled herbal medicine and alternative medicinal teas.

Patients with chronic kidney disease often lack vitamins B6, D, folic acid, zinc, and calcium.

For patients with chronic kidney disease, controlling food intake is important. In the case of fruits with high potassium, they can be consumed but must be limited and not eaten excessively, as this can cause complications.

• For patients with chronic kidney disease (period of dialysis), high protein foods or foods as directed by a physician should be selected.

Protein Calculation Formula: Ideal Body Weight x 1.2 = Recommended Daily Protein Intake (grams/day)

Example: If the ideal body weight is 55 kilograms, the protein calculation would be 55 x 1.2 = 66 grams/day.

Fats: Choose oils that are low in saturated and trans fats such as rice bran oil, coconut oil, soybean oil, and sunflower oil. Avoid consuming high-fat oils such as lard and palm oil.

Carbohydrates: For patients with chronic kidney disease before dialysis, choose to consume low-protein starches such as vermicelli, potato starch, sago, rice noodles, and white rice.

Potassium: Limit intake to 2,000-3,000 mg/day. Potassium affects the functioning of muscles and the heart. When there is kidney damage, the ability to excrete potassium is reduced, and blood potassium levels should be less than 5 mEq/L. If the potassium level in the blood is high, it can cause abnormal heartbeat or even heart failure. Patients with a GFR of 4-5 should avoid high-potassium foods.

Fruits that are high in potassium include dragon fruit, cantaloupe, watermelon, Thai pumpkin, guava, orange, papaya, durian, sweet tamarind, dried longan, avocado, strawberries, and canned fruit.

Vegetables that are high in potassium include purple cauliflower, purple cabbage, kale, spinach, carrots, green beans, tamarind leaves, gourd leaves, moringa, broccoli, tomatoes, radishes, sweet potatoes, beetroot, shiitake mushrooms, enoki mushrooms, red onions, bamboo shoots, pumpkins, squash, and lotus roots.

All types of green leafy vegetables can be boiled or cooked to reduce potassium in the vegetables. If the potassium level is higher than 5.5, it is recommended to avoid all types of fruits.

Phosphorus has an effect on the strength of bones. When there is a high level of phosphorus in the blood, it can affect the absorption of calcium in the bones, leading to the formation of calcified deposits in the blood vessels, which can increase the risk of heart disease. Phosphorus starts to become a concern when the kidneys begin to fail during stage 3 of kidney disease. It is found in milk, yogurt, cheese, butter, cookies, bread, ice cream, coffee powder, peanuts, red beans, Milo, Ovaltine, cocoa, Pepsi, mineral water, sunflower seeds, pumpkin seeds, corn, sesame seeds, red eggs, various insects, plant seeds, fried fish, dried shrimp, tofu, soy milk, and canned fish.

Sodium should not exceed 2,000 mg per day. Salty food causes swelling in patients with chronic kidney disease. Ways to control food include reducing salt in cooking by half, avoiding buying processed foods, reducing the use of fish sauce, soy sauce, and salt, using low-sodium seasoning, and avoiding other high-sodium foods such as sausage, ham, salted fish, canned food, pickled food, fermented fish, shrimp paste, pickled vegetables, crackers, French fries, and baking powder.

• The recommended amount of clean water to drink can be calculated by adding the volume of urine produced per day with 500 milliliters of water. 
• It is advised to avoid herbal drinks such as medicinal teas, tonics, and herbal remedies.
• Chronic kidney disease can cause deficiencies in vitamin B6, vitamin D, folic acid, zinc, and calcium. 

For patients with this condition, controlling their diet is important. Fruits that are high in potassium can be consumed, but in limited quantities and without excessive stress, as it may worsen the condition.