Diet in kidney disease

From a clinical point of view, kidney disease may be a condition of a rapidly developing and spreading inflammatory disease leading to acute renal failure, or it may be a progressive process from the beginning as chronic inflammation gradually and irreversibly impair kidney function.

From a dietary point of view, it is important to administer fluids, salt, potassium and protein in kidney disease. When planning a diet, body weight, water balance and the concentration of electrolytes in the blood should be taken into account. In acute renal failure, especially with high blood urea concentration, a protein-restricted diet is recommended, with energy supply optimally 30-50 kcal / 1 kg of body weight, if the disease is without complications. You should exclude meat, cold cuts, cheese, eggs from the diet, limit milk and foods rich in potassium and phosphorus. Restrictions also apply to the supply of salt and fluids. The exception is the stage of early polyuria with the recommendation to drink plenty of fluids. A gruel diet with the addition of rusks, low-protein flour wheat roll, boiled fruit puree, mashed compotes, mashed potatoes with butter is recommended. Fat is recommended to be 1g / 1 kg of body weight. In acute renal failure, patients may be treated conservatively or with dialysis. As you recover, you switch to a physiological diet, gradually increasing the amount of fluid and protein products.

In chronic renal failure, the clinical picture depends on the severity of renal impairment. Dietary recommendations in this period can be divided into 4 periods: 0,6st period – latent failure, where there are no dietary restrictions, 0,8nd period – compensated insufficiency, there is a reduction of protein 1-0,4 g / 0,6 kg of body weight, phosphorus, salt, Period III – decompensated insufficiency, in which a low-protein diet of 1-20 g / 25 kg of body weight is applied, low-sodium, low-potassium diet, it should often be enriched with high-calorie, low-protein preparations, period IV – end-stage failure, in which the supply protein is 15-20 g / day or dialysis, limiting sodium, potassium, phosphorus and fluids, it is required to add essential amino acids XNUMX-XNUMX g / day to the dishes, eg Ketosteril.

General principles of the diet in conservative treatment: energy demand in patients with normal body weight over 60 years of age should provide 35 kcal / 1 kg of body weight / day, and in patients under 60 years of age. it should provide 30-35 kcal / 1 kg of body weight / day, i.e. about 2000-2500 kcal / day. In less active patients, a sufficient intake is 1800-2000 kcal / day. protein limitation delays dialysis treatment, the amount of protein is determined by the concentration of urea and creatinine in the blood plasma and creatine clearance (GFR). The minimum protein content in the diet is 20 g / day with the addition of essential amino acids. Such a limitation can be obtained by using a potato diet in the amount of 1 kg of potatoes + 300 g of vegetables and fruit + 120 g of fresh butter and oil + 50 g of sugar and the addition of potato flour or low-protein starch flour with fresh or dried spices, without salting. The techniques of preparing potato dishes are cooking, baking, while frying is excluded in the case of fat metabolism disorders. The dishes that can be prepared are noodles, dumplings, dumplings, casseroles, stuffed potatoes, salads. The mean protein limit is 40-50 g / day and the small limit is 60-70 g / day. Protein should be wholesome, from animal products: lean meat, skim milk, cottage cheese, egg white, kefir, yoghurt. the supply of fat does not require a limitation of 1 g / 1 kg of body weight. It should come from plant products, ie olive oil, soybean oil, sunflower oil, rapeseed oil. Contraindicated fat products of animal origin are: lard, tallow, hard margarines, bacon, as well as fatty meats such as mutton, pork, offal, duck, goose, fatty fish, yellow and processed cheese, bacon, pates, sausages. Likewise, confectionery products containing a large amount of fat, such as puffs and cakes, are not advisable. fluid restriction depends on edema, hypertension and the amount of urine excreted during the day. You should pay attention to the water content in products, e.g. sauces, vegetables, fruit, providing an average of 400-500 ml. limiting sodium in the period of compensated insufficiency is not required, but it is recommended to limit to 3 g (1 teaspoon) of salt per day as a preventive measure, due to the widespread excessive consumption. It is enough not to add salt to the dishes, exclude salted products in the technological process, such as: canned food, pickles, cold meats, processed meat, smoked cheese, yellow cheese, silage, concentrates of soups and sauces, ready-made spices, e.g. vegeta, vegetables, broth cubes. reducing phosphorus from products rich in phosphorus, such as: offal, cereal products, rennet and processed cheese, legume seeds, fish, egg yolks, mushrooms, sausages, whole milk powder.

It is also recommended to eat preparations that bind phosphate in the digestive tract during meals. the demand for potassium in the period of compensated insufficiency should be increased, and in the period of end-stage failure it should be limited to 1500-2000 mg / day, excluding products rich in this mineral: dry legumes, bran, cocoa, chocolate, nuts, dried fruit, bananas , avocados, tomatoes, potatoes, leafy vegetables, mushrooms. Potassium can be reduced by soaking and cooking the food, with water being changed during cooking. the need for other minerals should supplement calcium deficiency, due to the limitations of protein products, supplementation of iron deficiency leading to anemia. the need for vitamins supplements vitamin deficiencies. from group B, folic acid, vit. C and D due to the low potassium diet.

General principles of the diet during the dialysis period: the energy demand due to frequent malnutrition of dialysed patients should be 35-40 kcal / 1 kg of body weight, i.e. 2000-2500 kcal / day. The main source of carbohydrates should be cereal products: pasta, groats, starch flour, low-protein starch bread. In patients treated with peritoneal dialysis, this requirement is partially covered by glucose in the dialysis fluid. the protein demand due to losses during dialysis is 1,2-1,4 g / 1 kg body weight in hemodialysed patients, and 1,2-1,5 g / 1 kg body weight in peritoneal dialysis, i.e. 75-110 g / day. The diet can be enriched with protein from nutritional supplements, eg Protifar. the demand for fat in extracorporeal dialysis should be 30-35% of energy, and in peritoneal dialysis 35-40%. energy derived from plant products, mainly olive oil and oils. the demand for potassium should be limited to 1500-2000 mg / day, meat and vegetable stocks should not be used. the need for phosphorus should limit the consumption of products rich in this component and the use of drugs that bind phosphate in the gastrointestinal tract. sodium restriction applies. the demand for minerals and vitamins requires supplementation of calcium, vit. D, A and C. fluid restriction calculated on the amount of urine output + 500 ml, the increased amount is indicated only in hot weather, high fever, vomiting and diarrhea.

Source: Chair and Department of Nephrology, Hypertension and Internal Diseases, Collegium Medicum im. L. Rydygier in Bydgoszcz

1. I period – latent failure, where there are no dietary restrictions,
2. IV period – end-stage failure, in which the supply of protein is 20-25 g / day or dialysis, limitation of sodium, potassium, phosphorus and fluids, it is required to add essential amino acids 15-20 g / day to the dishes, eg Ketosteril.
3. protein limitation delays dialysis treatment, the amount of protein is determined by the concentration of urea and creatinine in the blood plasma and creatine clearance (GFR). The minimum protein content in the diet is 20 g / day with the addition of essential amino acids. Such a limitation can be obtained by using a potato diet in the amount of 1 kg of potatoes + 300 g of vegetables and fruit + 120 g of fresh butter and oil + 50 g of sugar and the addition of potato flour or low-protein starch flour with fresh or dried spices, without salting. The techniques of preparing potato dishes are cooking, baking, while frying is excluded in the case of fat metabolism disorders. The dishes that can be prepared are noodles, dumplings, dumplings, casseroles, stuffed potatoes, salads. The mean protein limit is 40-50 g / day and the small limit is 60-70 g / day. Protein should be wholesome, from animal products: lean meat, skim milk, cottage cheese, egg white, kefir, yoghurt.
4. fluid restriction depends on edema, hypertension and the amount of urine excreted during the day. You should pay attention to the water content in products, e.g. sauces, vegetables, fruit, providing an average of 400-500 ml.
5. limiting sodium in the period of compensated insufficiency is not required, but it is recommended to limit to 3 g (1 teaspoon) of salt per day as a preventive measure, due to the widespread excessive consumption. It is enough not to add salt to the dishes, exclude salted products in the technological process, such as: canned food, pickles, meats, processed meat, smoked, yellow cheese, silage, concentrates of soups and sauces, ready-made spices, e.g. vegeta, vegetables, broth cubes.
6. reducing phosphorus from products rich in phosphorus, such as: offal, cereal products, rennet and processed cheese, legume seeds, fish, egg yolks, mushrooms, cold cuts, whole milk powder. It is also recommended to eat preparations that bind phosphate in the digestive tract during meals.
7. the demand for potassium in the period of compensated insufficiency should be increased, and in the period of end-stage failure it should be limited to 1500-2000 mg / day, excluding products rich in this mineral: dry legumes, bran, cocoa, chocolate, nuts, dried fruit, bananas , avocados, tomatoes, potatoes, leafy vegetables, mushrooms. Potassium can be reduced by soaking and cooking the food, with water being changed during cooking.
8. the need for other minerals should supplement calcium deficiency, due to the limitations of protein products, supplementation of iron deficiency leading to anemia.
9. the need for vitamins supplements vitamin deficiencies. from group B, folic acid, vit. C and D due to the low potassium diet.
10. the demand for fat in extracorporeal dialysis should be 30-35% of energy, and in peritoneal dialysis 35-40%. energy derived from plant products, mainly olive oil and oils.
11. the demand for potassium should be limited to 1500-2000 mg / day, meat and vegetable stocks should not be used.
12. the need for phosphorus should limit the consumption of products rich in this component and the use of drugs that bind phosphate in the gastrointestinal tract.
13. sodium restriction applies.
14. the demand for minerals and vitamins requires supplementation of calcium, vit. D, A and C.
15. fluid restriction is calculated from the amount of urine output + 500 ml, an increased amount is indicated only in hot weather, high fever, vomiting and diarrhea.

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