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Nutrition Therapy in Renal Disease
In the treatment of renal disease, nutrition therapy, in each case, is based upon the nature of the disease process.
In short-term acute renal disease, which may occur due to various causes, nutrition therapy is aimed towards an optimal nutritional support for healing and normal growth. Long-term chronic renal disease involves more specific nutrient modifications.
In patients with renal disease, an increasing loss of kidney function causes progressive weakness, shortness of breath, general lethargy and fatigue. Thirst, appetite loss, weight loss, diarrhoea and vomiting may occur, which can also lead to malnutrition.
Basic Objectives of Nutrition Therapy
The following are the basic objectives of nutrition therapy:
1. To reduce protein breakdown
2. To avoid dehydration or excess hydration
3. To correct electrolyte imbalances
4. To maintain appetite and a sense of well-being
5. To control complications of hypertension and bone pain
6. To retard the rate of renal failure, thereby postponing the ultimate need for dialysis
Principles of Nutrition
Nutrition for chronic kidney failure involves variable nutrient adjustment according to the individual needs of patients as follows:
1 Protein: It is required to provide just enough protein to maintain tissue integrity while avoiding a damaging excess. Protein is generally limited to 0.6 to 0.8 gram/kilogram body weight per day, of which at least 50% should come from the high biological value group.
2 Energy: Carbohydrates and fats must supply sufficient calories to reduce the need for proteins. The minimum energy needs for patients are 30-35 calories per kilogram per day.
3 Water: With non-dialysed patients, fluid intake should be sufficient to maintain an adequate urine volume. Intake is usually balanced with the output.
4 Sodium: The need for sodium varies. If hypertension and edema are present, sodium/salt intake is usually recommended in very low amounts. Salt intake usually ranges between 2-5 grams/day.
5 Potassium: The damaged kidney/kidneys cannot clear potassium adequately and so the dietary intake is kept low or moderate. Therefore, it is important for patients to be aware of the potassium levels in various foods so that they consume cereals, pulses, fruits and vegetables that have low to moderate potassium content.
6 Vitamins: A multivitamin supplement is usually added to the diet of renal patients.
When chronic renal failure advances to end-stage renal failure, the patient has two options in order to deal with the irreversible kidney damage:
Usually, nutrition therapy for dialysis patients is planned with more liberal nutrient allowances and the patient is encouraged to eat a variety of foods to help maintain normal body weight and nutritional status.
Diet for Patients Who Have Had a Kidney Transplant
After transplantation of a kidney in a patient with renal failure, near-normal function is restored. The patient usually experiences the restoration of a normal appetite, a gradual increase in dry body weight, strength, stamina and a sense of well-being.
Diet for transplant patients is less limited than it is for patients on dialysis. However, there are certain limitations that you may need to follow if you are a patient who has had a kidney transplant:
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Practice safe and hygienic methods of food preparation and handling.
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Eat food that is well-cooked and drink water and/or beverages that is/are boiled.
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Limit the use of salt in your diet. Avoid salty snacks and savouries.
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Extra care has to be taken in the washing and cleansing of green leafy vegetables before cooking. Avoid using raw coriander or curry leaves in cooked dishes.
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Fresh curd that has just set, or buttermilk, can be used by the second week of the transplant period. Avoid the use of refrigerated or sour curd.
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Use of fats and oils, sugar and sweets, high-fat milk, high-fat curd, etc., should be limited in order to help maintain body weight in the ideal range.
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Avoid raw eggs, half-boiled eggs, under-cooked or over-cooked meat. Avoid unpasteurised milk and milk products, cheese, cottage cheese, etc.
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Also avoid raw sprouted grams, raw vegetable salads, raw vegetable juices, fruit juices, fluids such as tender coconut water, soft drinks, etc.
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Avoid eating food outside home such as in hotels/restaurants, social gatherings, etc.
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