Nutrition Guide for Patients with Kidney Failure (Pre-Dialysis)

Doctor and Patient,

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This booklet includes nutrition information to help you reduce the progression of kidney failure and improve your quality of life. It is important to consider the following factors:

1. Keep your blood pressure controlled; Reduce your salt intake Follow your medication regimen

2. Keep your blood sugar controlled; Comply with your diet plan Comply with your medication regimen

3. Avoid smoking (active and passive) as smoking affects kidney function. Avoidance of smoking will also help to reduce the risks of other diseases such as stroke, heart disease, respiratory disease, and cancer.

4. Follow the diet plan as advised by the dietitian; Avoid consuming excessive animal protein such as meat, chicken, fish,

eggs, or milk and its products. Reduce your intake of animal fat, butter, ghee, and foods rich in

cholesterol. 5. Keep active and perform regular and moderate exercises.

Normal Kidney Functions

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Kidneys are vital organs for health that remove excess water, salt, and waste products from the blood and make urine to avoid the accumulation of these in the body.

Kidneys are involved in the production of Vitamin D, which helps calcium absorption from intestines. This keeps the bones strong.

Kidneys produce the hormone called Erythropoietin, which is important for the production of red blood cells from the bone marrow.

Causes of Kidney FailureDiabetes and high blood pressure are the leading causes of kidney failure. There are other causes that include: polycystic kidney disease, glomerulonephritis (bacterial/viral), and autoimmune diseases for example.

Health Complications of Kidney Failure Mild to moderate degree of kidney failure may not be noticeable. Nausea, vomiting, fatigue, headache, poor appetite, and weight loss are all

related to accumulation of urea waste products in the blood.

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Accumulation of fluids and salt in the body. This may lead to an increase in blood pressure and edema in many parts of the body including legs. The accumulation of fluids may also cause shortness of breath and heart failure.

Raised potassium and phosphorus in the blood as the kidneys are no longer able to excrete them in urine.

Anemia due to inability of the kidneys to produce Erythropoietin, which is important for the formulation red blood cells.

Nutritional Guidelines to Reduce the Progression of Kidney Failure

As kidney failure progresses, a special diet is recommended to reduce the intake of the following:

Protein is needed for the body to repair muscles and improve immunity, but patients with kidney failure are unable to remove the wastes from the protein. Avoid foods high in protein. Protein such as meat, poultry, fish, tuna, eggs, milk, laban, yoghurt, cheese, nuts, and dried legumes such as lentils and beans.

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Reducing the sodium intake will help control high blood pressure. Sodium such as table salt and salty foods including ketchup, olives, pickles, condiments, canned or processed foods such as vegetables, sausages, soy sauce, chips, salted nuts, soups, smoked meats, cheese, and sardines.

Kidney failure diet is deficient in many vitamins including vitamins B, C, and D. Patients should discuss the supplements of these vitamins with their doctors.

Many patients with kidney failure may experience poor appetite that results in weight loss. Increasing the caloric intake is important to avoid malnutrition. Patients can consume a high-caloric diet that is low in sodium and potassium and divide the meals into small and frequent portions, provided that they are not diabetic.

Patients with kidney failure will have iron-deficiency anemia as their diet plan is poor in iron content and they are unable to absorb iron well in the gut. Patients, who require iron supplements, are recommended not to take it with their calcium supplements as both interact with each other.

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Heart Care Tips for Kidney Failure Patients

Keep your body weight within normal range and lose weight if obese.

Reduce your intake of cholesterol and saturated fat to help you reduce your risks for heart attack and stroke. Foods rich in cholesterol are egg yolk, full cream milk products, butter, fatty meat, sausages, poultry with skin, and processed meat. Ghee and shortening are cholesterol-free but they are high in trans-fat and are not good for heart condition. The best oils to be used in food preparation are olive oil, canola oil, sunflower oil, and corn oil.

Avoid smoking (active and passive). Practice your daily exercise.

Kidney Failure Diet Specifications

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The below diet is recommended to patients with kidney disease in order to reduce known complications and to slow down the progression of their kidney failure.

Adequate calorie intake to maintain healthy weight Low in protein (40 grams/day) Low in sodium (2-4 grams/day) Low in potassium (1.5 grams/day) Low in phosphorus (0.6 grams/day) Adequate in calcium and vitamin D

Nutrition Information

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Patients with kidney failure are recommended to purchase foods low in sodium, protein, phosphorus, and potassium. They should read food labels carefully. They can consult their dietitians for nutrition advice on purchasing foods appropriate for kidney failure.

Potassium is a mineral found in many foods including fruits, vegetables, legumes, milk, and milk products. Healthy kidneys keep the potassium within a normal range in the blood by removing the excess amounts. Patients with kidney failure may have raised levels of potassium in the blood, which can seriously affect the heart, and may result in death. Potassium-rich foods should be eliminated from the diet and include:

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Foods HIGH in Potassium Content Include:

Foods LOW in Potassium Content Include:

FruitsOranges Apples (red, green, or golden)

Orange juice Apple sauce

Bananas Apple juice

Dates (fresh and dried) Strawberries

Kiwi Strawberry jam

Mango Grapes

Mango juice Grapefruit

Peaches Lemon

Sweet melon Pears

Dried fruits (figs and raisins) Pineapples

AvocadosWatermelon

VegetablesPumpkin Green beans

Carrots Cabbage

Carrot juice Corn

Your Daily Allowance of Potassium-Containing Food Milk: you are allowed to consume ½ cup per day. You can

replace the ½ cup of milk with ½ cup of laban or yoghurt. Select low fat or nonfat items instead of full cream to reduce your intake of cholesterol and saturated fat.

Fruits: you are allowed to consume three portions of the fruits that contain lower amounts of potassium per day.

Vegetables: you are allowed to consume two portions of vegetables that contain lower amounts of potassium per day.

Meat or chicken or fish: you are allowed to consume one portion of meat or chicken or fish at lunch and at dinner. The weight of the portion is only 30 grams (1 oz.). Select the lean cuts of red meat or skinless poultry.

Eggs: you are allowed to consume 1 egg per day. Food Preparation Method to Reduce the Potassium Content:Drain canned vegetables and canned fruits before serving. Peel the vegetables after washing, then cut them into thin slices or cubes and soak in water for two hours. Drain the water then boil the vegetables in large amount of water. Then drain the cooking water. Soaking vegetables can be repeated before boiling to get rid of more potassium. It is advisable to peel the fruits and wash them thoroughly before eating.

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Phosphorus: With the progression of kidney failure, the kidneys cannot remove phosphorus from the blood and eating foods with high phosphorus content may cause problems in the bones and blood vessels. A high phosphorus level in the blood reabsorbs calcium from the bones, making them brittle and easy to break. Patients need to avoid foods high in phosphorus (such as cheese, yogurt, laban, milk, organ meat, dried beans and lentils, soft drinks, and excess amount of meat, chicken or fish). Phosphate binders should be taken with meals and snacks to lower phosphorus. Phosphate binders reduce the absorption of phosphorus from the intestines.

Fluids: With the progression of kidney failure, the kidneys are unable to keep the body's fluid balance. Avoid drinking a lot of fluids and eating food that contains a lot of water. Fluids include water, juice, tea, coffee, soup, jello, milk, laban, yoghurt, and ice cream. Patients need to discuss with their doctors how many cups of fluids are allowed on a daily basis. They need to also use smaller cups for medications. More fluid in the blood will lead to health problems, such as respiratory, cardiac, and increase in blood pressure.

How to Measure Your Fluid Allowance

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Your doctor may ask you to measure the volume of your urine in milliliters and you may be provided with a measuring container for that.

Measure the amount of fluids you are allowed to take carefully and don’t exceed as extra fluids will cause health problems affecting your heart, lungs, kidney function, and blood pressure.

Drink only when thirsty. To reduce your sense of thirst, it is recommended to limit your salt

intake and keep your blood sugar controlled. You can sip the fluids slowly or suck on a frozen fruit or a lemon wedge or a piece of ice instead of drinking water. You can chew sugarless gum if you like.

Brush your teeth several times a day to keep your mouth moist. Contact your doctor and dietitian for any questions related to the allowed

amount of fluids you can drink per day.

Your Medicines

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Take your medications as advised by your doctor. It is important that you comply with your medication regimen to help control your blood sugar, blood pressure, and kidney function.

Contact your doctor for any questions related to your medications. Keep your medications safe at home and away from children and check the

expiry date for your medications. Avoid taking iron and calcium supplements together. These should be

taken separately. If your doctor prescribes for you a phosphorus binder, ensure taking it with

the meals. If your doctor prescribes for you a medication to lower your potassium level

in your blood (Kayexalate), ensure taking it with water, not with juice or milk.

Don’t purchase any multivitamins or mineral supplements without consulting your doctor as many of these contain high amounts of potassium and phosphorus and may cause complications to you.

Shop for Your Kidney Health

Don’t shop when you are hungry. Take a snack before that.

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Prepare your shopping list before proceeding to the shopping center. Purchase only the food items that you are allowed to have according to the

meal plan provided to you by your dietitian. Read the food label and select food items that are low in potassium,

phosphorus, and sodium. Check the expiry date for the food items. Store them safely at home. Ensure the availability of your food items at home, including your healthy

snacks.

Message to FamiliesFamilies of the patients with kidney failure disease are important members of the healthcare team and to play this important role, it’s recommended to do the following:

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Ensure the availability of the food items that are appropriate for the patient.

Prepare the food for the patient according to the recommended method by the dietitian.

Ensure that the patient takes his/her medications according to the advice of the doctor.

Ensure that the patient monitors his/her blood sugar and blood pressure. Support the patient in all his conditions and communicate with the

healthcare team in case of any emergency condition. Support the patient to adhere to the nutrition and medication plan and

encourage him/her to practice exercise. Engage the patient in social activities and support him/her in managing

his/her stress.

General Health Tips for Diabetic People

Maintaining blood sugar within the normal range and taking medications for diabetes as advised by the doctors.

Practicing regular and moderate exercise.

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Maintaining body weight within the healthy range and losing weight if obese.

Performing medical tests as advised by doctors, including testing of protein in the urine.

Maintaining blood pressure and lipids within normal range. Avoiding smoking (active or passive). Monitoring the blood pressure and blood sugar at home and discuss the

results with their doctors. Follow diet plan and discuss with the dietitian. The meals should include

less salt, potassium, phosphorus, and protein. They also should be low in cholesterol and saturated fat.

Sample Menu PlanBreakfast

- 1 serving fruit from allowed list

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- 1 egg (any style)

- 2 servings bread- ½ cup low fat milk- Healthy oil

Lunch - 1 serving meat, chicken, or fish (30 grams)- 2 servings bread or 2/3 cup rice or macaroni without

tomato- 1 serving cooked and drained vegetables

- 1 serving salad (cucumber, green pepper, and lettuce)- 1 serving fruit from allowed list- Healthy oil

Dinner

- 1 serving meat, chicken, or fish (30 grams)- 2 servings bread or 2/3 cup rice or macaroni without

tomato- 1 serving cooked/drained vegetables

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- 1 serving salad (cucumber, green pepper, and lettuce)- 1 serving fruit from allowed list- Healthy oil

Snack- 1 serving bread- 1 serving fruit from allowed list

- 1 serving vegetables from allowed list

Notes:1. Menu to be adjusted for diabetic people2. Fluids to be decided by the doctor3. Meals to be prepared without adding salt

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