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The progression to chronic kidney disease (CKD) can cause patients to be in dialysis treatments for many years. Apparently, more dialysis years can indirectly add more nightmares to CKD patients’ everyday life.
Generally, CKD can be grouped into 5 stages as follows:
Stage 1: kidney damage with normal or relatively high GFR or slightly diminished kidney function; ≥ 90 GFR (mL/min/1.73m2)
Stage 2: mild reduction in GFR with kidney damage; 60-89 GFR (mL/min/1.73m2)
Stage 3: moderate reduction in GFR; 30-59 GFR (mL/min/1.73m2)
Stage 4: severe reduction in GFR; 15-29 GFR (mL/min/1.73m2)
Stage 5: established kidney failure; < 15 GFR (mL/min/1.73m2)
At stage 5, patients are required to undergo renal replacement therapy (RRT) which includes either kidney transplant or dialysis. Statistics show that cases with kidney failure are on the rise, so are the number of new dialysis patients. If CKD patients can be treated at the early stage, the outcome will be optimistic.
It is recommended that screening tests be performed on an annual basis when one is still healthy. Patients with the help of dieticians and nephrologists can monitor the state of their kidneys by calculating urea excretion via urine and a nitrogen balanced test. A blood test for example can help identify how fast the kidneys clear the toxins out of the body. Like the blood test, a urine test is also very helpful in determining the kidney function in terms of whether there is leaking blood (haematuria) or protein (proteinuria) in the urine. An ultrasound can be used to detect the presence of stone (s) in the kidneys, in addition to detecting whether there is obstruction along the ureter and checking the size of the kidneys.
Not only are the screening tests useful for checking the condition of your kidneys, they are also useful to look at your general well-being. This is because kidney disease is also linked to the end result of other ailments including high blood pressure, and diabetes mellitus.
A Diet Modification Approach for More Dialysis-free Days
It is very important for patients to adhere to the diet modification plan if they wish to live on with more dialysis-free days. The patients will have to recall what they had eaten over the last three days to even one week, as this will help check the amount of protein intake they had. They can work this out with the assistance of a dietician and nephrologist to check if they had taken in too much protein.
Since protein can add more of a workload to an impaired kidney, patients should stick to a low protein diet. I would recommend patients to restrict the intake of meat, beans, and eggs which are higher in protein content. Also, patients must restrict their protein intake between 0.4 and 0.5 g of protein per kg (weight) in a day.
The impaired or diseased kidney is unable to clear off toxins fast (as like a healthy kidney) causing the formation of toxins inside the body. Most common symptoms are loss of appetite, vomiting, gastric ulcers, anemia, itchiness, blocked blood vessels, fatigue and even brittle bones.
It is not surprising to see patients with kidney failure having swollen legs, puffy faces and even fluid on the lungs. These may be signs of fluid retention, and thus patients must restrict their fluid intake from 800 to 1000 ml per day (or approximately 4-5 cups).
As kidneys control the potassium levels in the body, kidney failure patients are unable to excrete excessive potassium accumulating in their bodies. This will result in very high levels of potassium in their blood which can be life-threatening. Therefore, patients must cut down their intake of potassium-rich foods. That means to help ensure low intake of potassium, patients must restrict foods like lentils, canned food, spinach, bananas, citrus fruits, French beans, meat and pickled food.
Besides potassium, kidneys also control the metabolism of phosphate and calcium via vitamin D synthesis. When kidneys fail to perform their function, vitamin D synthesis will be interrupted in one’s body. Following by the impairment of kidney function, calcium levels remain extremely low while phosphate levels remain higher. When there is an imbalance between the calcium and phosphate levels, one will have brittle bones, in addition to heart disease due to the blockage in blood vessels. Hence, patients must adopt a low phosphate diet in their daily life. This can be done by restricting the intake of foods like canned food, cereals, carbonated drinks, red meat and peanuts.
Warning: Patients with low or very low protein diets may have higher risk of malnutrition. So, patients must get a doctor to monitor their condition particularly in measuring and monitoring the nutritional status, biochemical profile as well as the protein intake.
When it comes to taking supplements, patients should be selective in order to avoid those supplements with unknown or higher protein content. Taking such supplements may undoubtedly facilitate the progression to end-stage renal failure and promote more dialysis days in patients’ life. Some registered pharmaceutical companies do offer diet counseling services via a hotline in which patients can be connected to talk to a qualified dietician or nurse for further advice on their dietary plan.
A dietary plan or diet modification is a major challenge to diabetic patients. When diabetics need to be compliant with a low-protein diet they need to increase the intake of carbohydrates to compensate with the calorie loss, which will definitely make it more difficult for them to control their diabetes. That explains why diabetes accounts for more than 50% of kidney failure cases.
Final remark:
It is always recommended to seek your doctor’s advice when you are in doubt of your medications. Do not ever discontinue high blood pressure or diabetes medications without prior consultation with your doctor. If you are a CKD patient or a patient with kidney failure, you are advised to discuss with your doctor any plans regarding dietary modification in the first place.
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As always, stay well and healthy!
Now I learned so many things about CKD.
Very informative Chan! Your articles always make me crave for more knowledge. Exceptional!
Very much detailed Chan, very satisfying result for all readers, HIGHLY recommended!
some cool tips here. thanks Chan :) v+
Very useful info as always Chan. Thank you.
Great info Chan!
Just re-visiting and posting this one at FB. Thanks for all your support.
Excellent and enlightening facts on the series. Thanks for sharing, Chan.
I liked your series of articles about kidney failure. My mother suffered with kidney failure and lasted for 5 years with Haemodialysis. It is very important for us to learn about health conditions and diseases in advance.
Such a great collection of valuable health information about dialysis.
Contains minute details.