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Balancing Key Nutrients in Chronic Kidney Disease

Chronic kidney disease (CKD) is marked by long term, irreversible loss of function. Since it is irreversible, what we can do is only slow down its progress to end-stage renal disease (ESRD) which requires dialysis. Diabetes and high blood pressure are the most common causes of CKD. For the person having diabetes or high blood pressure, working with doctor to keep blood sugar and blood pressure under control is the best way to prevent kidney disease.

Why is good nutrition important for people with CKD?

Making healthy food choices is important to us all, but it is even more important if you have chronic kidney disease. Good nutrition gives you energy to:
– Do your daily tasks
– Prevent infection
– Build muscle
– Help maintain a healthy weight
– May keep your kidney disease from getting worsen

Will I need to control any other nutrients?

When your kidneys are not working as well as they should, waste and fluid build up in your body. Over time, the waste and extra fluid can cause heart, bone and other health problems.
You may need to balance fluids and other nutrients. There are:
– Sodium
-Phosphorus
-Potassium

SODIUM

Sodium is a mineral found in most foods. It is also found in table salt. Sodium affects blood pressure and water balance in body. If your kidneys do not work well, sodium and fluid build up in your body. This can cause high blood pressure and other problems, like swelling of ankles.

You can limit sodium by avoiding table salt and foods such as:
– Seasonings like soy sauce, sea salt, teriyaki sauce
– Most canned foods and frozen foods
– Processed meats like ham, bacon, hot dog, sausage
– Salted snack foods like chips and crackers


POTASSIUM

Potassium is a mineral found in almost all foods. Your body need some potassium to make your muscles work, but too much potassium can be dangerous. When your kidneys are not working well, your potassium level may be too high or too low.
Having too high or too low of potassium can cause muscle cramps, problems with heart beats and muscles weakness.

Use the list below to get some ideas about how to make healthy choices if you need limit potassium.

Eat this.. (Lower potassium foods)
Avoid this.. (High potassium foods)
Apples, cranberries
Oranges, Banana, Avocado, Prunes
Carrots, Onions
Potatoes, Tomatoes
White rice
Brown rice
Cauliflower, lettuce
Dairy foods (milk, yogurt)
Beef and chicken
Whole-wheat bread and pasta

Beans and nuts



PHOSPHORUS

Phosphorus is a mineral found in almost all foods. It works with calcium and vitamin D to keep your bones healthy. Healthy kidneys keep the right amount of phosphorus in your body. When your kidneys are not working well, phosphorus can build up in your blood. Too much phosphorus in your blood can lead to weak bones that break easily.

Use the list below to get some ideas about how to make healthy choices if you need limit potassium.


Eat this.. (Lower phosphorus foods)
Avoid this.. (High phosphorus foods)
Italian, French bread
Bran cereals and oatmeal
Fresh fruits and vegetables
Dairy foods
Corn or rice cereals
Beans and nuts
Some light-colored sodas (homemade iced tea or lemonade)
Dark-colored colas


FLUIDS

You need water to live, but when you have kidney disease, you may not need much water. This is because damaged kidneys do not get rid of extra fluids as well as they should. Too much fluids in your body can be dangerous. It can cause high blood pressure, swelling and heart failure. Extra fluid can also build up around your lungs and make it hard to breathe.

Depending on your stage of kidney disease, your doctor may tell you to limit fluid. To avoid dehydration, let your doctor help plan your fluids intake.


Urinary Tract Infection

What is a urinary tract infection?

A urinary tract infection (also called a “UTI”) happens when bacteria get into the urinary system and multiply. This infection can happen in any part of your urinary system — your kidneys, ureters, bladder and urethra.

Urinary tract is further divided into two sections:


The upper urinary tract is composed of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis).

The lower urinary tract consists of the bladder and the urethra. Infection in the lower urinary tract can affect the urethra (urethritis) or the bladder (cystitis).

Who are more prone to UTIs?

  • Women get UTIs much more often than men. This is because women have a shorter urethra, which may make it easier for bacteria to reach the bladder.
  • People with diabetes may have changes in their body’s defense system, making it easier to get urinary infections.
  • People with blockages in their urinary tract, such as a kidney stone, are more likely to get UTIs.
  • An enlarged prostate gland in a man can also block the flow of urine and cause a UTI.
  • People who have a catheter (tube) placed in their bladder for a long time are more prone to UTIs. This is because bacteria on the catheter can infect the bladder.
  • Couple who are sexually active. Sexual intercourse can introduce larger numbers of bacteria into the bladder.

What are the symptoms of a UTI?

Most people will have one or more of the following:

  • A burning feeling during urination
  • An urgent need to urinate, often with only a few drops of urine to pass
  • An aching feeling, pressure, or pain in the lower abdomen (stomach)
  • Strong odour of the urine
  • Cloudy or blood-tinged urine

If the infection spreads to the kidneys and becomes more serious, you may also have:

  • pain in the lower back
  • fever and chills
  • nausea and vomiting

Can anything be done to help prevent UTIs?

The following steps may help:

  • Drink plenty of fluids, 8 glasses of water a day.
  • Do not postpone going to the bathroom.  Urinate when you feel the urge.
  • Wipe from front to back to prevent bacteria from the bowels (intestines) from getting into the urinary tract.
  • Wash the genital area before and after having sex.
  • Regular change of catheter to prevent the growth of bacteria

DON’T

  • do not use scented soap/ vagina wash to prevent irritation
  • do not hold your pee in if you feel the urge to go
  • do not wear tight, synthetic underwear, such as nylon
  • do not drink lots of alcoholic drinks, as they may irritate your bladder
  • do not have lots of sugary food or drinks, as they may encourage bacteria to grow

NATURAL HOME REMEDIES FOR UTIS YOU CAN TRY RIGHT FROM HOME

  • Cranberry juice

The anthocyanidins and proanthocyanidins (PAC) are tannins found in cranberries and function as a natural defense system against microbes

  • Probiotic

probiotics may prevent harmful bacteria from attaching to the urinary tract cells, and may also lower the urine Ph, making it less hospitable to harmful bacteria.

Probiotics are found in supplement form (often a capsule), or they occur naturally in some types of food, including certain yogurts, kombucha, or kefir.

  • Eating Garlic

Allicin and other sulphur compounds are thought to be the major antimicrobial factors in garlic.

  • Adding vitamin C to your diet

Adequate amount of Vitamin C may also acidify your urine, which limits the growth of some bacteria and may prevent urinary tract infections from occurring.

  • Celery juice

Celery extract has antibacterial properties to inhibit the bacterial growth in urinary bladder

Source:

National Kidney Foundation_https://www.kidney.org/atoz/content/uti

https://www.nhs.uk/conditions/urinary-tract-infections-utis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370320/ _doi: 10.6061/clinics/2012(06)18

Universiti Putra Malaysia (UPM). “Using garlic to combat antimicrobial resistant urinary tract infections.” ScienceDaily. ScienceDaily, 10 July 2015.

https://www.medicinenet.com/urinary_tract_infection/article.htm

Nutritional Needs and Dietary Tips for Patients on Dialysis


Dialysis is a type of treatment that helps our body to remove extra fluid and waste products from the blood when the kidneys are failed to function normally. Dialysis can be done in hospitals, dialysis centres, or at home. For severe cases of Acute Kidney Injury (AKI), dialysis treatment is required for a short time until kidney function is recovered. However, for kidney failure or end-stage kidney disease (ESKD), dialysis is crucial for the rest of life or until the patient can opt for a kidney transplant.

Dialysis performs the duties that the kidney usually does to keep the body in balance, such as:

  • Removing waste and extra fluids in the body to prevent them from building up in the body
  • Keeping safe levels of minerals in the blood, such as potassium, sodium, calcium, and bicarbonate
  • Helping to regulate blood pressure

People who receive dialysis treatment need to be mindful of what they eat. The specific meal plan recommended for them may vary depending on their routine and lifestyle.

Between dialysis sessions, wastes can build up in the blood and make the patient unwell. Patients can reduce waste build-up by controlling some nutrients in their daily intake. Some foods cause waste to build up quickly between dialysis sessions. If the blood contains too much waste, the kidney treatment session may not remove them all.

For dialysis patients, the healthcare practitioners will recommend controlling the following nutrients:

1. SODIUM

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Sodium is a major constituent of many food items especially, in table salt. For dialysis patients, the kidneys are unable to drain out the excess sodium. Therefore, it is recommended to take sodium less than 2,000 gm per day.

Tips to reduce sodium:

  • Limit choice of foods like keropok, salty biscuits, nuts, potato chips, french fries, salted fish/egg/vegetable and pickles.
  • Do not add salt or monosodium glutamate (MSG) if possible when cooking. Seasoned foods with natural herbs and spices such as pepper, chili, lemon grass leaves, pandan leaves, coriander, or curry leaves.
  • Avoid belacan, budu, tempoyak and cencaluk.
  • Avoid processed food that high in sodium like cheese, bacon, sausage, ham, hot dogs or pepperoni. Limit processed beef, pork or poultry.
  • Omit salad dressing, condiments, sauces and gravies. Consider use lime/lemon juice or vinegar as salad dressing.
  • Choose fresh meat fish or poultry prepared without sauces or gravies. Limit salty sauces such as soy, teriyaki, barbecue, oyster, chili, tomato, and steak.
  • Limit or avoid broth, cream soup or soups prepared with stock cubes.
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Credit Photo: Food Manufacture
Product Reformulation to Reduce Salt Content in Food (Part II)
Credit Photo: Centre for Food Safety

2. POTASSIUM

Although potassium is crucial for the body, dialysis patients should limit it. Recommended intake is less than 2,000 gm of potassium per day.  Consuming the right amount of potassium in your blood can maintain your heart beating at a steady pace. Potassium levels can rise between hemodialysis sessions and affect your heartbeat. Too much potassium can be dangerous to your heart and even fatal.

Tips to control potassium intake:

  • Potassium is soluble in water. Cutting vegetables into small pieces and soaking them for 1-2 hours in several changes of warm water will help leach out of potassium content.
  • Drain away liquid from canned fruits and vegetables.
  • Peel off the skin from fruits.
  • Use whole rather than ground spices for flavoring.
  • Avoid herbal and traditional remedies such as ginseng roots, banana stem, akar kayu and others.
How eliminate potassium in food – Botanical online
Credit photo: Botanical-Online

3. PHOSPHATE

The recommended intake for phosphate is less than 800 mg to 1000 mg per day. Too much phosphate in the blood pulls calcium from bones. Losing calcium may result in weak and brittle bones subsequently will increase the risk of fracture. Also, too much phosphate may cause itchiness to the skin. Kidney patients are advised to take a phosphate binder to control the phosphate level in blood between hemodialysis sessions.

Tips to control phosphate intake:

  • Avoids eating the cartilage and soft bones of fish, shellfish and meat.
  • Reduce intake of cocoa, chocolate-based beverages and cola drinks.
  • Limit dairy food products such as milk, curd/yogurt and cheese. Use non-dairy creamer to replace milk in beverages.
  • Phosphate binders must be taken with meals. For calcium carbonate, it is best to chew the tablets.
  • If forgotten, phosphate binders can be eaten within 15 minutes after meal. Otherwise, it should be left out and the dose will not be doubled at the next meal. 

Dialysis patients need to bring their phosphate binders when eating out at all times.

4. PROTEIN

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For non-dialysis patients, they are advised to follow a low-protein diet. Being on dialysis, they are encouraged to eat high protein diet. Protein helps to restore muscle strength and repair tissues. Besides, a high-protein diet is crucial to fight infections and speed up healing from surgery. Eating high-quality protein is encouraged because it produces less waste for removal during dialysis. High-quality proteins come from meat, poultry, fish, and eggs. Avoid processed meats such as hot dogs and canned chili, which have high amounts of sodium and phosphorus.

5. LIQUID

Dialysis patients need to keep track of their liquid intake. Excess fluid can build up in the body, therefore causing swelling and weight gain between dialysis sessions. Besides, fluid buildup can affect blood pressure and subsequently burden the heart to work harder, which might lead to fatal heart conditions. Other than the heart, our respiratory function also can be threatened if fluid is excessive.

Tips to control thirst:

  • Identify the cause of frequent thirst
  • Gurgle often
  • Consume frozen cubed fruits
  • Use a mist sprayer to moisturize the mouth
  • Chew on sugar-free chewing gum
  • Cease smoking
  • Avoid too salty or sweet food

6. SUPPLEMENTATION

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Dialysis patients may not get enough vitamins and minerals in their diet because they have many nutrient restrictions from food. Healthcare providers may prescribe them with suitable vitamins and mineral supplements. For safety reasons, it is highly encouraged to take supplementation only when needed and under close supervision of healthcare providers.

Supplementation that is safe for dialysis patients:

  • B-complex: to aid red blood cell formation
  • Iron tablet: to increase haemoglobin level
  • Vitamin C (low dose: below 250mg): to enhance absorption of iron
  • Vitamin D:to maximize absorption of calcium to bone
  • Calcium: to strengthen bone, consume together with phosphate binder to prevent calcium-phosphate clump in blood.

Avoid supplement that contain:

  • Vitamin A, E & K: These vitamins can cause build-up in the blood and harm the body.
  • Herb-based remedies: May create interaction with prescribed medication and causes side effects.  
  • Megadose of vitamin C: Large doses of vitamin C produce by-product called oxalate that will deposit in bones and soft tissues subsequently result in painfulness.

REFERENCES

Malaysian Dietitians’ Association. Medical Nutrition Therapy Guidelines for Chronic Kidney Disease, 2005.

Ministry of Health. Clinical Practice Guidelines: Management of Chronic Kidney Disease in Adults, 2011

National Kidney Foundation (n.d). Dialysis. Retrieve May 7, 2023 from https://www.kidney.org/atoz/content/dialysisinfo

National Kidney Foundation (n.d). Dietary Guidelines for Adults Starting in Hemodialysis. Retrieve May 7, 2023 from https://www.kidney.org/atoz/content/dietary_hemodialysis

National Institute of Diabetes and Digestive and Kidney Diseases (2016). Eating & Nutrition for Hemodialysis. Retrieve May 7, 2023 from https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis/eating-nutrition

Paresh K.J. (2019). Diet and Nutrition for Kidney Patients. Retrieve May 7, 2023 from https://healthlibrary.askapollo.com/diet-and-nutrition-for-dialysis-patients/

Zhang KY, Zuo L. (2014). Vitamin C supplementation in patients on maintenance dialysis. World J Clin Urol. 3(3): 344-350. DOI: 10.5410/wjcu.v3.i3.344


The Hidden Dangers: How Medications Can Affect Your Kidneys

The kidneys are important organs that filter waste and maintain our body’s fluid balance. They also release hormones that help to regulate blood pressure at a normal level, and they play an important role in producing red blood cells in our body. Besides that, they are vital in producing the active form of vitamin D which is essential to promote strong and healthy bones.

In this article, we will discuss some common medications that will affect the kidney’s function. It’s important to understand and be aware of which medications may be harmful to the kidneys and precautions shall be taken to protect our kidneys.

Pain Relievers (Non-Steroidal Anti-Inflammatory Drugs-NSAIDs)

Some pain relievers, for example ibuprofen and naproxen, can harm the kidneys if taken frequently or in large doses. These medications relieve pain and help with inflammation.

However, it can be dangerous for those who have existing kidney problems or those who are dehydrated. Thus, we shall not take too much of pain relievers but to take them cautiously according to the dosage recommended by doctors.

Antibiotics

Certain antibiotics can hurt the kidneys through a variety of mechanisms. For example, some antibiotics can block the urine flow by producing crystals that cannot be broken down. Some antibiotics have substances that can damage certain kidney cells when they are excreted from the kidneys. There are also cases where some people develop allergic reactions towards antibiotics that will adversely affect their kidneys.

When antibiotics are used for a short period of time, they are generally safe. The risk of damage to kidneys is increased when antibiotics are used in high dosage or for a prolonged period. So, bear in mind that we should only take antibiotics when prescribed by doctors and we should strictly follow their medical advices.

Diuretics/Water Pills

Diuretics, or water pills, are usually prescribed by doctors to treat high blood pressure and swelling. They work by helping to excrete extra fluid in the body. However, some diuretics, like furosemide, can affect kidney function. This is because sometimes diuretics will dehydrate the body, disturbing the balance of electrolytes in the body and the blood flow to the kidneys which can be bad for the kidneys.

Thus, it is crucial for people taking diuretics to have regular monitoring of kidney function and electrolyte levels.

Contrast Dyes

In many cases, the use of a contrast dye is necessary while carrying out diagnostic tests such as CT scans, angiograms and MRIs to help doctors see certain body tissues or blood vessels better. However, it is important to know that sometimes these dyes can be harmful to the kidneys and will either cause kidney problems, or cause problems in patients with existing kidney disease. Thus, it is important to inform doctors if you have any kidney diseases before undergoing any imaging tests involving contrast dyes.

Antiviral Medications

Some antiviral medications, such as acyclovir and tenofovir, used to treat viral infections, can damage the kidneys. These medications can cause harms to the kidneys or reduce kidney function, especially when taken at high doses or for a long period. Antiviral medications can cause renal failure in many ways such as through crystal deposition in the kidneys as well as causing injury on the renal transporters and renal cells. Thus, it is imperative to have regular monitoring of kidney function if taking these antiviral medications.

Take away messages

While medications can be beneficial, it is crucial to understand the potential risks they pose to the kidneys. Be aware of which medications will affect kidney function and take necessary precautions to protect our kidneys. We shall always take medications according to the recommended dosage so as to reduce the risk of developing medication-related kidney problems and always talk to your doctors if you have any existing kidney diseases.

Reference:

1.    National Kidney Foundation. (n.d.). Pain Medicines (Analgesics). Retrieved from https://www.kidney.org/atoz/content/painmeds_analgesics

2.   American Association of Kidney Patients. (n.d.). Understanding Diuretics. Retrieved from https://aakp.org/dialysis/understanding-diuretics/

3.    Radiological Society of North America. (2020). Contrast Materials. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=contrast-ct

4.     National Kidney Foundation. (n.d.). Common Medicines Used for People with Kidney Disease. Retrieved from https://www.kidney.org/atoz/content/medications-kidney-disease

5.     WebMD. (2022). What Meds Might Hurt My Kidneys? Retrieved from https://www.webmd.com/a-to-z-guides/medicine-hurt-kidneys

6.     National Kidney Foundation. (n.d.). Contrast Dye and the Kidneys. Retrieved from https://www.kidney.org/atoz/content/Contrast-Dye-and-Kidneys#:~:text=Contrast dyes are often used,the way they normally should.

7.     National Library of Medicine. (2005). Retrieved from https://pubmed.ncbi.nlm.nih.gov/15861345/#:~:text=Antiviral drugs cause renal failure,epithelial cells of the kidney.

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