Guidelines for the Pre-Dialysis Patient

In the next upcoming blogs, I will tailor the information as it relates to each stage of kidney disease. I get lots of questions related to the different stages of kidney diseases. Hopefully, you can find your basic nutrition needs in these blogs. Always remember, these are basic guidelines and your diet should always be individualized based upon your labs, other disease states, other specific needs, etc..
It is very important for people who have kidney disease, but who are not on dialysis, to be able to identify foods that may help and hinder reaching your nutrition goals. Your diet affects how you feel and may delay the progression of kidney failure. Your goal should be delaying the onset for the need of dialysis, minimizing failing kidney symptoms, such as uremia, and maintaining and/or achieving optimal nutritional health.

It will be important for you to understand how to eat well – how to get the right amount of protein or vitamin-enriched foods, maintain a healthy target weight and manage your fluid balance. Your doctor or dietitian may prescribe a renal diet that should take into account such individual factors such as: your treatment goals, your medical history, your current symptoms, your nutrition goals, your weight status, and MOST IMPORTANTLY – your nutrition lab results

The special dietary considerations behind this plan are designed to help you avoid foods with waste products that your compromised kidneys may have difficulty eliminating. You may need to regulate your intake of minerals such as sodium, potassium, phosphate and calcium. You will know if you should regulate your intake of these minerals, based upon your lab results and how you feel.

Goals of the pre-dialysis diet

Cutting down the workload of your kidneys
Helping to keep the kidney function that is left
Reducing symptoms like fatigue, nausea, itching and a bad taste in the mouth Controlling the effects of high blood sugars, if you have diabetes
Helping to control high blood pressure
You should also eat and drink as needed to regulate your fluid balance, which means regulating your intake of fluids, including alcohol.

It is important to follow the guidelines your doctor and/or dietitian give you. There are many kidney-friendly recipes that can help put these recommendations into practice.

General Diet Guidelines

Calcium: It’s recommended that those ages 11 and up should consume about 1,000 mg of calcium daily. This includes calcium from all sources, both food and supplements. Your intake should be based upon keeping your blood calcium levels between 8.4 and 10.2 mg/dl.

Phosphorus: Phosphorus in the diet may be restricted if blood levels reach greater than 5.0 mg/dl. Recommended intake is less than 1,200 mg/day, if serum phosphorus levels are high. Foods high in phosphorus include: dairy products, dark sodas, nuts and peanut butter, beer, legumes, organ meats and chocolate.
A phosphate binder may also be initiated once levels reach greater than 5.0 mg/dl. If prescribed, these binders should be taken 10 minutes prior to or during meals.

Sodium: May be restricted with co-morbid diseases, like high blood pressure. Recommended intake is 2,000-3,000 mg/day.

Potassium: No need to change your dietary intake of potassium, unless your serum potassium is out of range. Recommended intake is 2,000-3,000 mg/day. An optimal potassium level is 3.5-5.0 mg/dl.

Calories: Adequate to maintain ideal body weight and nutrition status.

Fluid: Your fluid intake should be monitored by examining your individual fluid status. If you are retaining fluid, cut back on your intake and vice versa.
1. People with healthy kidneys should drink 8-10 eight-ounce glasses (64 ounces) of water everyday
2. Signs of dehydration: headaches, heartburn, joint and back pain, kidney stones, constipation and fatigue
3. Drinking water lowers risk of urinary tract and bladder infections, which can be common in kidney disease patients.
4. Signs of fluid overload include swollen fingers and ankles, high blood pressure, bloating and difficulty breathing.

Protein: Recent literature does not support severe protein restrictions in this patient population. A recommended intake is 0.8 grams/kilogram of ideal body weight per day.
To calculate how much protein you should consume per day, follow the equation below.
You will first need to figure out your Ideal Body Weight (IBW).
To do this:
Women – First 5 ft = 100 lbs; every inch above 5 feet, add 5 pounds
Men – First 5 ft = 106 lbs; every inch above 5 feet, add 6 pounds
To calculate the amount of protein to eat per day:
1. Ideal Body Weight (insert your number) / 2.2 (kg) = Weight (kg)
2. Weight (kg) x .8 = g of protein to eat per day

Example: 5-foot-3 Woman
1. IBW = 100 lbs + (3 x 5 lbs) = 115 lbs
2. 115 lbs/ 2.2 = 52.3 kg.
3. 52.3 (kg) x .8 = 42 g of protein/day
4. Equates to 6 oz (1 oz = 7 g of protein)

Other General Guidelines

Include Anti-inflammatory Foods
Call it too much of a good thing. Inflammation is the immune system’s first line of defense in the war against infection and disease. A critical part of the healing process, the inflammatory response appears to possess an unfortunate sense of irony, sometimes overreacting and becoming the very thing it’s supposed to destroy. Inflammation exacerbates most and probably all diseases, including kidney disease. Normally, inflammation is part of the body’s immune response to injury or infection. Inflammation helps kill the germs that cause infections, and it also stimulates the healing process. The problem occurs when inflammation becomes chronic. Chronic inflammation starts breaking down the body or specific organs.

General Guidelines:
Aim for variety
Include as much fresh/organic food as possible
Minimize your consumption of processed foods and fast foods
Eat an abundance of fruits and vegetables
Include Essential Fatty Acids: Those Fatty Acids that are required in our daily diets: Omega 3’s: Anti-inflammatory (coldwater fish, flaxseed, leafy- green vegetables, walnuts). The recommended intake of Omega 3’s, for disease management is 2,000-3,000 mg/day. Check with your physician before starting any Omega 3 supplements. Caution should be taken with patients who are currently on a blood-thinning medication.

Information or materials posted on this blog are intended for general informational purposes only, and should not be construed as medical advice, medical opinion, diagnosis or treatment. Any information posted on this blog is not a substitute for patient specific medical information or dietary advice. Please consult with your healthcare team or dietitian for a more complete dietary plan and recommendations.

Q and A | 5 Comments
Posted by Kelly Welsh on January 30, 2013 at 10:40 am