What You Need to Know About Nutrition Management Author: Angela Bradford

Chronic kidney disease is described in 5 different stages.  The level of filtration shown by the kidneys determines each stage.  This filtration rate is called the glomerular filtration rate (GFR).

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Stages of CKD:

Stage 1-GFR >90

Stage 2-GFR 60-89

Stage 3-GFR 30-59

Stage 4-GFR 15-29

Stage 5-GFR<15

Nutrition intervention is important for the management of chronic kidney disease.  A doctor might refer you to a Dietitian while in stages 3-4 to help prevent progression of the disease.  Once diagnosed end stage renal disease (ESRD) and dialysis is started, a Renal Dietitian is available at most dialysis centers to provide guidance and counseling.
Pre-dialysis nutrition advice:

While in stages 1-4 chronic kidney disease, nutrition counseling focuses on preventing the progression of the disease. Determining what is the cause of the kidney disease is the first step.  Hypertension and diabetes are the two leading causes of kidney disease.  Nutrition advice will focus on managing those diseases to help prevent any further deterioration of the kidneys.

Some doctors will make dietary restrictions to lessen the strain put on your kidneys.  The doctors will monitor your lab values to help determine if dietary restrictions are needed.  A referral to a Registered Dietitian is beneficial in helping patients modify their diets to make the changes needed.

Common dietary restrictions prior to starting dialysis are made with potassium and protein.  As chronic kidney disease progresses, the kidneys are not able to filter the byproducts of protein that has been broken down in the body.  Eating too much protein would overexert your kidneys during this stage.  The Doctor would recommend decreasing protein in your diet.

Kidneys play a big role in excreting potassium from your body.  When there is a build up of potassium, you are at risk of having a heart attack or stroke.  A Dietitian can help you identify high potassium foods to avoid.

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Once the chronic kidney disease progresses to the final stage, the doctor will recommend the patient start dialysis.  The nutrition advice for dialysis patients has some differences from pre-dialysis patients.

Dialysis nutrition advice:

Protein is recommended to be increased when on dialysis because the dialysis treatment will actually lower your protein in your body.  There is no worry of overexerting the kidneys because in this stage the kidneys will no longer be working.

Potassium continues to be restricted.  The consequences of high potassium are the same as before dialysis.  When the kidneys completely stop filtrating the blood, potassium levels can rise quickly.  The doctor will monitor potassium levels very closely.

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Phosphorus and calcium are restricted while on dialysis because they easily rise when kidneys fail.  The increase is from an overactive parathyroid gland.  The gland excretes a hormone that pulls phosphorus and calcium from the bones, which makes the bones brittle.

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Malnutrition is also a problem seen with many patients that have chronic kidney disease.  When the blood isn’t cleaned effectively by the kidneys, the toxins that accumulate will cause you to feel nauseated.  Complications from other diseases like high blood sugars will make you experience nausea and vomiting as well.  This GI upset can cause you to eat less and not get enough calories and protein in your diet.

Not getting enough nutrition is a slippery slope.  It can lead to organ failure and diminished quality of life.  A Dietitian is trained to see the signs and symptoms of malnutrition and get you the help you need

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How can a Dietitian help manage this disease?

A Dietitian is a nutrition expert that can help prevent the progression of the disease and help improve the quality of life of those already on dialysis.  You can request a referral from your doctor prior to starting dialysis to meet with nutrition professional.  The Dietitian will review the restrictions recommended by the doctor and help you create a diet that works best for you.

Patients have been shown to improve with the help of Dietitians.  They work closely with the rest of the multi-disciplinary team to get the patient the help they need.

Although other health professionals are able to provide diet advice, dietitians are the nutrition experts and the availability of trained renal dietitians is essential in the management of these patients.

Dietitian counseling can potentially improve nutrition for patients with chronic kidney disease through recommendations for adequate protein and caloric intake and nutritional supplements as needs, resulting in better nourishment.

Dietitians could help to increase patient adherence to dietary recommendations.  Studies show that the presence of competent renal dietitians fully dedicated to hemodialysis unites was superior in improving patient outcomes.

WORKS CITED

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Gentry J, Webb J, Davenport D, Malluche HH. Serum phosphorus adds to value of serum parathyroid hormone for assessment of bone turnover in renal osteodystrophy. Clin Nephrol. 2016;86(7):9-17.doi:10.5414/CN108823.

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Karavetian M, Abboud S, Elzein H, Haydar S, Vries N. Nutritional education for management of osteodystrophy (NEMO) trial; Design and patient characteristics, Lebanon. Nutr Res Pract. 2014;8(1):103-11. doi:10.4162/nrp.2014.8.1.103

Babayev R. Nickolas TL. Bone Disorders in Chronic Kidney Disease: An Update in Diagnosis and Management. Demin Dial. 2015;28(6):645-653. doi:10.1111/sdi.124323.

Karavetian M, Elzein H, Rizk R, Jibai R, de Vries N. Nutritional education for management of osteodystrophy: Impact on serum phosphorus, quality of life, and malnutrition. Hemodial Int. 2016;20(3):432-440. doi:10.1111/hdi.12405.

AlSadhan AA, Hejaili F, Salih SB. Level of dietary awareness among Saudi dialysis patients and the influence of various factors. Saudi J Kidney Dis Transpl. 2015;26:544-8. http://www.sjkdt.org/article.asp?issn=1319-2442;year=2015;volume=26;issue=3;spage=54.com

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