The amount of protein allowed in the diet is determined by checking the amount of protein (and protein waste byproducts) in the person's blood. The suggested amount of protein in a low protein diet is 0.6g/kg/day.
In patients who are losing large amounts of protein in their urine in diseases (such as nephrotic syndrome), the kidney specialist will recommend a moderate protein restriction of 0.8g/kg/day.
Laboratory tests may include chem-20, creatinine, albumin, and blood urea nitrogen. Low-protein diets may prevent or slow the progress of some kinds of kidney disease. The amount of protein the person can eat is based on how well the kidneys are functioning and the amount of protein needed to maintain good health
Sodium content in the diet is also controlled. This helps avoid fluid retention. Reduced amounts of sodium in the diet also helps control high blood pressure and congestive heart failure.
The daily intake of potassium is also a concern. Controlling it helps prevent hypokalemia (a low level of potassium, rarely a problem for people with renal disease) as well as hyperkalemia (a high level of potassium, a common problem for people with renal disease).
The mineral phosphorus is often controlled as well. When the amount of phosphorus is decreased by the reduced intake of dairy products and other foods high in phosphorus, there is a need to provide calcium supplements to prevent bone disease.
The amount of phosphorus in the diet is controlled by the use of phosphorus binders (medications that bind the phosphorus in the food and make them unavailable to the body). Vitamin D supplements may also be provided to help control the calcium and phosphorus balance in the body.
During renal failure, the amount of urine the body produces may be decreased. The recommended daily amount of fluid is based on the amount of urine produced in a 24-hour period. Other considerations are the amount of fluid retention present, the level of dietary sodium, the use of diuretics, and the presence or absence of congestive heart failure.
People with renal disease are more prone to cardiovascular (heart) disease, so a diet with most of the calories from complex carbohydrates is recommended. Calories from fats should be from monounsaturated and polyunsaturated fats.
The daily calorie intake needs to be adequate to maintain the person's nutritional status at an optimal level and to prevent the breakdown of body tissue. The person's weight and protein status should be monitored regularly, even daily.
Vitamin supplementation is very individualized. It is dependent on the various dietary restrictions and the extent of renal failure. The requirements for the fat-soluble vitamins (A, D, E, and K) are usually met by the diet. Vitamin D may need to be supplemented -- this is an individual medical decision. The intake of water-soluble vitamins is usually adequate until a patient begins dialysis.
The minerals that are also monitored include calcium, iron, and magnesium. The recommended supplementation of daily calcium is 1,000 to 1,500 milligrams per day. Iron supplementation is based on the person's need.
Magnesium supplementation is NOT recommended, as it can cause an increase in the magnesium levels in a person with renal disease. Iron is usually supplemented as most patients with advanced renal failure also have severe anemia.
Note: Not all people with kidney disease need dietary supplements.
|