Diet for Chronic Renal Failure

Ezekiel T. Arteta

Kidney Function
Detoxify blood Increase calcium absorption
Calcitriol

Stimulate RBC production

Erythropoietin

Regulate blood pressure and electrolyte balance

Renin

Determinants of GFR

Other factors: Rate of Plasma flow Total Surface area of the glomerular capillaries

Chronic Renal Failure

Progressive, irreversible damage to the nephrons and glomeruli
150 200 cases per million people = new cases each year Chronic renal failure and ESRD affect more than 2 out of 1,000 people in the U.S Mortality = 20%

Acute Versus Chronic

Acute
sudden onset rapid reduction in urine output Usually reversible Tubular cell death and regeneration

Chronic
Progressive Not reversible Nephron loss

75% of function can be lost before its noticeable

Stages of CRF

Chronic Renal Failure Causes

Diabetic Nephropathy Hypertension Glomerulonephritis HIV nephropathy Reflux nephropathy in children Polycystic kidney disease Kidney infections & obstructions

CRF Symptoms
Malaise Weakness Fatigue Neuropathy CHF Anorexia Nausea Vomiting Seizure Constipation Peptic ulceration Diverticulosis Anemia Pruritus Jaundice Abnormal hemostasis

CRF Effects
Decreased: GFR, tubular function & tubular reabsorption capabilities. Dysfunction of fluids & electrolytes, Acid base disturbances, & Systemic problems

Treatment Modalities
Decrease fluid 1000ml/day Decrease protein (.5-1kg body weight) Decrease sodium (1-4gm variable) Decrease potassium Decrease phosphorous (<1000mg/day) Dialysis (peritoneal, hemodialysis) RBC, Vitamin D (calcitrol replacement) etc.

Protein Restriction
Protein = Malnutrition;
Protein Diet Protein Metabolism Product: AMMONIA Urea Cycle Product: UREA GFR Urea accumulates in the blood Uremia SUN

Protein =

urea

Protein Restriction
Other effects of High Protein diet
Severe acidosis (serum bicarbonate <15mmol/l)

Severe hyperphosphataemia (serum phosphate >7mg/dl) severe azotaemia (blood urea nitrogen values >120mg/dl) Hyperuricaemia

Protein Restriction

Protein Restriction
BEFORE DIALYSIS: Low-protein diet AFTER DIALYSIS: Increased-Protein diet compared to the diet before dialysis.
Recommended amount: 2 grams/kg weight

Good quality Proteins

eggs, milk, meat, fish and poultry.

Proteins of lower biological value

pulses, cereals, nuts, oilseeds and in some vegetables like greenpeas and dried beans.

Treatment Modalities
Decrease fluid 1000ml/day Decrease protein (.5-1kg body weight) Decrease sodium (1-4gm variable) Decrease potassium Decrease phosphorous (<1000mg/day) Dialysis (peritoneal, hemodialysis) RBC, Vitamin D (calcitrol replacement) etc.

Fluid and Sodium Control

Impaired renal mechanisms for conserving sodium and water.

Fluid and Sodium Control

GFR Aldosterone Na+ and water reabsorption Intravascular fluid Renin, angiotensin

Edema Cadiovascular and Respiratory effects

Hypertension Further damage

Fluid and Sodium Control

Rise in body weight and Pressure
Retention of sodium and fluid

Decline in body weight and Pressure

Fluid loss

Water intake must not exceed the capacity for free water clearance

FOODSTUFFS HIGH IN SODIUM Baking soda Salt Ajinomoto Salted wafers, popcorns, salted biscuits. Papads all varieties. Salted pickles, chutneys, curry powder commercial. Commercial salad dressings and sauces. Soup cubes. Soft drinks containing sodium benzoate. Bakery products, bread , biscuits. Nuts such as salted cashewnuts, pistachio, walnuts, peanuts. Commercial cheese. Preservative containing foods. Canned and tinned foods. Sea food, chicken, dry fish, bacon, ham . Meat and yeast extracts like marmite. Proprietary drinks Bournvita , chocolate drinks , Horlicks. Milk and curds. Pulses and legumes all varieties. Vegetables such as cauliflower , snakegourd , beetroot , carrot , coriander leaves, fenugreek(methi) leaves, lettuce ,spinach(palak) ,amaranth, radish

Rich in Sodium

Rich in Fluid

Treatment Modalities
Decrease fluid 1000ml/day Decrease protein (.5-1kg body weight) Decrease sodium (1-4gm variable) Decrease potassium Decrease phosphorous (<1000mg/day) Dialysis (peritoneal, hemodialysis) RBC, Vitamin D (calcitrol replacement) etc.

Potassium Control
GFR renal K+ excretion GI K+ excretion Certain drugs inhibit K+ entry into cells or K+ secretion in the distal nephron.
Beta blockers,ACE inhibitors and angiotensin receptor blockers, K-sparing diuretics (amiloride, triamterene, spironolactone), and NSAIDs

HYPERKALEMIA

Potassium Control
Leaching
Method 1: Wash, peel and cut vegetables into small pieces. Soak in warm water for 2-3 hours. Discard water. Add large volume of fresh water and cook vegetables. Discard water. Method 2:Peel vegetables and cut into small pieces. Bring to a boil in a large quantity of water. Discard water and cook in a large volume of fresh water. Discard excess water.

Treatment Modalities
Decrease fluid 1000ml/day Decrease protein (.5-1kg body weight) Decrease sodium (1-4gm variable) Decrease potassium Decrease phosphorous (<1000mg/day) Dialysis (peritoneal, hemodialysis) RBC, Vitamin D (calcitrol replacement) etc.

Phosphorus, Vitamin D and Calcium

Phosphorus and calcium
Slows down renal failure and prevent bone disease

renal function active Vit. D phosphorus in the body renal function active Vit. D calcium in the body phosphorus + calcium = BONE RESORPTION

Phosphorus, Vitamin D and Calcium

List Of Foods High In Phosphorus All-bran Cereal Almonds Beef Brazil Nuts Cashew Nuts Cheese Chicken Dried Fruit Egg Garlic Halibut Fish Hard Potatoes Legumes Lentils Liver Meat Milk Peanuts Poultry Roe Salmon Sesame Seeds Sunflower Seeds Turkey Wheat Bran Wheat Germ Whole Wheat Bread Yogurt

Phosphorus, Vitamin D and Calcium

Phosphorus, Vitamin D and Calcium

Phosphorus, Vitamin D and Calcium

BALANCED INTAKE OF CALCIUM AND VIT. D
Too much calcium: HYPERCALCEMIA Too much Vitamin D: VITAMIN D TOXICITY

Caloric Intake
Patients with CHF needs enough energy
Prevent protein catabolism and to maintain a desirable weight.

As renal failure progresses, consuming adequate energy becomes difficult. Energy needs are slightly lower once dialysis begins.

Other Considerations
Thiamin (B1) Folate Vitamin B6 Vitamin B12 Water-soluble vitamins Fat-soluble vitamins Iron Erythropoietin Zinc

AVOID Aluminum Magnesium