There are 26 million Americans with chronic kidney disease and many millions more are at risk for developing it. Early detection and immediate treatment is necessary for this progressive disease which slowly destroys the ability of the kidneys to filter waste from the bloodstream and will eventually lead to the need for dialysis and/or a kidney transplant. Risk factors for chronic kidney disease (CKD) include hypertension, diabetes, family history, and being of African American, Hispanic American, Pacific Islanders or Native American descent. Hypertension is the number one risk factor for chronic kidney disease, which in turn can be a risk factor for developing kidney disease as well. (Source: The National Kidney and Urologic Disease Information Clearinghouse)
Kidney disease, especially CKD, is typically given a stage to describe the severity of the disease and the course of action. In its mildest form, only a few dietary and lifestyle changes are recommended as well as continued monitoring by the doctor. In subsequent stages of the disease, however, there are several serious restrictions, including a limit on the amount of protein that is eaten every day, which will require a nutritionist’s or dietician’s guidance. Protein is a vital part of a healthy diet and changing the amount that is eaten or restricting it can have serious consequences. During this stage of the disease, maintaining weight will be important for a number of reasons and suddenly reducing or changing the types of protein that are included in the diet can cause the body to start seeking additional food sources until the right protein level is reached (Source: Massey University).
When the body breaks down protein, it is first broken down into individual amino acids and then used to create new amino acids, enzymes, and hormones that regulate digestion, sleep, and ovulation. After this process is completed, the waste products are filtered by the kidneys. These two organs are small, only about four inches long and weighing less than a pound in total, but filter blood through them at a rate of about 18 gallons per hour. The kidneys filter about 60% of the fluid in the entire body (Source: MacLean 2005).
Once the kidneys are damaged or diseased, they lose the ability to accomplish this filtration of protein-breakdown-related waste products. Kidney disease is given a stage, which is related to how serious it is based on the glomerular filtration rate, or how much blood the kidney can filter. Stage I chronic kidney disease has a GFR that is still considered to be normal, however, the disease is still present because there is an abnormal amount of protein found in the urine (proteinuria). Stage IV of the disease is the final stage before dialysis is needed.
In stage V, the patient will either need dialysis for life or will need a kidney transplant. Dialysis will need to be performed until a transplant is available and, in some cases, until the patient is strong enough to handle the surgery itself. In the case of some underlying medical conditions, surgery may not be a viable option. The GFR for stage V chronic kidney disease is typically below fifteen and the kidneys are functioning at about ten percent of their normal capacity (Source: Davita.com).
Dietary Concerns in Stage Five
In stages I-IV, the protein intake is restricted. This restriction is only slight in the first three stages, with a more serious restriction imposed by dietician direction and doctor’s orders in stage four. The protein intake may only be around 10%, as opposed to the normal diet of 14-18% of daily calories coming from protein. The typical vegan diet is around 10-12% protein, so the restriction is not that extreme overall (Source: Mangels, PhD, RD). It is still important that any protein restriction only be done with the express advice and consent of the doctor.
In Stage V, which is end stage renal failure, the reverse is true. In this stage, the need for dialysis will become a fact of life as will the need for good nutrition, including additional amounts of protein. There might be restrictions on the amount of fluids that will be considered to be safe as well as restrictions on sodium, potassium, and phosphorous intake. There may also be restrictions on the types of foods that can be eaten based on the type of dialysis that is being used and the patient’s overall health.
Dialysis is the mechanical separation of waste matter and water from the bloodstream. Although dialysis can be used in other ways, it is primarily used to replace kidney function either temporarily or on a more permanent basis. The procedure of dialysis is fairly complex and typically takes several hours per session, which might be done three times per week or more depending on need (Source: MacLean 1993).
During this time, the diet must include enough calories to ensure that the health level be maintained and/or improved and to prevent muscle wasting. The cornerstone of the diet will become increased levels of protein, which should come from sources that are high in essential amino acids, including eggs, meat and some dairy, while keeping in mind any other restrictions that are involved in the diet. Some foods, though high in overall protein, are lacking in the amino acids that will be converted to muscle and should not be used, including nuts, beans and nut butters.
Calories in this stage will be based on “dry weight”, which is actual weight minus estimated fluid retention weight. Protein intake can be as high as 2 grams per kilogram of dry weight, which is double the average recommended amount. The dietician will suggest that you increase your intake of meat, frequently eat egg dishes (eggs are considered to be the perfect protein) and take protein supplements as well. It is also important that you get about 25% of your daily protein from each meal.
Food restrictions will still be important and will include dairy products which, while high in protein, may be limited because they are also high in phosphorous. Additional foods that will be restricted include brown rice, bran cereals, dried beans, salmons, organ meats and sardines, chocolate and cola drinks. One of the early signs of phosphorous buildup in the body is extremely itchy skin (Source: Maree, 2002).
Protein Supplements to Boost Intake
Because protein intake is double that of a normal diet, it might be hard to get enough from only food sources. End stage renal failure may leave you feeling exhausted and nauseas and destroy your appetite, which makes it even harder to get the right amount of protein as well as the other nutrients that you need to get. Using a protein supplement can help greatly. There are several kinds to choose from: powders, shakes, liquid supplement shots, and snacks, like protein bars and puddings.
Protein Powders
There are four kinds of protein powders: rice, egg, soy, and whey. Whey protein is especially beneficial to boost the immune system and to build and maintain lean muscle mass. Whey protein is a milk derivative and may be restricted by your doctor, however.
Protein Shakes
There are several brands of protein shakes, including those that are designed specifically for use by diabetics. While increasing calories and protein intake is important, blood sugar control is also a major concern.
Protein Supplement Shots
Smaller than a shake, liquid protein shots should still be fairly high in protein and other nutrients without having anything that is not needed. Profect, from Protica, is small at 2.9 fluid ounces and 100 calories but is high in protein, with 25 grams in total. There are zero carbohydrates and zero fats but a number of additional vitamins.
Protein Snacks
Protein bars and puddings can be a good way to get additional protein, as long as they do not have a lot of added sugar. Sugar can weaken the immune system.
Protica Research (Protica, Inc.) specializes in the development of Capsulized Foods. Protica manufactures Profect, IsoMetric, Pediagro, Fruitasia and over 100 other brands, including Medicare-approved, whey protein bullets for weight loss surgery patients. You can learn more at Protica Research – Copyright