‘Dietary protein in adequate amounts is required for normal body function, growth and repair but too much is not recommended in Chronic Kidney Disease. Here the Kidney (Renal) Dietitians explain about protein needs & the kidney diet’

 

Dietary protein is important for normal function, growth and repair in all parts of the body, including the skin, muscles, blood and internal organs. Meat, fish, chicken, eggs and milk are foods rich in protein. Other foods, such as bread, pasta, rice and potatoes also contain protein in smaller amounts.

How much protein do I need to eat in my Kidney (Renal) diet?

The amount of protein you need depends on your stage of kidney disease, your size and whether or not you are on dialysis. Most people with kidney disease who are not on dialysis need to eat a moderate amount of protein. Your Kidney (Renal) Dietitian will give you a daily protein allowance and discuss with you how you can make small changes to your Kidney (Renal) diet to achieve this. Your Dietitian may guide you to estimate a serving or portion of protein as follows:

1oz cooked meat = a small matchbox size

3oz cooked meat = a deck of playing cards or average sized adult palm

Dietary Protein and Dialysis

When people start dialysis, they are usually advised to increase the protein they eat in their kidney diet. This is because a small amount of protein is lost with each dialysis session.

What happens if I get too much or too little protein in my kidney diet?

Eating too little protein can cause:

* Muscle Weakness

* Fluid Retention / Swelling at the ankles

* Poor health

* You to lose muscle instead of fat stores

Eating too much protein can cause:

* Nausea and Vomiting

* High levels of urea

* Loss of Appetite

* Fatigue

You may need more protein if you have an infection, or a wound to heal. If you cannot meet your protein needs with food alone, you may require a protein supplement. It is important to discuss this option with your Kidney (Renal) Dietitian before commencing any supplements.

Blood tests and Protein

Albumin is a type of protein found in the blood. It can be used to evaluate your nutritional status. A low albumin on your blood test can mean that you are not getting enough protein in your kidney diet. You should discuss this with your Kidney (Renal) Dietitian.

Phosphate Binders and Dietary Protein

If you have been prescribed a medicine called a phosphate binder, remember to take your binders as prescribed, as all foods that are high in protein are also high in phosphate.

‘A high potassium level in your blood stream is serious and can cause an irregular heart beat leading to a crisis medical situation and in some cases a heart attack. Learn more about potassium here and how your kidney diet plays a key role in protecting your heart and maintaining your safety’

What is Potassium

Potassium is a mineral. It is found in many foods in different amounts. Some foods are known to be higher in potassium than others, for example: potatoes, fruit, vegetables, dairy foods (milk based foods) and protein foods (meat, poultry, fish and eggs).

You will hear these foods referred to as High Potassium Foods.

What is the function of Potassium?

Potassium’s main function is in muscle contraction. It helps control the contraction of the heart.

What should my levels be?

It is important that you understand what a normal level is and also know your own potassium level. On average a normal potassium level in our blood is between 3.5-5 mmol/L. Anything above 5mmol/l indicates a high potassium level (please note laboratory reference ranges may differ from hospital to hospital. Ask you Kidney (Renal) Dietitian what reference ranges are used in your hospital).

What causes a high Potassium level?

When you eat a food high in potassium, the level of potassium in your blood will increase. One of the functions of the kidney is to clear this excess potassium from your blood and keep your levels safe.

If your kidney is not functioning properly the level of potassium could remain dangerously high.

Consequences of high potassium?

High levels of potassium can be dangerous.

Some of the signs and consequences of high potassium include: muscle weakness, weak legs and a tingling sensation. If left untreated, the consequences of a high potassium level can result in a heart attack.

How can I help control my potassium level?

Your Kidney (Renal) Dietitian will look at your blood results and tell you if you need to follow a Low Potassium Kidney Diet in order to help maintain safe potassium levels.

By looking after what foods you eat and their amounts you will be able to control your Potassium levels. Your Kidney (Renal) Dietitian will provide an individualised diet plan built around your daily potassium allowances.

Low Potassium Diet

Potatoes, fruit, vegetables, and dairy products are all foods that contain a lot of potassium. Your Kidney (Renal) Dietitian will advise you on how many portions of each you can eat daily. All vegetables and potatoes should be boiled to allow some of the potassium in these foods to leach out into the surrounding water. Some Kidney (Renal) patients who find controlling their potassium levels difficult will be required to ‘double boil’ their potatoes i.e. change the water during the boiling process. Cooking methods like steaming or roasting of vegetables and potatoes should be avoided.

Your Kidney (Renal) Dietitian  will advise you regarding your individualised dairy allowance.

Where necessary, the Kidney (Renal) Dietitian will also advise you on other high potassium foods that you should avoid and your individualised daily protein allowances to help to keep your blood potassium levels safe.

‘A high phosphate level in your blood (hyperphosphataemia) can over time, shorten your life, weaken your bones, harden your blood vessels, cause painful soft tissue sores and lead to itchy skin. Here, the Kidney (Renal) Dietitians explain this critical component of the Kidney (Renal) Diet’

 

Phosphate is a mineral found in foods that is necessary for strong bones. Our kidneys filter it out of our blood if we eat too many high phosphate containing foods. When your kidneys are not working as well as they should be, they are unable to remove excess phosphate from your blood. This leads to an increase in the level of phosphate in your blood (hyperphosphataemia).

High levels of phosphate in the blood may weaken your bones and lead to hard deposits in certain parts of the body, including your eyes, joints, skin, heart and blood vessels. Over time this can lead to restricted blood flow and heart disease. Itchy skin may be a sign that your phosphate levels are too high. However you may not realise that your phosphate level is high as you may not feel any different.

To help control phosphate levels in your body, it is important to eat a low phosphate kidney diet. To do this you will need to; limit the amount of dairy products you eat, keep to your daily limit of high protein foods and avoid other foods that contain a large amount of phosphate.

Reducing your intake of Phosphate

Your Kidney (Renal) Dietitian will give you specific advice on how much dairy and high protein foods you should have and also advice on particular foods to avoid.

As phosphate is widely used in the food industry you will also need to look out for hidden sources of phosphate in processed foods. To help stick to your low phosphate kidney diet, check the food label for ingredients that contain the word phosphate such as diphosphates, sodium polyphosphate and phosphoric acid.

Don’t eat foods containing these ingredients.

Using phosphate binders

If a low phosphate kidney diet alone does not bring your phosphate to a normal level then you may need to take a tablet called a phosphate binder with your meals and snacks. Your Kidney (Renal) Dietitian will let you know if you need phosphate binders. There are a number of different binders available.

The amount and type of phosphate binder prescribed for you may change over time depending on your phosphate levels. Phosphate binders must be taken at the correct time as advised by your Doctor or Kidney (Renal) Dietitian  to work effectively.

It is important that you monitor your own phosphate levels and take control of your dietary phosphate load.

‘Advice from the Kidney (Renal) Dietitians on the importance of avoiding food containing phosphate additives’

 

Phosphate additives are added to foods for many reasons. They can be used to extend shelf life, improve colour, enhance flavour, or retain moisture.
The phosphates in food additives are especially dangerous if you have kidney disease since our bodies absorb them much more efficiently than the phosphates that occur naturally in foods like dairy foods, lentils and whole-grains.
Unfortunately there is no complete list of all foods containing phosphate additives because there are too many of them. Some examples of processed foods which may contain these additives are listed below.

Processed meats, processed fish and cheese, dried foods, dessert and cake mixes, cola drinks, alcoholic beverages, salt substitutes, instant pasta, sauces and bakery products.

Many products marketed as “low sodium” contain high amounts of phosphate additives. Cold meats with phosphate additives may contain up to 70% more phosphates than brands containing no additives.

How to avoid phosphate additives in your Kidney Diet

Reading labels is the key. Try to read the food labels of processed foods that you use regularly. Food additives are considered ingredients and must be listed in the ingredients list by specific name or designated E number.

The most common ones are listed below:

E338    Phosphoric acid

E339    Sodium phosphates

E340    Potassium phosphates

E341    Calcium phosphates

E343    Magnesium phosphates

E450    Diphosphates

E540    Dicalcium diphosphate

E541    Sodium aluminium phosphate

E542    Bone phosphate

E544    Calcium polyphosphates

E545    Ammonium polyphosphates

Foods containing these ingredients are best avoided on the Kidney (Renal) Diet.

Compare products and choose those without phosphate additives.

Look for foods labelled “free from artificial colours, flavours and preservatives”.

If you need help or advice ask your Kidney (Renal) Dietitian.

The Irish Nephrology Society currently recommends classifying Chronic Kidney Disease into five stages based on a measure estimated glomerular filtration rate (eGFR). eGFR is a test that is used to assess how well your kidneys are working. It is based on age, sex, and blood creatinine level.

Stages of Kidney Disease

Discuss your stage of Chronic Kidney Disease with your Doctor or Kidney (Renal) Dietitian

‘Managing fluid intake is often a balancing act when you have kidney disease. Here, the Kidney (Renal) Dietitians give tips to help you with this tricky part of the Kidney (Renal) Diet’

When your kidneys are not working properly, you may not be able to get rid of enough fluid from your body. A build up of fluid can lead to problems such as high blood pressure, swelling of the ankles & shortness of breath. How much fluid you should have each day depends amongst other things on how much kidney function you have left, if you are on dialysis or not, and how much urine you pass.

If you require any changes to your fluid intake (a fluid allowance) as part of your kidney diet, Your Kidney (Renal) Dietitian will have this information and will develop an individualised fluid and kidney diet plan for you.

Tips to help you manage your fluid intake and your kidney diet Reduce thirst by reducing salt

• Avoid adding salt to foods. Salt holds onto fluid in the body and increases thirst. Click here for more info.
• Use Fresh foods in preference to processed foods to reduce salt intake. About 65 – 70% of the salt we eat comes from processed foods, fast food, canteen and restaurant food (Irish Heart Foundation 2012). Salt increases thirst.

Reduce Volume of fluid

• Use a small cup/glass and divide out your fluid intake over the day. Keeping a written record of your intake is helpful to keep track of your kidney diet fluid allowance.

Typical household measures to help you add up your fluid intake each day:

• A mug = 300mls
• A Standard Water Glass = 200mls
• A Small cup = 150mls
• A Tablespoon = 15mls
• A small ice cube = 15ml
• Foods with high water content include: soup, ice cream, jelly, custard, rice pudding, sauces, and gravy. Cut down or even avoid some of these foods if fluid retention (gain) is a problem.

Avoid a Dry Mouth – Keep It Fresh!

• Keep your mouth feeling fresh by chewing gum, brushing your teeth or rinsing with mouth wash regularly. Discuss your dry mouth with your Kidney (renal) Dietitian as artificial saliva sprays and gels may be suitable for you.

• Sucking on an ice cube can help relieve thirst whilst using the smallest amount of fluid.  Try freezing some diluted squash in your ice cube tray to add some flavour. If you have Diabetes, use a ‘No Added Sugar’ variety.

‘Advice from the Kidney (Renal) Dietitians on the importance of adequate energy in your kidney diet.’

 

Sufficient energy intake is important as part of your kidney diet, to help maintain your weight and muscle stores and ensure you have enough energy to perform the basic activities of daily living such as washing and dressing.

Our bodies get energy from the foods we eat and drink. Foods containing carbohydrates, protein and fat are used by our bodies to provide energy.

The amount of energy (calories) we need depends on our age, size, gender, physical activity level and nutritional status (e.g. overweight or underweight). Starchy foods e.g. potatoes, rice, pasta, bread and breakfast cereals are good sources of energy and provide valuable energy (calories) in the kidney diet.

A starchy food should be included at each meal to ensure an adequate energy (calorie) intake. Speak to your Kidney (Renal) Dietitian to receive an individualised kidney diet meal-plan.

The Challenges

When you or your family member have kidney disease meeting energy (calorie) needs may be challenging.

Many people with kidney disease experience a reduced appetite and taste changes, which are associated with elevated urea levels (waste product level). These symptoms commonly result in a poor dietary intake and unnecessary weight loss if not addressed.

Your Kidney (Renal) Dietitian will be able to provide you with individualised advice to manage your appetite and weight.

Conversely if you are overweight or obese a recommendation for weight reduction may be made, to aid the management of your kidney disease or to facilitate your eligibility for a transplant.

If you are trying to reduce your weight a reduction in your energy intake may be required to facilitate this, your Kidney (Renal) Dietitian will provide you with a tailored weight reduction plan.

‘Learn to adapt your favourite home cooked foods making them suitable for your kidney diet.’

The good news is that, many standard cookbooks or celebrity chef recipes can be used safely through a little adaptation and some imagination to make them lower in potassium, sodium and phosphate.

To help you to identify any adaptation required, we recommend that you read each new recipe (or old favourites) with your kidney (renal) diet allowances clear in your head and your diet sheet of foods best avoided close to hand. Your Kidney (Renal) Dietitian can help you to adapt recipes or review those that you have self adapted.

Here are some suggestions to make your favourite recipes more kidney friendly

Tips to help you to become a kidney friendly baker:

• Use reduced amounts of salt or omit it all together from the recipe. Use herbs and spices (e.g. nutmeg, cinnamon) instead of salt to add flavour.

• Use yeast, bread soda / bicarbonate of soda as a raising agent instead of baking powder. Breads and cakes will then be lower in phosphate than those using baking powder. Bread soda / bicarbonate of soda require an acidic fluid like lemon juice or buttermilk to act as a raising agent. Be sure to include these in your daily allowances.

• Choose lower potassium fruits when baking tarts, muffins and fruit pies such as apple, pear, pineapple, cranberries and blueberries or drained tinned fruit (remember to include the fruit as part of your daily kidney diet fruit allowance).

• Choosing the unsalted varieties of butter for baking will make a recipe more kidney friendly by reducing the salt (sodium) content.

• Double cream plus water is a good alternative to single cream or milk. Making this simple change will lower the phosphate content of the recipe and help you with your daily dairy allowances (reduced phosphate kidney diet).

• Unfortified rice milk is lower in potassium and phosphate than cow’s milk and may be used to make puddings.

• Use egg whites as they are lower in phosphate than egg yolks and are useful for desserts e.g. meringues.

Making main meal dishes kidney friendly:

• Reduce potato intake to reduce dietary potassium intake. Use rice, pasta, noodles, couscous or breads instead of potatoes with main meals. This will lower the overall potassium content of the dish.

• Avoid prepared tomato sauces. Try a small amount of fresh tomato instead, or if making a pasta dish, use olive oil and garlic instead of a tomato based sauce to dress / flavour the pasta. This will lower the potassium content and make your pasta dish more Kidney friendly.

• To lower potassium content, vegetables can be par boiled before being added to recipes (e.g. carrots, broccoli or cauliflower in a curry). If you are following a strict low potassium kidney diet, fully boil your vegetables (link low potassium vegetable cooking instructions page) and add to the composite meal (e.g. kidney friendly stew, curry) for the last 10 – 15 minutes of cooking.

• For dishes that contain high potassium vegetables e.g. Mushrooms, substitute them for lower potassium vegetables e.g. Green (French) beans

• For stir-fry dishes avoid using higher potassium vegetables such as pak choi, bamboo shoots or mushrooms. Substitute them with Green (French) beans, Bean-sprouts or Cabbage. If you require a strict low potassium kidney diet, remember that stir fry vegetables retain a high percentage of potassium during cooking. Link with your Kidney (Renal) Dietitian and discuss your kidney diet allowances.

• To reduce salt (sodium) intake in your kidney diet, avoid using regular soy sauce, limit reduced salt (sodium) soy sauce to small amounts and limit the amount of other high salt (sodium) sauces such as fish, oyster, teriyaki or sweet and sour sauces. Try using vinegar, ginger or a little sesame oil as alternative flavourings to make a meal more kidney friendly.

• Double cream plus water is a good alternative to single cream or milk in savoury dishes. Making this simple change will lower the phosphate content of the recipe and help the recipe to fit into the daily allowances of a reduced phosphate kidney diet.

• If dishes contain cheese, use this sparingly or choosing a lower
  phosphate cheese e.g. Brie, camembert, parmesan, feta, cottage or cream cheese.

• Make a fish dish more Kidney friendly by substituting shellfish or smoked fish in the recipe for white fish such as cod, whiting or plaice. This will reduce the salt (sodium) and phosphate content of the dish.

• To reduce salt (sodium) content use a low salt stock cube as recommended by your Kidney (Renal) Dietitian as a base for stock. Do not add any extra salt.