Kidney disease is listed by stages, with each stage having slightly different dietary needs to keep the patient as healthy as possible. During some of the later stages, the need for protein goes down slightly to accommodate the body’s inability to process or digest protein. In the end stage, Stage Five, the patient will not only be facing dialysis, but his dietary needs will change as well. During this stage, it is important to work with a dietician so that the best health level can be maintained. In addition to changing the need for protein, the end stage of kidney disease will also restrict the amount of sodium, potassium and phosphorous in the diet. The intake of fluid will also be restricted at this point.
The diet for end stage renal disease is designed to help the body maintain a balance of electrolytes, minerals and fluids. It is helpful to keep in mind the goal and purposes of dialysis itself: dialysis is used to perform the task of the failing kidneys, primarily to remove the waste products from the blood. In a healthy person, the kidneys are responsible for filtering an incredible amount of blood each hour. After these waste products, leftovers from digestion and infections are strained from the bloodstream, they are sent to the bladder to be flushed from the body in the urine. In addition to these waste products, urine is also comprised of the excess fluid that is removed from the body during the day.
When the kidneys start failing, the fluid can start backing up in the body and can cause problems in the heart, lungs and around the feet and ankles. During dialysis, patients may not urinate at all or may urinate in very small amounts. The urine that they do expel may be very concentrated and may also cause additional problems like urinary tract infections. Because of this problem with urination, the dialysis patient will usually be given a very strict fluid restriction to prevent the buildup of fluid in the body because of the additional problems that it can cause. For instance, excess fluids can build up around the heart and make it harder for it to pump correctly. The excess fluids can buildup in and around the lungs and cause pneumonia and breathing difficulties. Excess fluids can also lead to electrolyte imbalances, which also cause problems for the heart and its normal rhythms and can lead to other problems related to the functioning of the brain. An electrolyte imbalance can cause confusion, depression and other mental problems that can be present and worsened by the excess fluids or can be caused by them.
In addition to the fluid restriction, the dialysis patient will also be given the exact amounts of protein and other nutrients that they need to stay as healthy as possible. Again, it is very important to work closely with a nutritionist to devise the right eating plan for your needs.
When a patient starts dialysis, the blood levels of sodium, potassium, phosphorous, calcium, albumin and urea are all checked. This testing is repeated at the end of each dialysis session as well, which will allow the nutritionist to keep track of and adjust the amounts of the nutrients in the diet. The amount of fluids that you are allowed will be adjusted on a continuing basis, with the amount that you will be allowed based on the amount of urine that is being made and released and the amount of water weight gain that is seen between the dialysis treatments.
When a patient is first diagnosed with kidney disease, the amount of protein that they are allowed to eat will be reduced so that the disease’s progression will be slowed as much as possible. However, when dialysis starts, the need for protein will increase. How high the amount goes up will depend on the type of dialysis itself. The type of dialysis that is needed will depend on the type of kidney disease and the other health conditions that are in place. The two types of dialysis are hemo-dialysis and peritoneal dialysis. For the patient who is being treated with the latter, the need for protein will be higher because of the amount of protein that is lost in the fluid that is discarded from the body during each treatment session.
There are some problems with being able to get the increased amount, especially after dialysis has started on a regular basis. First, most of the patients are dealing with not only kidney disease, but other secondary and serious conditions as well. Second, the average kidney patient is not going to have a good appetite and may not feel much like eating at all. In light of these problems, the need for good nutrition becomes more vital and it may be necessary to supplement protein intake as well, ensuring that the right amount of this very important macronutrient is reached each day.
Finally, because kidney disease tends to be caused by or cause the development of high blood pressure and heart disease, most of the patients who are being treated for kidney disease, no matter what stage, will be advised to follow a low-fat diet to protect their heart from new or further damage as their disease progresses from stage to stage.
Vitamins can also be a serious consideration in kidney disease and dialysis. Many of the types of vitamins can be met in fair amounts in the diet, however, there are many of the water-soluble vitamins that are not only in not present in high enough amounts in the remaining diet but are also lost during the treatment itself. These must be supplemented in addition to other nutrients.
Kidney Disease and Dialysis: A Case Study
Ericka has been struggling with kidney disease for much of her adult life. She first was diagnosed with chronic kidney disease, often referred to as CKD, when she was in her late twenties by a doctor who found that her high blood pressure was completely abnormal. Further testing led to a diagnosis of the kidney disease and she was directed to a nephrologist. This kidney specialist found her disease was in Stage Two and set her up with a treatment plan and then sent her to a nutritionist for education and guidelines for the healthiest diet.
In addition to following a low-fat diet, Ericka was directed to reduce the amount of protein that she was eating as well as the electrolytes in her diet. She is also restricted in the amount of fluids that she can have every day. Because she is very serious about her health, and she knows about her family history with not only kidney disease but heart disease and other health problems, Ericka is very dedicated to her day-to-day care and follows all of her guidelines to the letter. Sadly, this is not always enough to keep a disease from progressing further, and she soon finds herself facing the need for dialysis. At this point in her care, the doctor and nutritionist determine her dietary needs, greatly increasing the amount of protein that she needs each day and adding supplemental forms of certain water-soluble vitamins to help maintain her health and strength.
Because Ericka is not feeling well most days and spending five hours or more at the kidney center, she uses protein supplements to help reach the required amount. One that she enjoys is Profect, a protein supplement from Protica which gives her a large amount of protein (25 grams per serving) in a small size (less than three fluid ounces.) There are a number of flavors that she can use so that she never gets bored, and because they are temperature stable, the vials can be stashed in her car or purse while she is getting her treatment.