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Diet of Chronic Renal Failure

By Mumtaz Khalid Ismail

More Links Clinical manifestations Causes of Chronic Renal Failure Dietary management Points to be noted for the diet

Chronic renal failure is the deterioration of kidney function, which progress over a prolonged period towards a fatal termination. The normal kidney function includes regulation of body fluids, electrolytes, pH and excretion of non-volatile metabolites. Urea, a toxic by product of metabolism gets accumulated in the body during renal failure. This occurs when 90% of the functioning of renal tissue is destroyed.

1. General
   1. Weakness, lethargy, dizziness, and confusion
   2. Head ache
   3. Bad breath
   4. growth failure
   5. Increases susceptibility to infection
   6. Acidosis

2. Renal
3. Increase frequency of urination both at day and night.

1. Cardiovascular symptoms
   1. Oedema of the lungs and ankle
   2. High blood pressure
   3. Irregular heart beats

2. Gastrointestinal symptoms
   1. Loss of appetite
   2. Vomiting and diarrhoea
   3. Hiccups
   4. Abdominal pain
   5. Abdominal distension

3. Neuromuscular symptoms
   1. Peripheral neuropathy
   2. Muscle weakness, cramps and twitching
   3. Weakness of legs
   4. Convulsions
   5. Coma

4. Hemopoietic system
   1. anaemia
   2. Small bleeding spots over the skin or mucous membrane

5. Skin
   1. pigmentation
   2. Itching

6. Skeletal
   1. Osteodystrophy
   2. Dwarfism
   3. Rickets

1. Chronic interstitial nephritis
2. Chronic infection of the urinary tract like chronic pyelonephritis
3. Immunological disorders like glomerulonephritis
4. Obstruction to urinary tract like Kidney stones, urethral valves etc.
5. High blood pressure
6. Hereditary disorders like polyctstic kidneys
7. Other conditions like diabetes mellitus, gout etc

The principle of dietary management is to encourage patient to take appropriate amount of fluid and electrolyte and adjust his or her diet to prevent accumulation of toxic waste product to the minimum possible level.

1. Fluids
   A large fluid intake and high urine flow ensure a maximal rate of urea excretion. Generally no water restriction is required, in fact they should be encouraged to have fluid. But in patient with cardiac failure or in later stages when urine out put is reduced for the reason other than dehydration fluid to be restricted.

2. Energy
   Carbohydrates and fat must supply sufficient energies to spare protein breaking down to the lowest possible limit. If energy intake is inadequate endogenous protein tissue catabolism takes place to supply energy and will further aggravate the exciting uraemia. Carbohydrates should be the main source of calories and ingested simultaneously with the protein so that the protein will not be utilised for energy. For adults caloric needs range from 35 -50 kcal per kilograms of ideal body weight. Where as for children 80 - 110 kcal / kg and for infants it is 100 -120kcal /kg.

3. Protein
   Severe restriction of protein is not required protein intake can be reduced to 0.5gm/ kg of body weight per day mainly from eggwhite, rice or potato. With haemodialysis the protein intake should be increased to 1 gm per kg per day. But those on peritoneal dialysis more protein lost and they require daily 1.2 to 1.5gm protein per kg body weight per day. Canned and preserved meat should be avoided. Cheese, butter, which contains salt also, should be avoided.

   

4. Sodium
   Dietary sodium intake depends on its amounts in serum and urine. Both the excess and deficiency of sodium is dangerous. Usually sodium depletion is associated with water depletion resulting in weight loss. Daily recording of weight gives us an indirect idea of sodium requirement. Sodium restriction may be needed because of oedema, hypertension, and threat of heart failure. Non dialysed patients, who are hypertensive, may be permitted less than 1 gm sodium. But patients on haemodialysis are usually permitted intakes of 1.5 to 2.0 gm where as those on peritoneal dialysis are to receive 2 to 3 gm. The sodium allowance in children is 50mg per kilogram per day.

5. Potassium
   Daily potassium to be restricted to 1 mmol/kg of body weight. Excess or deficiency of potassium is detrimental to the patient. In chronic renal failure hyperkalemia (increase potassium) is the rule. The potassium allowance is individualised in accordance with the patients blood chemistries, urinary out put and amount of potassium in the dialysis fluid. Foods high in animal protein are usually high in potassium and fruits and vegetables should be limited or excluded from the diet. The vegetables should be sliced and rinsed in running water and boiled with excess water and drain the water to reduce the potassium content of cooked vegetables.

1. The food should be high in calories and low in protein.
2. High protein sources like fish, chicken, meat and pulses should be taken in smaller quantities.
3. Avoid canned, baked, processed and preserved foods.
4. Salted cheese, butter and nuts should be avoided
5. To reduce potassium content cook the vegetables with more water and drain off excess.
6. Avoid fruits, fruit juices, and coconut water.
7. If potassium is restricted avoid tea, coffee, bajra, maize, raji, wheat flour, pulses and legumes, chocolates, vegetables, fruits, sauces, jam, jellies.

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