Diet in chronic kidney disease

Chronic kidney disease is a condition characterized by abnormally decreased glomerular filtration rate (GFR) and acid base imbalance. Chronic kidney disease or CKD is caused by recurrent episodes of acute kidney injuries. Various reasons pave way for this condition to occur. Talking about diet exclusively in this article, there are various reasons that cause CKD and also that cures CKD. We shall therefore talk about the foods to avoid and foods to consume. This article will also give you all the necessary information about the methods to cook and dietary plans for patients with CKD.

Low potassium diet and low sodium diet in CKD.

Potassium rich foods cause damage to the renal tubules in turn causing CKD. Potassium should hence be avoided. What items are considered to be potassium rich foods?

• Avoid Dry fruits: these are some of the most nutritious food stuffs that we know of. They provide with minerals, nutrition, and energy to the body. But always remember, CKD patients should stay away from them. As it contains a lot of potassium, it causes a bad impact on the kidney. Eating cashew nuts ( Kaju) , almonds ( badam), raisins, fig ( anjeer), avocados, apricots (khubani), fox nuts (makhana), dates (khajoor), etc. 
• Avoid sodium in your diet: sodium is present in the table salt that we use for daily cooking. It is bad because it causes water retention in the blood thereby increasing blood volume and hence blood pressure. This causes damage to the renal glands. 
• Eat low potassium vegetables: many vegetables are considered good for such patients. But taking precautions is better and hence using these vegetables such as cabbage, cucumber, egg plant, beans can prove to be safer. But proper boiling and cooking these vegetables is of utmost importance and id dealt with in detail later in this page.
• Avoid meat and all animal based proteins: animal protein contains excessive minerals and fats. This is therefore prohibited in CKD. These contain high potassium, sodium, and phosphorus which is a threat to kidneys and its already hampered functioning. 
• Milk and milk products: should be avoided in kidney damage due to excessive calcium, sodium, and potassium in it.

DASH diet in CKD patients.

A dietary approach to stop hypertension is a dietary guide that is made to control the blood pressure and maintain good cardiovascular fitness. Hypertension is one of the major reasons to develop kidney disorders. Excess blood volume causes kidney overload and thus causes impaired functioning of kidneys. So, to stop hypertension the main reason for CKD, one has to understand the concept of the DASH diet.

DASH diet comprises of low fat, high fiber, low potassium, and sodium containing diet. Foods that are included in this type of diet are as follows.

• Low fat diet: limiting the use of oil, reducing the use of groundnuts, milk products like cheese, butter, the cream should be controlled. Fish, chicken, beef, eggs should be stopped as it contains cholesterol that is bad for health.
• High fiber diet: use of unpolished dals, cereals, and pulses with precaution. Rice can be consumed. Brown loaves of bread, bajra, jowar in the patient who aren’t allergic to gluten. 
• Low mineral diet: minerals cause water retention and thus mineral rich diet is not a good option here.

High cholesterol and fats cause accumulation of cholesterol in arteries that lead to high blood pressure and heart problems which then cause kidney damage. So, controlling hypertension with diet is extremely important in cases with acute and chronic kidney disease. Water consumption should be monitored throughout the day for kidney disease patients. It is very important to maintain proper electrolyte levels.

Why to avoid non vegetarian diet in CKD patients?

Non vegetarian diet includes chicken, fish, mutton, beef, pork, crabs, lobsters, etc.

• These food materials have a lot of minerals in them which causes water retention in the body.
• They have high cholesterol levels and lipids levels.
• They increase the risk of kidney stone formation.
• Urea produced by the body is more in a non-vegetarian diet which causes overloading of kidneys for blood filtration.
• The energy required for digesting these food items is more which is not affordable by the stressed kidneys and the patient’s body in general.
• Eggs contain cholesterol and are also not recommended.

Water intake and management of CKD.

Water is the main factor that washes the waste out of the body. But it is also the component that increases the blood volume in the body. In the general population, drinking plenty of water is beneficial and recommendable, but in CKD patients with reduced kidney functions, the amount of water that should be flushed out is not eliminated causing renal hypertension.

• Drink a limited amount of water. The amount differs from patient to patient.
• Consult your nephrologist for the same.
• Usually, 1-1.5 liters of water is necessary.
• The use of less oil can help prevent thirst.

How to cook for a patient with chronic kidney disease?

Not only choosing the right food is important but also cooking it in the right way is important. Cooking food in certain ways and certain amount makes it better for patients. In CKD we shall focus on the duration and preparation before turning on the gas flame.

Pre preparation for cooking leafy vegetables:

• Soak the green leafy vegetables like spinach, palak, coriander, mint, lettuces, etc for a couple of hours. This ensures the removal of additional potassium and sodium content from it in the water. This step is very essential for the patient and cannot be omitted. 
• Wash the leaves 5-6 times before cooking them. Washing helps in getting rid of unwanted minerals for the patient’s health as these minerals are not very helpful as for a healthy individual.
• Use fresh vegetables for the patient.

Cooking strategies for leafy vegetables:

• Cook the leaves for a longer time than usual.
• Keep the flame low and cook slowly.
• Do not serve the watery part of the dish to the patient as it has the potassium and other substances.
• Keep the meal light and bland.
• Do not add excessive oil, spices, and chilly.
• Avoid adding sugar or any artificial color or sauces as far as possible.

General considerations for cooking a meal for CKD patients:

• Do not add excess salt. Use salt below the limit which is 1.5 to 2 grams every day.
• Do not add preservatives to the food.
• Do not make the meal heavy with spices, nuts, meat, etc.
• Avoid gluten as far as possible.
• Consider cooking the food for a longer duration of time.
• A bland diet is better recommended.
• The freshly prepared meal is better for the patient than the stored one.
• Dietitian’s advice should be considered for more details.

Calorie intake for a CKD patient throughout the day.

• Breakfast should contain a total of 35% of calories from throughout the day.
• After about a couple of hours, a mini meal can be containing 5% of the calories.
• Lunch should contain about 25% of the calories throughout the day.
• Evening snacks can take up the 20% of the calories.
• Dinner takes up about 10% of the calories throughout the day.
• Late dinner food can consist of the last 5% of the daily calories.

This is a general division of calories for the day. This will ensure proper nutrition and planning better treatment for the patient.

Calorie count should be reduced from that of the normal for CKD patients as per recommended by the doctor.

Medications should be consumed properly at their time along with the diet and water intake.

Dietary foods for the patient with CKD include the following.

• Rice and dal: use the white or brown rice which is better if it is unpolished. As polished rice and pulses have no fiber content in them. Cook the rice for a long time which makes it easier to digest. Dal can be cooked with the least oil and spices and salt too. This can be together consumed as a proper and regular meal.
• Rotis and chapatis or slices of bread: use of gluten should be avoided. and eating jawar and bajra should be reduced if there is a condition such as inflammatory bowel disorder, Whipple’s disease, or chron’s disease.
• Soups: these are favorite options for everyone. Soups with peas, cabbage can be prepared. But avoid usage of sauces and artificial taste makers.
• Puddings: making use of sooji or rava which is very commonly used in India. It can be made with a few vegetables.
• Puffed rice or murmura can be used to make various delicious recipes with less oil and more healthy vegetables.
• Rice flakes or poha are famous and loved in India. These are approved for CKD. It should be well soaked and vegetables should be well cooked before the patient consumes them.
• South Indian cuisines like fermented rice items including idli, dosa, phaddu can be made.
• Dalia can be a good ingredient to make use of for preparing a porridge or upma.
• Parathas can be made using cabbage, methi, or fenugreek which should be well washed and boiled earlier for washing away of the potassium and sodium.
• Making some boiled vegetables with added salt in limited proportion can be a good option than anything else.
• Ragi is a great food item to use for CKD patients. Make ragi porridge, roties, or dosas.
• Fruits can be consumed in the day time by the patients as instructed by the doctor. Take into consideration all the other underlying conditions like diabetes before consuming them.
• Buttermilk can sometimes be acceptable.
• Drinking juices made from a pomegranate can be a good option.
• Lemon and oranges can be consumed in the form of juice or lemonade by with caution.
• Don’t eat anything raw in vegetables and have boiled it first.

What not to consider in a dietary plan for chronic kidney disease?

This becomes a huge list of things.

• Dry fruits as mentioned earlier. So avoid dishes like ice creams, kheer, basundi, barfi, pedha, etc.
• cheese. So, avoid dishes like lasagne, pizza, burgers, pasta.
• Blackberries and blueberries. Avoid dishes like sauces, juices, black current ice creams, and pastries.
• Raw spinach and lettuce. Avoid raw salads.
• Fried foods. Avoid bhaji, vadas, samosa, kachori, and all the other deeply fried items.
• Tomatoes. So, avoid tomato sauce, soup, dressings, or toppings on any dish.
• Smoked foods. Avoid barbeques, kebabs kind of food pieces of stuff.
• Carbonated drinks. Avoid soda and cola drinks.
• Avoid beverages containing alcohol, caffeine, animal fats.
• Stop consuming tobacco and such harmful substances.
• Potatoes, olives. Avoid tikkis, burgers, pizzas, olive sauces, and slices in salads, pasta, and pizzas.
• Strawberries. Avoid fruit salads, ice creams, and milkshakes.
• Heavy food items like rabadi, jalebi, shrikhand, milk based items are not recommended for kidney disorders.

Advantages of maintaining a proper diet in CKD patients.

1. Blood pressure remains under control which is the main relief for your kidneys.
2. Diabetes is under control which assures quicker recovery from any kidney conditions.
3. Less stress on the kidney makes the kidney efficient and healthy.
4. Renal tubules get their own time to heal and rest.
5. The patient feels energetic and fresh.
6. No digestive system complications occur as all the food is prepared fresh at home.
7. Better quality of life.
8. Better response to the treatment in the form of medications or dialysis.
9. Reversible kidney damage cases heal quickly.
10. No secondary complications occur in most cases.

Exercise along with diet for better recovery in CKD patients.

Walking is the best exercise for kidney disease patients. It promotes muscle activity and better joint mobility. Walking for 20-40 minutes per day remarkably shows positive signs of renal complications. It should be better done post food for its proper digestion.

Yoga and meditation should be done two hours post food. It ensures better breathing and better digestion of food consumed. Sit in vajrasana after food as it promotes digestion.

Stretching exercises can be done in the morning time for ten to twenty minutes for five days a week.

In later stages start mild weight lifting and simple resisted exercises to improve the strength and body fitness for a better life in the future.

Avoid immediate sleeping, slough sitting, strenuous activities after the food. It will hamper the digestion.