Dietary Concerns for Chronic Kidney Disease: Managing Anemia and Phosphorus Levels

What are some dietary issues related to chronic kidney disease?

Hello Doctor: My mother previously suffered from a myocardial infarction that affected her kidney function.
Last month, her blood test showed a creatinine level of 2.23, and the doctor said this indicates stage 4 chronic kidney disease.
At that time, the doctor also mentioned that her hemoglobin level was low and that her phosphorus level was elevated.
I have a few questions:
1.
Is low hemoglobin what people commonly refer to as anemia, which requires iron supplementation? If supplementation is necessary, should chronic kidney disease patients avoid certain herbal tonics for blood replenishment? What ingredients would be suitable for improving hemoglobin levels?
2.
Regarding the elevated phosphorus level, my mother has been adding ground calcium carbonate tablets to her meals.
However, a pharmacist friend of mine mentioned that excessive calcium intake could lead to kidney stones.
Is it appropriate for her to continue adding calcium tablets to her meals?
3.
My mother’s kidney function was impaired due to a myocardial infarction.
An ultrasound showed that her kidney structure is relatively intact, with no signs of atrophy.
Is there a possibility that her creatinine level could be reduced to below 1.0 through a diet low in protein, phosphorus, sodium, and potassium?

Liao Mingquan, 30~39 year old female. Ask Date: 2017/07/21

Dr. Cai Xiuwen reply Nutrition

Hello! Anemia caused by kidney disease first requires confirmation that caloric intake is sufficient; otherwise, simply supplementing iron will only address the symptoms, not the root cause.
If caloric intake is adequate, animal-based iron sources such as beef and lamb can be included, but portion sizes should not be excessive, ideally around 1-2 ounces per meal.
Sprinkling calcium powder on meat is intended to reduce phosphorus intake, so phosphorus consumption must also be controlled.
A proper low-protein diet can help lower phosphorus levels.
There are many factors that can contribute to the formation of kidney stones, and it is not necessarily due to calcium supplementation.
It is advisable to follow the physician's instructions regarding medication.
Kidney failure caused by myocardial infarction is due to inadequate renal perfusion, and adjustments should be made in accordance with the guidance of a physician and nutritionist to navigate the acute phase.
Recovery will depend on individual constitution and other factors, so dietary adjustments should be prioritized.
This information is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Ministry of Health and Welfare.

Reply Date: 2017/07/21

More Info

Managing chronic kidney disease (CKD), especially in its later stages, requires careful attention to dietary habits and nutritional intake. Your mother's situation, with a creatinine level of 2.23 mg/dL and signs of anemia and elevated phosphorus, indicates that she is in a critical phase of CKD. Here are some insights and recommendations regarding her dietary concerns:

1. Understanding Low Hemoglobin Levels
Low hemoglobin levels, or anemia, in CKD patients often result from decreased erythropoietin production by the kidneys, which is crucial for red blood cell production. While it is commonly referred to as "needing to supplement blood," the approach to managing anemia in CKD is different.
For dietary management, it is essential to focus on iron-rich foods, as iron deficiency can exacerbate anemia. However, CKD patients should be cautious with certain supplements and herbal remedies, including traditional Chinese medicine, as they may contain high levels of potassium or phosphorus, which could worsen her condition. Recommended dietary sources of iron include:
- Lean meats (if her diet allows)
- Dark leafy greens (like spinach and kale)
- Legumes (beans and lentils)
- Fortified cereals

2. Managing Elevated Phosphorus Levels
Elevated phosphorus levels can lead to bone disease and cardiovascular issues in CKD patients. The use of calcium carbonate (like the one you mentioned) can help bind phosphorus in the gut, reducing its absorption. However, excessive calcium intake can lead to complications such as kidney stones or vascular calcification.

It is crucial to monitor the total calcium intake from both dietary sources and supplements. If your mother is using calcium carbonate, it should be done under the guidance of her healthcare provider, who can adjust the dosage based on her phosphorus levels and overall calcium intake.
In addition to calcium supplements, dietary modifications to limit phosphorus intake are essential. Foods high in phosphorus include:
- Dairy products
- Nuts and seeds
- Processed foods
- Dark sodas
Instead, focus on low-phosphorus foods such as:
- Fresh fruits and vegetables
- Rice and pasta
- Corn and corn products

3. Potential for Improvement in Kidney Function
While it is challenging to reverse kidney damage, especially in stage 4 CKD, dietary management can help slow the progression of the disease and improve overall health. A diet low in protein, phosphorus, sodium, and potassium can help reduce the workload on the kidneys.
The goal of a low-protein diet is to minimize the production of urea and other nitrogenous waste products that the kidneys must filter. However, it is essential to ensure that your mother still receives adequate calories and essential nutrients. Consulting with a renal dietitian can provide personalized meal planning that meets her specific needs.

Conclusion
In summary, managing your mother's CKD involves a multifaceted approach that includes dietary modifications to address anemia and phosphorus levels. It is essential to work closely with her healthcare team, including a nephrologist and a dietitian, to tailor her diet and monitor her condition. Regular blood tests will help assess her hemoglobin and phosphorus levels, guiding necessary adjustments in her diet and treatment plan.
Encourage her to maintain a balanced diet that supports her overall health while being mindful of her kidney function. With careful management, it is possible to improve her quality of life and potentially slow the progression of her kidney disease.

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