Is It Safe for Stage 4 CKD Patients to Eat Plain Rice Balls?

Is it suitable for a patient with stage 4 chronic kidney disease to eat glutinous rice balls (without filling)?

Hello, Nutritionist: My mother is currently in stage 4 chronic kidney disease.
In addition to her regular three meals a day, she also consumes 2 packets of nutritional supplement drinks daily to increase her caloric intake.
Occasionally, she prepares some tapioca balls, rice cakes, or glutinous rice balls as snacks to supplement her calories.
I have a couple of questions: 1.
We make the glutinous rice balls without any filling, using glutinous rice.
Is this suitable as a snack? 2.
For her regular meals, she consumes about half a bowl of white rice, blanched green vegetables (approximately half a bowl), and a portion of fish or chicken, or pork (about the width of two fingers).
With the additional 2 packets of nutritional supplement drinks, is this sufficient to meet her daily caloric needs? Thank you, Nutritionist.

Liao Mingquan, 30~39 year old female. Ask Date: 2017/10/07

Dr. Cai Xiuwen reply Nutrition

Hello! The ingredients for plain tangyuan (glutinous rice balls) are glutinous rice flour.
Generally, for patients with stage 4 chronic kidney disease, it is recommended to reduce the intake of flour-based foods (such as noodles and bread) and to increase the consumption of low-nitrogen starches (such as mung bean noodles, rice noodles, and tapioca).
This is to minimize the intake of low biological value protein sources.
Tangyuan, made from glutinous rice flour, contains starch with low biological value protein, so it is advised not to consume it frequently.
However, during festivals, occasional consumption of 1-2 small servings should not be overly restricted.
Long-term consumption, however, is not recommended.
Your daily caloric needs should be considered based on your height, weight, and physical activity level.
A typical serving of easy-to-digest food provides about 200 calories and contains 0.8 grams of protein.
The purpose of limiting protein is to reduce the metabolic burden on the kidneys, but this should not lead to insufficient caloric intake.
If caloric intake is inadequate, resulting in weight loss and protein breakdown, it may actually increase the burden on the kidneys.
Therefore, when limiting protein, it is essential to increase the proportion of fats to compensate for the caloric deficit, such as by increasing the intake of plant oils.
You can supplement your diet with stir-fried mung bean noodles or rice noodles, and for vegetables, it is recommended to sauté them with plant oils at low temperatures to enhance fat intake.
Based on your current caloric intake of about 1200 calories per day, it is suggested that you should prepare your main meals with vegetables and meats cooked in fats, and include fruits as snacks.
The recommended caloric intake is approximately 30 calories per kilogram of body weight (excluding any water retention).
Currently, the protein recommendation is about 0.7 grams per kilogram of body weight, and this should be monitored in conjunction with your physician, keeping track of blood phosphorus and potassium levels.
This information is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Ministry of Health and Welfare.
Wishing you peace and health!

Reply Date: 2017/10/07

More Info

When managing a diet for a patient with Stage 4 Chronic Kidney Disease (CKD), careful consideration of food choices is crucial. Your mother's situation, where she is consuming plain rice balls (or "湯圓" made from glutinous rice) and other starchy foods, raises important questions regarding their suitability in her diet.

1. Consumption of Plain Rice Balls (湯圓):
For patients with Stage 4 CKD, it is generally recommended to limit the intake of high-starch foods, particularly those made from refined grains or glutinous rice. While plain rice balls may not contain added sugars or fats, they are still primarily composed of carbohydrates. In CKD, especially at advanced stages, the focus should be on reducing protein intake while ensuring adequate caloric intake. Glutinous rice, while a source of carbohydrates, has a low biological value for protein, which means it does not provide sufficient essential amino acids. Therefore, while an occasional small serving of plain rice balls may not be harmful, they should not be a staple in the diet. It is advisable to prioritize low-nitrogen starches, such as rice noodles or rice, which can be easier on the kidneys.

2. Daily Caloric and Nutritional Needs:
The dietary intake you've described includes approximately half a bowl of white rice, a bowl of blanched vegetables, and a portion of protein (fish, chicken, or pork), along with two packets of nutritional supplement drinks (like "益能充"). The caloric content of these meals should be evaluated based on her specific energy needs, which can vary depending on her weight, height, activity level, and overall health status.
A rough estimate for caloric needs in CKD patients is around 30 calories per kilogram of body weight, assuming there is no fluid retention. If your mother weighs, for example, 60 kg, her daily caloric requirement would be approximately 1800 calories. The two packets of nutritional drink typically provide around 400 calories (200 calories each), which means the rest of her meals must provide the remaining calories.
The protein intake should be limited to about 0.7 grams per kilogram of body weight per day. For a 60 kg individual, this would equate to around 42 grams of protein daily. It's essential to monitor her protein intake closely, as excessive protein can lead to increased waste products in the blood, further stressing the kidneys.

3. Monitoring and Adjustments:
Regular follow-ups with a nephrologist and a dietitian are essential for managing CKD. They can help adjust her diet based on her blood work, including levels of potassium, phosphorus, and creatinine. If her blood tests indicate elevated levels of these minerals, dietary adjustments may be necessary.

4. Alternative Snack Options:
If your mother feels hungry between meals, consider healthier snack options that are lower in potassium and phosphorus. Fresh fruits (like apples or berries), unsalted rice cakes, or low-protein snacks can be good alternatives. Always consult with a healthcare provider before making significant changes to her diet.

In conclusion, while plain rice balls can be consumed occasionally, they should not be a primary food source for someone with Stage 4 CKD. It's essential to focus on a balanced diet that meets caloric needs without overloading on protein or harmful minerals. Regular consultations with healthcare professionals will ensure that her dietary plan is safe and effective for her condition.

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