Dietary Guidelines and Fish Restrictions for Chronic Kidney Disease

Q: Dietary Guidelines and Fish Restrictions for Chronic Kidney Disease

Ms. <br>Chen： Hello! Based on your grandmother's medical history, her "chronic kidney failure" is likely a complication caused by long-term "diabetes" and/or "hypertension." How long has she been suffering from "diabetes" and "hypertension"? How well are her blood sugar and blood

Chronic Kidney Failure

Hello Dr.
Chen: My grandmother is 74 years old and has diabetes and hypertension.
Last month, she was diagnosed with chronic kidney failure (currently not on dialysis).
1.
What dietary considerations should we be aware of? 2.
Are there any types of fish she should avoid? 3.
Is uric acid related to kidney disease or diabetes? Thank you for your response!

Ms. Chen, 20~29 year old female. Ask Date: 2007/08/21

Dr. Chen Junji reply Urology

Ms.
Chen: Hello! Based on your grandmother's medical history, her "chronic kidney failure" is likely a complication caused by long-term "diabetes" and/or "hypertension." How long has she been suffering from "diabetes" and "hypertension"? How well are her blood sugar and blood pressure being controlled? Although I am unaware of the current severity of her "chronic kidney failure" (clinically, chronic kidney disease can be classified into stages 1 to 5, from mild to severe; stage 5 requires consideration of dialysis or kidney transplantation), both "diabetes" and "hypertension" are systemic diseases.
If there is already kidney function impairment, other organs may also be affected; the most common being "retinopathy," which can lead to vision impairment.
Therefore, a comprehensive physical examination and health status assessment are necessary.
I recommend seeking a nephrologist nearby or including them in your grandmother's healthcare team.
Regarding your three questions, here are brief answers:
1.
Since your grandmother has "diabetes," "hypertension," and "chronic kidney failure," the primary focus should be on actively controlling her blood sugar and blood pressure.
In addition to medication, proper diet and exercise are also crucial.
The general dietary principle emphasizes "balance," encouraging the consumption of fresh, natural foods, while moderately limiting "protein" intake and avoiding excessive sweets, salt, and fats (commonly referred to as a "light diet").
This can help control blood sugar and blood pressure, reducing the burden on the kidneys.
However, as kidney function continues to decline, appetite typically worsens, and excessive dietary restrictions may lead to malnutrition, which is counterproductive.
Additionally, it is important to note that commercially available "healthy low-sodium salt" or "light soy sauce" (which contains potassium salt) is only suitable for healthy individuals with normal kidney function; excessive consumption can be dangerous for patients with chronic kidney disease.
Similarly, while consuming more vegetables and fruits (such as grass juice or raw soups) is beneficial for healthy individuals, it poses a risk of hyperkalemia for patients with severe kidney failure.
Starfruit is contraindicated as it has neurotoxic effects on patients with kidney failure.
There are countless types of food, and it cannot be summarized in a few words.
Fortunately, most medium to large hospitals have professional nutritionists available for consultation.
Additionally, I recommend the Taiwan Society of Nephrology's "Kidney Life" website (http://kidney.tsn.org.tw/index.php) for more educational resources.
2.
Fish (especially deep-sea fish) is an excellent source of protein and is recommended for healthy individuals with normal kidney function.
However, for patients with chronic kidney disease, excessive protein intake can increase the burden on the kidneys and elevate the production of uremic toxins; thus, it should be consumed in moderation (approximately 0.6 to 1.0 grams of protein per kilogram of body weight per day, adjusted according to the condition).
As for "which fish should be avoided?", there are no specific prohibitions.
However, I generally advise patients to limit the consumption of "shellfish" (such as crabs, shrimp, oysters, clams, etc.) as they contain higher levels of "cholesterol," purines (which metabolize to "uric acid" in the body), and "phosphorus," all of which are detrimental to patients with kidney disease.
3.
"Uric acid" is the final metabolic product of nucleic acids—"purines"—in the body.
If there is excessive production or poor renal excretion of uric acid, it leads to "hyperuricemia" (elevated uric acid levels in the blood), which can subsequently cause gouty arthritis (acute or chronic), kidney stones, and kidney damage.
Renal impairment can result in poor uric acid excretion, leading to "hyperuricemia." Diabetes is unrelated to uric acid metabolism; however, due to poor dietary habits, many individuals suffer from both conditions, which can be described as "civilization diseases" or "affluent diseases."

Reply Date: 2007/08/21

More Info

When managing chronic kidney disease (CKD), especially in older adults like your grandmother, dietary modifications are crucial to slow the progression of the disease and maintain overall health. Given her existing conditions of diabetes and hypertension, a tailored diet can help manage these issues while also addressing her kidney health.

Dietary Guidelines for Chronic Kidney Disease
1. Protein Intake: In CKD, particularly in the earlier stages, it's important to monitor protein intake. While protein is essential for health, excessive amounts can put additional strain on the kidneys. For someone with stage 3 CKD, a moderate protein intake is often recommended, typically around 0.6 to 0.8 grams of protein per kilogram of body weight. It's best to consult with a registered dietitian to determine the appropriate amount based on her specific health needs.

2. Sodium Reduction: High sodium intake can lead to increased blood pressure and fluid retention, both of which can exacerbate kidney issues. Aim for a low-sodium diet, ideally less than 2,300 mg per day. This can be achieved by avoiding processed foods, canned goods, and adding less salt during cooking.

3. Potassium and Phosphorus Management: Depending on her blood test results, it may be necessary to limit potassium and phosphorus. Foods high in potassium include bananas, oranges, potatoes, and tomatoes, while phosphorus is found in dairy products, nuts, and certain meats. Regular monitoring of her blood levels will help determine if these restrictions are necessary.

4. Fluid Intake: Depending on her kidney function and whether she experiences swelling or fluid retention, fluid intake may need to be monitored. It's essential to discuss this with her healthcare provider.

5. Carbohydrate Control: Since your grandmother has diabetes, managing carbohydrate intake is vital to maintain stable blood sugar levels. Focus on complex carbohydrates like whole grains, legumes, and vegetables while limiting simple sugars.

Fish Restrictions
When it comes to fish consumption, certain types may be better than others for someone with CKD. Generally, fish is a good source of protein and omega-3 fatty acids, which can be beneficial for heart health. However, some fish are higher in purines, which can increase uric acid levels and may not be suitable for individuals with kidney issues.

1. Fish to Limit or Avoid:
- High-Purine Fish: Anchovies, sardines, mackerel, and herring are high in purines and should be limited.

- Canned Fish: Some canned fish can be high in sodium, so it's essential to check labels.

2. Better Choices: Opt for fish that are lower in purines, such as salmon, tilapia, and cod. These can provide health benefits without the added risks associated with high-purine fish.

Understanding Uric Acid
Uric acid levels can be influenced by both kidney function and dietary choices. Elevated uric acid can lead to gout, a form of arthritis, and is often associated with kidney disease. In your grandmother's case, it’s essential to monitor her uric acid levels, especially if she has a history of gout or if her kidney function is compromised.
In summary, your grandmother should focus on a balanced diet that is low in sodium, controlled in protein, and mindful of potassium and phosphorus levels. Consulting with a healthcare provider or a registered dietitian will provide personalized guidance tailored to her specific health conditions. Regular monitoring of her kidney function and blood levels will also help in making necessary dietary adjustments.

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