Nutritional Guidelines for Stage 4 Chronic Kidney Disease in Seniors

Chronic Kidney Disease Stage 4

The patient is an 82-year-old woman, 153 cm tall, currently weighing 74 kg.
She has diabetes and hypertension, and recently developed edema.
She has been diagnosed with chronic kidney disease, with kidney function at only over 20% and elevated creatinine levels.

1.
Is a sodium intake of 5000 mg per day acceptable?
2.
Is a protein intake of 50 grams per day acceptable?
3.
Are there restrictions on potassium and phosphorus intake?
4.
What foods should be avoided?
5.
Are there published books available that introduce the nutritional components of various foods?

MARIAN, 50~59 year old female. Ask Date: 2009/09/11

Dr. Cai Xiuwen reply Nutrition

Hello! I believe you have done your homework, so you are aware of the dietary management guidelines.
Generally speaking, the dietary principles for chronic kidney disease are as follows:
1.
Sodium intake: Approximately 2-3 grams of salt, which is equivalent to about 1200 mg of sodium.
In comparison, the recommended intake for a healthy individual is about 6-8 grams of salt, or 2400 mg of sodium.
Sodium is not only found in table salt but also in seasonings such as soy sauce, satay sauce, ketchup, and pickled foods.
Even natural ingredients contain sodium.
A balanced diet typically contains around 300 mg of sodium per day.
If there is edema, stricter sodium restrictions are recommended.
2.
Protein intake: Based on the grandmother's height, her ideal weight is approximately 50 kg.
It is unclear what her usual weight is without edema, but based on the ideal weight, it is suggested that her protein intake should be around 43-50 grams.
This would translate to about 2-3 servings of protein sources such as eggs, beans, fish, and meat per day.
It is also important to note that staple foods contain protein, so low-nitrogen starches like mung bean noodles or rice vermicelli should be used as substitutes.
3.
Potassium and phosphorus levels should be adjusted according to blood test results.
Generally, individuals with impaired kidney function are more prone to metabolic abnormalities related to potassium and phosphorus.
If the levels are high, restrictions are necessary, but not everyone needs to limit these nutrients, as excessive restriction can lead to malnutrition.
4.
Foods to limit generally include processed and pickled items.
Additionally, it is important to avoid starfruit, which contains neurotoxins, as it can be harmful to patients with poor kidney function.
5.
The Department of Health has published a food nutrition composition database that can be used to look up the nutritional content of foods.
You can also visit the Department of Health's food information website for more details.
This information is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital of the Department of Health.
Wishing you good health!

Reply Date: 2009/09/11

More Info

When managing Stage 4 Chronic Kidney Disease (CKD) in elderly patients, particularly in your grandmother's case, it is crucial to adhere to specific dietary guidelines to help mitigate the progression of the disease and manage associated conditions like diabetes and hypertension. Given her age, weight, and current health status, here are some important dietary considerations and recommendations:
1. Sodium Intake: The recommended sodium intake for individuals with CKD is significantly lower than that for the general population. While the general guideline for healthy adults is about 2,300 mg of sodium per day, for CKD patients, especially those experiencing edema (swelling), the intake should ideally be limited to around 1,200 mg to 2,000 mg per day. Therefore, a daily intake of 5,000 mg is too high and could exacerbate her water retention and hypertension. It is essential to avoid processed foods, canned goods, and high-sodium condiments like soy sauce and ketchup, as these can contribute to excessive sodium intake.

2. Protein Intake: For patients with Stage 4 CKD, protein intake should be carefully monitored. The general recommendation is to limit protein to about 0.6 to 0.8 grams per kilogram of ideal body weight. In your grandmother's case, if her ideal body weight is around 50 kg, her protein intake should be approximately 30 to 40 grams per day. This can help reduce the burden on her kidneys while still providing enough protein to maintain muscle mass and overall health. It is advisable to focus on high-quality protein sources, such as lean meats, fish, eggs, and dairy, while minimizing red meat and processed protein sources.

3. Potassium and Phosphorus: Both potassium and phosphorus levels can become elevated in CKD due to impaired kidney function. Therefore, it is essential to monitor blood levels of these electrolytes regularly. If potassium or phosphorus levels are high, dietary restrictions will be necessary. Foods high in potassium include bananas, oranges, potatoes, and tomatoes, while phosphorus is found in dairy products, nuts, and certain meats. It is crucial to work with a healthcare provider to determine the appropriate limits based on her blood test results.

4. Foods to Avoid: In addition to high-sodium, high-potassium, and high-phosphorus foods, your grandmother should avoid processed foods, pickled items, and certain fruits and vegetables that are high in potassium. Additionally, star fruit should be completely avoided, as it contains toxins that can be harmful to individuals with kidney disease. It is also advisable to limit foods high in saturated fats and sugars, especially given her diabetes and hypertension.

5. Nutritional Resources: There are numerous resources available for understanding the nutritional content of various foods. The USDA National Nutrient Database is a reliable source for detailed nutritional information. Additionally, many health organizations and kidney foundations publish guides and books that outline dietary recommendations for CKD patients. Consulting with a registered dietitian who specializes in renal nutrition can also provide personalized guidance tailored to your grandmother's specific needs.

In conclusion, managing Stage 4 CKD requires a comprehensive approach that includes dietary modifications, regular monitoring of blood parameters, and collaboration with healthcare professionals. By adhering to these guidelines, your grandmother can better manage her condition and improve her quality of life. It is essential to have open communication with her healthcare team to ensure that her dietary plan is effective and safe.

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