Dietary Guidelines for Pre-Dialysis Kidney Patients: What to Know

I would like to ask about dietary issues for dialysis patients?

I'm sorry to hear about your mother's condition.
Here are some dietary adjustments that can help:
1.
Yes, you can use reduced-sodium salt when cooking.
It's important to limit sodium intake to help manage blood pressure and reduce the workload on the kidneys.
2.
Foods that are generally safe for her to eat include:
- Fresh fruits and vegetables (avoid those high in potassium if advised by her doctor)
- Lean proteins such as chicken, turkey, and fish
- Whole grains like brown rice and whole wheat bread
- Low-fat dairy products (if her potassium levels are normal)
- Healthy fats such as olive oil and avocados in moderation
It's crucial to consult with a healthcare professional or a registered dietitian for personalized dietary recommendations based on her specific health needs.

Xiao Bu, 20~29 year old female. Ask Date: 2012/03/26

Dr. Wu Jiyu reply Internal Medicine

1.
The most appropriate course of action is to visit a nephrology outpatient clinic (if you regularly see a nephrologist, consult with your usual physician or dietitian) to discuss in detail with the physician or dietitian (including the arrangement of subsequent treatment plans, such as the choice and preparation for dialysis methods, which I believe is as important as dietary control).

2.
The function of the kidneys is to excrete toxins produced from protein metabolism (uremia), as well as excess water, electrolytes (potassium, phosphate), and acids.
Therefore, dietary control (what to eat and how much) primarily focuses on managing protein, fluid, and foods high in potassium or phosphorus.
3.
Commercial low-sodium salt substitutes, low-sodium soy sauce, and similar products achieve flavoring by replacing sodium with potassium.
Generally, individuals with severely impaired kidney function (your mother's kidney index is as high as 10.7, which I assume refers to a serum creatinine level of 10.7 mg/dL; if kidney function has been at this level for a long time, it can be considered uremic) have significantly reduced potassium excretion, which can lead to hyperkalemia, necessitating dietary potassium restriction.
Therefore, these products are not suitable for your mother.
4.
In simple terms, it is essential to reduce the intake of foods high in potassium, and similarly, to limit foods high in phosphorus, as well as restrict fluid and protein intake.
You can search online for foods that are high in potassium and phosphorus, and bookstores sell guides like "Dietary Guidelines for Kidney Disease," which contain this information for reference.
Another key point is that the aforementioned situation applies to most individuals with severely impaired kidney function, but each person's condition may vary.
A safer approach is to regularly attend nephrology outpatient follow-ups, allowing the physician and dietitian to assess how to adjust the diet.

Reply Date: 2012/03/26

More Info

When it comes to dietary guidelines for pre-dialysis kidney patients, it is essential to understand that the diet can significantly impact kidney function and overall health. Your mother's situation, with a kidney function indicator of 10.7, suggests that she is in a critical stage of chronic kidney disease (CKD). While she has not yet started dialysis, making appropriate dietary adjustments can help slow the progression of her kidney disease and improve her quality of life.

General Dietary Recommendations
1. Protein Intake: For patients with reduced kidney function, it is crucial to manage protein intake. Generally, a lower protein diet is recommended to reduce the workload on the kidneys. The typical recommendation is about 0.6 to 0.8 grams of protein per kilogram of body weight. However, this should be personalized based on her overall health, nutritional needs, and any other medical conditions she may have.

2. Sodium Reduction: Reducing sodium intake is vital for managing blood pressure and preventing fluid retention, which can exacerbate kidney problems. Using reduced-sodium salt can be beneficial, but it is essential to monitor the total sodium intake from all sources, including processed foods, which can be high in sodium.

3. Potassium and Phosphorus Management: As kidney function declines, the ability to excrete potassium and phosphorus diminishes. Foods high in potassium (like bananas, oranges, potatoes, and tomatoes) and phosphorus (like dairy products, nuts, and whole grains) should be limited. Your mother may need to work with a dietitian to determine her specific limits for these minerals.

4. Fluid Intake: Depending on her level of kidney function and any signs of fluid retention, fluid intake may need to be monitored. It is essential to keep track of how much she drinks and to be aware of any swelling or weight gain that could indicate fluid overload.

5. Balanced Diet: While managing protein, sodium, potassium, and phosphorus is crucial, it is also important to ensure that her diet is balanced and includes a variety of fruits and vegetables that are low in potassium, healthy fats, and carbohydrates. Foods like apples, berries, and green beans can be good choices.

Specific Foods to Include
- Low-Protein Options: White rice, pasta, and certain grains can be included in moderation.

- Fruits and Vegetables: Apples, berries, grapes, and green beans are generally lower in potassium and can be included in her diet.

- Healthy Fats: Olive oil and canola oil can be used for cooking and salad dressings.

- Low-Sodium Products: Look for low-sodium versions of canned vegetables, soups, and broths.

Foods to Avoid
- High-Potassium Foods: Bananas, oranges, potatoes, spinach, and avocados should be limited.

- High-Phosphorus Foods: Dairy products, nuts, and processed foods with added phosphorus should be avoided.

- Processed Foods: Many processed foods contain high levels of sodium and preservatives that can be harmful.

Consultation with a Dietitian
Given the complexity of dietary management for kidney disease, it is highly recommended that you consult with a registered dietitian who specializes in renal nutrition. They can provide personalized dietary plans based on your mother's specific health status, preferences, and nutritional needs.

Conclusion
In summary, managing your mother's diet as she navigates pre-dialysis kidney disease involves careful consideration of protein, sodium, potassium, and phosphorus intake. Using reduced-sodium salt can be a part of her diet, but it is essential to monitor her overall sodium intake. A balanced diet that includes low-potassium fruits and vegetables, healthy fats, and controlled protein intake will be beneficial. Consulting with a dietitian will provide the best guidance tailored to her needs. This proactive approach can help manage her condition and improve her quality of life as she prepares for potential future treatments.

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