General Guidelines for patients with CKD

When the kidneys are not working as well as they should there are certain foods which may need to be restricted to make you feel better, while your intake of other nutrients may need to be increased.

Protein

Protein is needed to repair old tissue, build new muscle, and for growth. It is an important part of any diet. More protein than is necessary for good health may be damaging to the kidneys.

Protein is found in most foods but the most complete type is from the animal products such as eggs, milk, fish, poultry, red meats, and cheese. These types of protein leave less waste products in the blood stream than do vegetable proteins. Vegetable proteins are found in foods like grains, starches such as potatoes, rice, and beans. Your dietitian will help to plan a meal pattern with the right balance of these proteins.

Sodium

Sodium is a mineral that helps to control the blood pressure. Sodium is found naturally in foods and is also in table salt and many “store bought” items often used. Some of these high sodium items are seasoning salts, soy sauce, boullion cubes, canned soups, dry soup mixes, olives, pickles, sauerkraut, and canned or potted meats. Fresh or frozen vegetables contain less salt than do regular canned vegetables.

Excess sodium can lead to problems with fluid retention and swelling. The dietitian will instruct you on the amount of sodium allowed in the diet.

Potassium

Potassium is another mineral found naturally in foods. If your kidneys are damaged, they may not be able to remove the potassium as easily as before. Major sources of potassium are meats, milk, chocolate, fruits, vegetable, nuts, and salt substitutes. Canned fruits generally contain less potassium than fresh fruits. A pattern to achieve the correct amount of potassium will be established.

Calories

Calories are important to the diet. They provide the energy needed to the body. Calories can be increased by using extra margarine, butter, oils and shortening. If diabetes is not a problem sweets like ice cream and candy are a source of extra calories. The diabetic will remain on the same restrictions followed on the diabetic diet.

Always read the labels when shopping to avoid large amounts of ingredients that are restricted on your diet. When in doubt, ask the doctor or dietitian they will answer any question. When dialysis is started other special diets will be recommended to meet the needs of dialysis.

Guidelines for Purine Restricted Diet

This diet is designed to be used as an adjunct to drug therapy for the treatment of gout or elevated levels of uric acid. It is aimed at lowering serum uric acid levels by restricting dietary purines, a precursor of uric acid.

Characteristics

Drug therapy has replaced the need for a rigid purine restricted diet. However, since purine metabolism is disturbed, the elimination of foods containing more than 150 mg purine/100 grams food is recommended to avoid metabolic stress. Protein intake is limited to aid in the reduction of uric acid biosynthesis. Most of the protein in this diet comes from cheese, eggs, milk and vegetables which contain small amounts of preformed purine.

Other dietary modifications include limitation of calories and alcohol. If patient is obese, weight reduction and maintenance of body weight 10-15 percent below ideal body weight is advised. Alcohol intake should not exceed 100 grams per day, mostly taken with meals.

General Information

Acute Stage: In severe stages of gout, the purine content of the diet is restricted to 100-150 mg purine per day. Fat is limited to 40 percent of total calories and carbohydrate intake should exceed 100 grams per day. Moderate protein intake is indicated. Fluids are encouraged, up to 3 liters per day, to assist with the excretion of uric acid.

Interval Stage: Dietary treatment for patients maintained on medication for gout between attacks is a normal nutritionally adequate diet for ideal body weight maintenance. The diet is moderate in protein content (not to exceed 1.0 grams/kg of body weight/day), increased carbohydrate content and low in fat. Foods with avery high purine content are excluded (see Group I). Further dietary restriction does not seem to be justified in the majority of patients. Fluids are encouraged with a minimum of 2 liters per day.

Foods in Group I are eliminated for patients who have acute recurrence. In Group II, one serving of (2-3 ounces) of meat, fish or fowl, or one serving (1/2 cup) vegetable is allowed each day or 5 days a week, depending on condition, during remissions.