Queensland Health Dietitians Guide to Nutrition for Chronic Kidney Disease

This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011.This is a consensus document from Queensland Health Dietitians/Nutritionists. Developed: Jan 2009 Review: Jan 2011.
Disclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEWDisclaimer: http:/www.health.qld.gov.au/masters/copyright.asp UNDER REVIEW
Eating Well with ChronicEating Well with Chronic
Kidney DiseaseKidney Disease
Pre-dialysis EducationPre-dialysis Education
Queensland Health NEMO Renal GroupQueensland Health NEMO Renal Group

Why Nutrition?Why Nutrition?
 To keep healthy and well nourished.To keep healthy and well nourished.
 To prevent build-up of unwantedTo prevent build-up of unwanted
nutrients and waste products.nutrients and waste products.
 To help help slow the progression ofTo help help slow the progression of
kidney disease.kidney disease.

Keeping Healthy isKeeping Healthy is
important!important!
You need to be in tip top shape!You need to be in tip top shape!
 Why?Why?
 Well nourished people do better.Well nourished people do better.
– Less chance of problems with dialysis.Less chance of problems with dialysis.
– Improved ability to fight infection.Improved ability to fight infection.
- Less time in hospital.Less time in hospital.
- You feel better.You feel better.

How’s your nutrition?How’s your nutrition?
 Ask yourself a few simple questions.Ask yourself a few simple questions.
– How is your appetite?How is your appetite?
– Have you gone off protein foods?Have you gone off protein foods?
– Have you lost weight without trying?Have you lost weight without trying?
– Are you in your healthy weight range?Are you in your healthy weight range?

Your Healthy Weight RangeYour Healthy Weight Range
BMI(body mass index) = weight(kg)/Ht x Ht(m)

If you are underweight…If you are underweight…
 Eat small meals regularly.Eat small meals regularly.
 Make every mouthful count…Make every mouthful count…
– Choose nutritious foods that areChoose nutritious foods that are
energy dense.energy dense.
– Make sure your drinks are nutritious.Make sure your drinks are nutritious.
 See a Dietitian.See a Dietitian.

If you are overweight…If you are overweight…
 Your kidneys work harder if you areYour kidneys work harder if you are
overweight.overweight.
 Losing weight can help your kidneysLosing weight can help your kidneys
work as well as they can for as long aswork as well as they can for as long as
they can.they can.
 See a Dietitian.See a Dietitian.

The kidneys are yourThe kidneys are your
body’s waste disposal unitbody’s waste disposal unit
 Healthy kidneys remove wasteHealthy kidneys remove waste
products from the bloodstream.products from the bloodstream.
 In Chronic Kidney Disease…In Chronic Kidney Disease…
– Waste products can build up in your blood.Waste products can build up in your blood.
– Some of these waste products come from theSome of these waste products come from the
food we eat.food we eat.
– You may need to limit some foods.You may need to limit some foods.

How to tell if you need toHow to tell if you need to
limit some foodslimit some foods
 Regular blood tests will show ifRegular blood tests will show if
any waste products areany waste products are
building up in your blood.building up in your blood.
 The Kidney Team will let youThe Kidney Team will let you
know if you need to limit anyknow if you need to limit any
particular foods.particular foods.

When will you see aWhen will you see a
Dietitian?Dietitian?
 You will see a Dietitian through theYou will see a Dietitian through the
Chronic Kidney Clinics.Chronic Kidney Clinics.
 If you start dialysis, you will see aIf you start dialysis, you will see a
Dietitian as your diet will change.Dietitian as your diet will change.

What to expect from theWhat to expect from the
DietitianDietitian
 The Dietitian will look at your…The Dietitian will look at your…
– Medical History,Medical History,
– Weight History,Weight History,
– Blood Levels,Blood Levels,
– Recent Dietary Intake with a DietRecent Dietary Intake with a Diet
History.History.

Taking a Diet HistoryTaking a Diet History
 Your Dietitian will ask you lots ofYour Dietitian will ask you lots of
questions about what you normally eat.questions about what you normally eat.
 No right or wrong answers!No right or wrong answers!
 Used to see if you are getting too much orUsed to see if you are getting too much or
too little of any particular nutrient.too little of any particular nutrient.

Which nutrientsWhich nutrients
 Protein,Protein,
 Sodium (Salt),Sodium (Salt),
 Fluid,Fluid,
 Potassium,Potassium,
 Phosphate.Phosphate.

ProteinProtein
 Protein is found in red and white meats, fish,Protein is found in red and white meats, fish,
eggs, dairy products and legumes.eggs, dairy products and legumes.
 It’s important to have the right amount ofIt’s important to have the right amount of
protein you need for growth, healing andprotein you need for growth, healing and
fighting infection.fighting infection. too much protein can leadtoo much protein can lead
to a build up of a wasteto a build up of a waste
product called Urea.product called Urea.
Too littleToo little
protein couldprotein could
lead to underlead to under
nutrition.nutrition.

Sodium or SaltSodium or Salt
 Most people eat too much salt.Most people eat too much salt.
 You don’t need to add salt to get too much salt.You don’t need to add salt to get too much salt.
– 75% of salt comes from processed foods.75% of salt comes from processed foods.
– Corned, smoked, pickled and takeaway foods.Corned, smoked, pickled and takeaway foods.
Tinned and packet soups, sauces.Tinned and packet soups, sauces.
 Too much saltToo much salt causes fluid retention andcauses fluid retention and
increases blood pressure.increases blood pressure.

Hints to cut down on SaltHints to cut down on Salt
 Salt is an acquired taste.Salt is an acquired taste.
 Limit processed foods,Limit processed foods,
 Limit takeaway foods,Limit takeaway foods,
 Avoid adding salt in cooking and at theAvoid adding salt in cooking and at the
table,table,
 Do not use Salt Substitutes.Do not use Salt Substitutes.

FluidFluid
 Excess fluid can cause:Excess fluid can cause:
– High blood pressure,High blood pressure,
– Swelling in the ankles, hands and face,Swelling in the ankles, hands and face,
– Shortness of breath.Shortness of breath.
 Check with your Renal Team regularlyCheck with your Renal Team regularly
about how much fluid you should drink.about how much fluid you should drink.
 Fluid is not just water.Fluid is not just water.
– Count anything that is liquid at roomCount anything that is liquid at room
temperature.temperature.

PotassiumPotassium
 Potassium is a mineral needed by the body toPotassium is a mineral needed by the body to
make your muscles and cells work.make your muscles and cells work.
 High or Low blood levels can be dangerous forHigh or Low blood levels can be dangerous for
your heart.your heart.
 Not everyone needs a low potassium diet.Not everyone needs a low potassium diet.
– You will only need to start a low potassiumYou will only need to start a low potassium
diet if your blood levels are highdiet if your blood levels are high..

What does a low potassiumWhat does a low potassium
diet look like….?diet look like….?
 Potassium is found in a variety of foods.Potassium is found in a variety of foods.
– not just bananas!not just bananas!
 If you need a low potassium diet, yourIf you need a low potassium diet, your
dietitian will check…dietitian will check…
1.1. The amount and type of fruit you eat,The amount and type of fruit you eat,
2.2. If you are having too many dairy foods,If you are having too many dairy foods,
3.3. Your intake of high potassium foods.Your intake of high potassium foods.
e.g. dried fruit, nuts, seeds, juices, fruit cake, salte.g. dried fruit, nuts, seeds, juices, fruit cake, salt
substitutes, caramels, chocolate, liquorice, potato chips,substitutes, caramels, chocolate, liquorice, potato chips,
tomato sauces, coffee.tomato sauces, coffee.

PhosphatePhosphate
 Phosphate is a mineral that is important forPhosphate is a mineral that is important for
strong bones and teeth.strong bones and teeth.
 High levels can weaken your bones andHigh levels can weaken your bones and
damage your blood vessels.damage your blood vessels.

Treating a high PhosphateTreating a high Phosphate
 Phosphate bindersPhosphate binders
– Tablets that you take with meals.Tablets that you take with meals.
– Act like a sponge to suck the phosphate out of yourAct like a sponge to suck the phosphate out of your
food before you absorb it.food before you absorb it.
– Cal-sup, Caltrate, Titrilac, Renagel, Alutab.Cal-sup, Caltrate, Titrilac, Renagel, Alutab.
 Low Phosphate DietLow Phosphate Diet
– Not everyone needs a low phosphate diet.Not everyone needs a low phosphate diet.
– You will only need to start a low phosphate diet ifYou will only need to start a low phosphate diet if
your blood levels are high.your blood levels are high.

What does a lowWhat does a low
Phosphate Diet look like…?Phosphate Diet look like…?
 Phosphate is found in a variety of foods.Phosphate is found in a variety of foods.
 If you need a low Phosphate Diet, the dietitian willIf you need a low Phosphate Diet, the dietitian will
check …check …
1.1. If you are getting the right amount of protein and dairyIf you are getting the right amount of protein and dairy
foods.foods.
2.2. If you are getting too many high phosphate foods,If you are getting too many high phosphate foods,
particularly between meals.particularly between meals.
e.g. chocolate, cola drinks, nuts and seeds, some typese.g. chocolate, cola drinks, nuts and seeds, some types
of fish.of fish.

Everyone is different…Everyone is different…
 Your kidney team will tell you if youYour kidney team will tell you if you
need to start a special diet.need to start a special diet.
 There is no need to avoid potassiumThere is no need to avoid potassium
or phosphate foods unless your bloodor phosphate foods unless your blood
levels are high.levels are high.

Everyone is different…Everyone is different…
 There is no one special diet for peopleThere is no one special diet for people
with renal disease.with renal disease.
 It all depends on…It all depends on…
– Your level of renal function.Your level of renal function.
– What your blood tests show.What your blood tests show.
– What kind of dialysis you choose.What kind of dialysis you choose.

Any Questions?Any Questions?

Queensland Health Dietitians Guide to Nutrition for Chronic Kidney Disease

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