Transcript Slide 1

Kidney Disease Awareness Programme
Facts And Myths
SOCIETY OF RENAL NUTRITION AND METABOLISM (SRNM)
www.srnm.in
Facts About Renal Disease
Renal disease is a complex disease.
• It does not occur in isolation, rather it is multifactorial.
• As the disease progresses, it affects other organ systems as well.
• Kidney disease can cause malnutrition.
• Appropriate nutritional intervention can prevent malnutrition.
What Is Chronic Kidney Disease (CKD) ?
• CKD means kidney damage for 3 or more than 3 months as defined by
structural or functional abnormalities of the kidney, with or without
decreased glomerular filtration rate (GFR).
• GFR measures level of kidney function.
• GFR describes the flow rate of filtered fluid through the kidney.
• A GFR below 60 for three months or more or a GFR above 60 with kidney
damage (marked by high levels of albumin in your urine) indicates chronic
kidney disease.
5 Stages of CKD Depending Upon GFR ml/ minute.
Stage
Description
GFR ml/minute
1
Kidney damage with normal kidney
function
90 or above
2
Kidney damage with mild loss of
kidney function
60-89
3a
Mild to moderate loss of kidney
function
59 to 44
3b
Moderate to severe loss of kidney
function
44 to 30
4
Severe loss of kidney function
29-15,
5
Kidney failure
<15
Ways To Know How Well Your Kidneys Are Functioning?
• You can calculate kidney function by using the following equation:
For Men
For Women
(140- Age years) x Body Weight (kg)
---------------------------------------------72 x serum creatinine
(140- Age years) x Body Weight (kg)
---------------------------------------------- x0.85
72 x serum creatinine
Serum creatinine can be known through blood test
Facts About Renal Disease
How will you know you have kidney disease?
Symptoms of Kidney disease
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Facial puffinees (swelling)
Pedal Edema (Swelling on legs and feet)
Loss of appetite
Weight loss
Swelling over body.
Reduced urine output, difficulty in passing urine.
Malignant hypertension (high blood pressure) in young individuals
Unexplained fatigue which develops due to low hemoglobin (anemia)
or ongoing silent infection.
Patients of kidney disease have low hemoglobin as sick kidney cannot
make enough hormone which is required for formation of blood.
Loss of hair, sensitivity to sun rays, bony pains, unexplained rashes on
face and nose, frothy urine (presence of protein in urine),
Simple Tests For Kidney Disease?
Kidney function is assessed through blood test and urine test
1. Blood test:
Serum creatinine
BUN
Sodium
Potassium
Calcium
Phosphorus
2. Routine urine test: presence of protein
What Causes Kidney Disease?
• There are several causes of kidney disease.
1. High Blood pressure can cause kidney disease.
High Blood Pressure
Patients who have High Blood Pressure should
• Restrict salt intake. High salt intake can cause hardening of blood vessels.
• Avoid fried food.
• Fats increase cholesterol and triglycerides which causes plaque (blockages
in blood vessels) formation. Plaques can hinder blood supply to organs .
• Eggs are good. But egg yolk is rich in cholesterol, therefore, it is not good
for patients with high blood pressure and kidney disease. Patient of kidney
disease can eat egg white (albumin) if doctor advises.
• Patient should take blood pressure medication on time. If you are
forgetful, set alarm on your mobile to remind you of your medication
time.
• Blood pressure medications can be taken empty stomach.
What Causes Kidney Disease? ….. Contd.
2. Diabetes can cause kidney disease.
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Keep your blood sugar under control.
Regular exercise like walking and cycling can help in controlling sugar.
Diet is an important way of controlling blood sugar.
Keep your meal time fixed.
Do not skip meals. Diabetic patients must have routine checkup of kidney
function (serum creatinine) and presence of proteinuria.
Patients with deranged renal function should avoid metformin (oral
hypoglycemic medication)
What Causes Kidney Disease?.... Contd.
4. Painkiller (like ibuprofen, NSAIDs, aspirin ) and Aminoglycoside
antibiotics can also cause kidney disease.
5. Excessive loss of fluid from body due to diarrhoea and vomiting can
bring blood pressure down and affect blood supply of kidneys and
kidneys can stop making urine.
6. Excessive blood loss after delivery can also lead to kidney failure.
Kidneys can stop making urine. Avoid delivering baby at home.
7. Venoms (wasp sting, snake poisons) can cause kidney failure.
C) What Should Patient Of Kidney Disease Eat?
Kidney Disease Patient should not eat food items which are high in
potassium, sodium and phosphorus.
Fruits:
a) All Fruits are not good for kidney patient. Fruits like anar (pomegranate),
malta, musammi (sweet lime), cheeku, tarbooz, kharbooja, , lemon,
mango should not be eaten by kidney patients. These have high potassium
content.
b) Patient with kidney disease can eat apple, banana, papaya, orange,
pineapple and pear if serum potassium is below 5.0 mg/dl.
c) Fruit juice, vegetable juice and vegetable soup, coconut water are
harmful for the kidney patient.
Vegetables
A) Avoid leafy vegetables like spinach (palak), mustard (sarson), chaulai,
cauliflower (gobhi), brinjal (baingan), Bitter gourd (karela), tomatoes,
carrots, raw salad,and dry fruits.
B) Patients can eat Parval, lauki, turai, green Peas, bhindi (ladies finger),
potato, tinda
Take Low Potassium Fruits
• High serum K+ Can cause arrhythmia
• Take low potassium fruits if serum
potassium is <5.0mg/dl
• Apple, banana, guava, pear, orange, papaya
Is it possible to remove potassium from vegetables?
Yes it is possible to remove (leach) potassium from vegetables by doing
the following:
1. Soak chopped vegetables in Luke warm water for half an hour
or
2. Boil chopped vegetables in water. Discard water and then cook.
Leaching process can be used before cooking dal (pulses).
Reduce Potassium Content Of Vegetables
Leach/remove potassium from vegetables
by soaking chopped vegetables in luke
warm water for half an hour.
Kidney Patients should refrain from eating
green leafy vegetables, tomatoes,
cauliflower sweet lime, lemon, carrots,
raw salad, mango, dry fruits, fruit juice,
vegetable soup, coconut water.
What Should Patient Of Kidney Disease Avoid?
• Avoid canned Foods/Fruits/Pickles/fruit jam
• Canned foods and pickles have salt as preservative. Fruit jam is high
in potassium.
• Restrict salt: 1 tsp of salt is equal to 5g of salt. 5 g of salt contains
2.5 g of sodium. Patient should not take more than 2.4 g of sodium
for better control of blood pressure and to prevent edema.
• Restrict Oil: Patient should not consume more than 15-20 g (3-4 tea
spoons) of refined/mustard oil in a day.
Sodium intake in CKD <2.4 g/d
(AHA/KDOQI Guidelines for control of Hypertension)
1 tsp=5g =2.5 g Na
Low Sodium Diet for Renal Patients for better control of blood pressure and to
prevent edema
Avoid Foods containing Sodium>100 mg/100g
Avoid canned foods/fruits/Pickles/fruit jam
Should Patient With Kidney Disease Eat Food
Containing Protein?
Yes. Patient of kidney disease should eat low amount of protein.
To calculate protein intake /day here is an example.
Protein intake = weight x 0.7g/kg/d
• A patient who has 50 kg of weight can take 35 grams (0.7g x body
weight in kg ) of protein in one day.
• He can take 1 bowl of dal (neither very thin nor very thick), 150 ml
of milk and 100 grams of curd.
• Rest of protein will be consumed in bread slice, chapatti and rice.
• If a patient is on maintenance dialysis, protein intake should be
increased to 1.2g/kg/day.
Do Not Eliminate Protein From Diet.
Kidney Patient should take
Low Protein 0.6g/kg/d
Example:
Weight of patient = 50 kg
50 x 0.6 = 30 g of protein
1. Milk 150 ml = 4.5 g/protein
2. Dal 1 bowl = 6 g protein
3. Chappati=2 g 8 chappaties = 12 g
4. Rice: 50 g raw = 3 g
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Total Protein Content = 25.5g
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Patient should not stop eating protein completely otherwise
body muscles will break down and the patient will become
malnourished.
Malnutrition is an important challenge in
kidney disease. It sets in silently causing
patient’s Physical condition to deteriorate
over time.
Patient will have
 Progressive weight loss
 Wasting of fat and skeletal muscle tissues
 Reduction of serum proteins.
Myths
1. Myths about low sodium salt
These are high in potassium.
Warning : High potassium is not meant for patients with kidney disease. This
can be bad for heart.
2. Myth Drink a lot of waterPatients with kidney disease should restrict water intake.
Water intake will depend on how much urine the patient is
making. Ask your doctor how much water you should drink.
Too much of water intake can cause edema (swelling) when kidneys are
diseased. The kidneys will not be able to remove water from the body.
Are All Patients Alike?
No every patient is different.
For example If a patient has kidney stone disease then he is advised to take
more fluids because patient with kidney disease should not have concentrated
urine as this will precipitate stone formation. Patient should make at least 2
liters of urine/day. For this fluid intake will have to be two or more than 2
liters/day.
 Do not follow what other patients advise you.
 Follow your own doctor's advise.
 As soon as one comes to know that he has kidney disease, he should see a
nephrologist (kidney specialist).
Your Cooperation Can
Help Fight
Malnutrition In Kidney
Patients
KIDNEY DISEASE MALNUTRITION
DIALYSIS
For More Information Contact www.srnm.in
Official Address of SRNM: Secretary SRNM, Department Of Nephrology, SGPGIMS, Lucknow
President SRNM, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi
Thank you for your attention !