One in nine Australian adults over age 25 has some degree of kidney disease. If you’ve been diagnosed, you’ll need to take the following steps, says dietitian Cherie Hugo.
By the time you finish reading this article, your kidneys will have filtered about one litre of blood – a flash in the pan compared to the 53,000 litres they’ll filter in the next year. Quite a hefty job for two little organs – each about the size of a fist – to manage!
Unfortunately, one in three Australians is at risk of developing chronic kidney diease (CKD). According to the latest statistics, diseases of the kidney and urinary tract are the 10th leading cause of death in Australia, with one in nine of us already showing some degree of kidney damage, or reduced kidney function.
How do i know if my kidneys are healthy?
It’s often difficult to tell if your kidneys’ function is compromised, because there’s a lack of symptoms in the early stages – you can lose up to 90 per cent of kidney function before you realise anything is wrong. Damage to the kidneys cannot usually be reversed, but, if detected early enough, the progress of kidney disease can be slowed, or even halted.
One in nine of us has some degres of kidney disease – but most of us don't know it. Warning signs include:
Changes to urine, especially at night – including quantity passed, blood, pain or burning, or foaming urine
Back pain under the lower ribs (where the kidneys are located)
Puffy eyes or ankles due to fluid retention.
A general feeling of being unwell
Tiredness or poor concentration
Loss of appetite
Nausea and/or vomiting
Shortness of breath
If you have any of these symptoms, see your doctor.
How do I keep my kidneys healthy?
A healthy, balanced diet is essential for maintaining kidney health. For optimal kidney health, it’s important that you:
Moderate your sodium intake.
Moderate your protein intake.
Control your weight.
Keep hydrated. While there’s not much evidence to support the commonly recommended 2L fluid a day goal, it is essential that you drink to prevent thirst.
Manage your blood glucose levels (BGLs) closely, if you have diabetes, as poor BGLs can damage the miniscule blood vessels within the kidneys, hampering their function.
What happens if i have CKD?
You’ll need to chat to your doctor about your individual situation once diagnosed, but these measures have been shown to help.
Step 1. Limit saturated fats
Heart disease is common, and a leading cause of death, amongst CKD patients who consume too much saturated fat.
Some of the best ways to lower your saturated fat intake are the simplest: trim the fat from meat, discard chicken skin, opt for lower-fat dairy foods and avoid butter. If your doctor or Accredited Practising Dietitian (APD) requires you to have higher energy intakes, then increasing the amount of unsaturated fat in your diet may be a way to add kilojoules without placing undue stress on the kidneys. Consult with your GP or a dietitian before adjusting your diet.
Step 2. Moderate protein intake
Protein is an essential part of our diet, but after digestion it creates a waste product called ‘urea’, found in urine. Kidneys with diminished function may not be able to excrete urea efficiently and high blood urea levels can cause nausea, headaches, lethargy, bad breath, poor appetite and itchy skin.
Your protein intake will depend on the severity of your condition, but generally, you’ll need to eat smaller portions of protein – generally, between 0.75g–1g protein per kilogram of your ideal body weight. For example, a 60kg female with stage 3 or 4 CKD could consume between 45g–60g protein a day. Meat, fish, chicken and eggs should make up at least half of your daily protein requirements.
Step 3. Sodium intake
Excessive sodium in your diet places additional stress on the kidneys, increases fluid retention, may increase blood pressure and makes any imposed fluid restrictions difficult to adhere to – a recipe for disaster for people with CKD. If your CKD is progressive and high blood pressure is present, sodium restriction is essential.
Avoid adding salt to your food during cooking or at the dinner table. Avoid high sodium foods, such as processed meats (especially ham and corned beef), Vegemite, gravies, sauces, canned foods, cheese, soups, chips and savoury biscuits. Check food labels for sodium content and purchase foods that contain less than 150mg sodium per 100g.
Step 4. Focus on fluid
Drinking water to curb thirst also keeps your kidneys happy, but as kidney function deteriorates, so does your body’s ability to regulate fluid balance. If urine output diminishes, once diuretics are required or if blood pressure is high, fluid intake often needs to be restricted.
You’ll need to talk with your doctor about your specific fluid requirements. Be aware that all fluid sources, even the less obvious ones (such as sauces, gravies, jelly, ice-cream, yoghurt and fruit), need to be accounted for in your daily fluid tally.
Step 5. Monitor your potassium levels
Potassium is found in many foods we eat and plays an essential role in muscle contraction, heart function and keeping the water levels in your body balanced. High blood potassium levels lowered promptly.
Not everyone with CKD needs to lower their potassium intake, but there may be instances when high-potassium foods need to be avoided. All fruits and vegetables contain potassium, but the fruit and veg particularly high in potassium include: bananas, apricots, dates, mangoes, oranges, pawpaw, potatoes, baked beans, broccoli, carrot, pumpkin, spinach, tomatoes, lentils, soups and fruit and vegetable juices. Low potassium fruit and vegetable choices include: apples, blueberries, honeydew, watermelon, pears, mandarine, strawberries, tinned, fruit, zucchini, cooked cabbage, corn, celery, green beans, frozen mixed vegies, peas and choko. Peel and pre-soak your vegies before cooking to help reduce potassium content, and stick to the fruit and veg quota specified by your dietitian.
Step 6. Phosphate intake
Phosphate, which is important for bone health, is filtered by the kidneys. Reduced kidney functioning may lead to high blood levels of phosphate, resulting in bone loss and blood vessel damage.
You mayneed to monitor your intake of phosphate-rich foods, namely dairy, nuts, legumes, beer, soft drink and cocoa, under the supervision of an APD.
Step 7. Manage your weight
Carrying too much or too little weight can be taxing on your kidneys, so it can be a balancing act to get it right. Excess weight causes the kidneys to work harder, while being underweight compromises immune function, both of which increase your risk of hospital admissions and complications associated with dialysis.
If you have kidney disease and need to manage your weight, you should do so under the supervision of an APD. Visit www.daa.asn.au to find a dietitan in your area.
Can supplements help my kidneys?
Increased dietary restrictions can mean a higher risk of developing nutrient deficiencies, so supplements may help. Vitamin D, B vitamins and omega-3 supplements are most commonly prescribed for those with CKD, however, it’s important that you speak to your health professional before adding any supplements to your diet. Liquid nutrition drinks specifically formulated for people with CKD, like Nepro and Novosource Renal, are also available but should only be included under the guidance of your dietitian. Preliminary studies also indicate that probiotics may be beneficial in CKD management, so it could be worthwhile taking them, too.
Are liver and kidney health related?
Just like your kidneys, your liver can be largely impacted by diet. Following a healthy, balanced diet will go a long way towards keeping your liver and kidneys healthy, but these tips are also important:
Sudden weight changes in either direction, along with carrying too much weight, can increase risk of fatty liver.
Avoid saturated fats. Trim your meat, leave the chicken skin behind and opt for low-fat dairy foods.
Moderate your alcohol intake.
Manage your diabetes. High blood glucose levels hamper liver and kidney function.
Australia and New Zealand Renal Guidelines Taskforce (ANZRGT). September 2006 (Last reviewed 18 April 2008). Evidence Based Practice Guidelines for Nutritional Management of Chronic Kidney Disease. Nutrition and Dietetics, 63 (s2): pages s33-s45. Campbell KL. 2007. Nutritional Management in Pre Dialysis Chronic Kidney Disease – An Investigation for Methods for Nutritional Assessment and Intervention in Pre-Dialysis Chronic Kidney Disease. Thesis. CARI Guidelines. December 2005. Chronic Kidney Disease Guidelines – Nutrition and Grown in Chronic Kidney Disease. Available at URL www. cari.org.au . http://www.cari.org.au/ckd_nutrition_list_published.php. Accessed November 2010. Chadban S, Boyle J, McCartney T, Sturtevant J, Levidiotis V. 2008. Highlights from the Renal Allied Health Workshop. Available at URL www.daa.asn.au. Accessed November 2010. Kidney Health Australia. 2006. National Chronic Kidney Disease Strategy. Available at URL www.kidney.org.au. Accessed November 2010.