CCIP WEEK 2: CKD by Brianna Carone

What is Chronic Kidney Disease?

j02163250 — 2023-03-23 18:41:33 UTC

Chronic Kidney Disease (CKD) is a characterized by a slow decrease in kidney function. CKD is usually caused by another condition that has not been controlled properly and has put a large strain on the kidneys. Some of these conditions include:
- Hypertension
-Type II diabetes
-Glomerulonephritis

There are 5 stages of CKD which are based off of a test known as Glomerular Filtration Rate (GFR).
Stage 1: GFR >90
Stage 2: GFR 60-89
Stage 3: GFR 45-59
Stage 3b: GFR 30-44
Stage 4: GFR 15-29
Stage 5: <15

What do I need to monitor?

j02163250 — 2023-03-23 18:51:16 UTC

As mentioned above the kidneys are responsible for regulating the electrolytes, such as sodium, potassium, and phosphorus in the blood. In addition, they also regulate fluid levels. So, individuals with CKD may need to lower their intake of these key nutrients in order to ensure that the kidneys are not working harder than they should be and are not being damaged further.

Why do I need to lower my sodium intake and by how much?

j02163250 — 2023-03-23 19:10:32 UTC

Normally, if there is too much sodium within the body the kidneys excrete the excess through urine. In CKD, the damaged kidneys retain the excess sodium instead of excreting it. This excess of sodium within the body can lead to a build up of fluid and thus cause swelling known as edema, an increase in blood pressure and an increased strain on one's heart.

It is recommended that individuals lower their intake of sodium to <2300mg per day.

Foods high in Sodium:

j02163250 — 2023-03-23 19:14:22 UTC

Foods that are high in sodium that should be limited are:

Processed foods
- Fast food
- Prepackaged foods
Cheese
Canned soups
Luncheon meats
- Hot dogs
- Cold cuts
Cured foods
- Pickles
- Lox
- Bacon

Why do I need to monitor my potassium intake?

j02163250 — 2023-03-23 19:23:20 UTC

Like sodium, the kidneys regulate the amount of potassium within one's body. In CKD, the kidneys cannot get rid of excessive amounts of potassium that is consumed through one's diet. It is important to monitor potassium intake because too much potassium within the body can lead to either an increase or decrease in heart rate or can lead to a heart attack.

It is recommended that females aged 31-50 should consume 2600mg of potassium and males aged 31-50 should consume 3400mg of potassium. Those with CKD should should try not to exceed these values, and depending on the stage of kidney failure a reduction in potassium intake may be recommended by a doctor or dietitian.

What foods are high in potassium?

j02163250 — 2023-03-23 19:27:05 UTC

Tomatoes
Potatoes
Chocolate
Oranges
Avocado
Spinach
Bananas
Watermelon
Beans
For a complete list of high potassium foods visit: https://www.dietaryguidelines.gov/food-sources-potassium

Do I need to lower my fluid intake?

j02163250 — 2023-03-23 19:30:41 UTC

As mentioned earlier, the kidneys are responsible for regulating fluid balance. Depending on what stage of CKD your body is in your doctor may recommend that you reduce your fluid intake. If your doctor doesn't recommend a fluid restriction, then you should continue to consume 8-10 cups of water a day in order to ensure that you achieve adequate hydration.

How can I enjoy fruits and vegetables in without having too much potassium?

j02163250 — 2023-03-23 19:44:02 UTC

Boiling fruits and vegetables can cause potassium to leech out into the water.
Buying canned fruits, vegetables and beans as these have lower levels of potassium.
- Caution: When buying canned foods make sure to look for low-sodium or no salt added.

What are some diets that may help slow down my kidney disease?

j02163250 — 2023-03-23 20:05:12 UTC

DASH (Dietary Approaches to Stop Hypertension) Diet: This diet is low in sodium, added sugar, red meats and emphasizes fish, poultry, fruits, vegetables, low-fat dairy, nuts and seeds.
for more insight on DASH diet ask a dietitian or go to https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456
Plant-based Diet: This diet emphasizes whole grains, fruits, vegetables, beans, nuts and seeds. On this diet, meat, poultry and fish items are allowed but are not eaten as much.
For more information ask a dietitian or go to https://www.kidney.org/atoz/content/plant-based

Substituting for salt

j02163250 — 2023-03-23 20:13:32 UTC

Alternative ways to lower sodium intake:

Reduce the amount of meals eaten away from home
Utilize salt substitutes (ie: Mrs. Dash)
- Caution: if restricting potassium be careful of salt substitutes as they may contain potassium chloride
Replace salt with herbs and spices
- Parsley
- Dill
- Cilantro
- Oregano
- Cinnamon
- Nutmeg
- Allspice

*It doesn't matter if you use fresh or dried, herbs and spices are a great way of adding flavor to your meals without the added salt.

Another way to decrease salt usage is by using more vinegar in cooking. Vinegar can help extract more salt flavor without additional salt.

References

j02163250 — 2023-03-23 20:32:06 UTC

1. Dietary Guidelines for Americans. (2020). Dietary guidelines for Americans. Dietary Guidelines for Americans . Retrieved March 23, 2023, from https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
2. Harvard school of public health. (2023, March 7). Phosphorus. The Nutrition Source. Retrieved April 27, 2023, from https://www.hsph.harvard.edu/nutritionsource/phosphorus/
Harvard school of public health. (2023, March 7). Potassium. The Nutrition Source. Retrieved April 27, 2023, fromhttps://www.hsph.harvard.edu/nutritionsource/potassium/#:~:text=Potassium%20is%20an%20essential%20mineral,foods%20and%20as%20a%20supplement.
Harvard school of public health . (2023, March 7). Salt and sodium. The Nutrition Source. Retrieved April 27, 2023, from https://www.hsph.harvard.edu/nutritionsource/salt-and-sodium/

Mayo Foundation for Medical Education and Research. (2021, September 3). Chronic kidney disease. Mayo Clinic. Retrieved March 23, 2023, from https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521
National Kidney Foundation. (2022, August 11). Phosphorus and your diet. National Kidney Foundation. Retrieved April 27, 2023, from https://www.kidney.org/atoz/content/phosphorus

National Kidney Foundation. (2022, August 29). Nutrition and early kidney disease (stages 1–4). National Kidney Foundation. Retrieved March 23, 2023, from https://www.kidney.org/atoz/content/nutrikidfail_stage1-4

National Kidney Foundation. (2022, January 31). How your kidneys work. National Kidney Foundation. Retrieved March 23, 2023, from https://www.kidney.org/atoz/content/howkidneyswork
Nutrition Care Manual. Chronic Kidney Disease: Nutrition Intervention. Accessed (March, 23, 2023)
Nutrition Care Manual. Phosphorus content of food. Client Ed. Accessed (April, 27th, 2023)
Ogobuiro, I., & Tuma, F. (2022). Physiology, Renal. In StatPearls. StatPearls Publishing.

j02163250 — 2023-04-27 16:48:54 UTC

RM, is 40y/o female who has been recently diagnosed with stage 1 chronic kidney disease. RM has a medical history of hypertension. RM expressed that she knows how to and loves to cook, but according to her food recall she cooks a lot of foods that are fried and full of sodium and saturated fat. She knows she has to limit her sodium intake, but not sure how to cook with her new dietary restrictions. She also has expressed that she is willing to change her diet to prevent her kidneys from worsening.

Why are the kidneys so important?

j02163250 — 2023-04-27 16:56:16 UTC

The kidneys take part in many important physiological processes such as filtering out water, electrolytes, and waste products within the blood, converting vitamin D into a usable form, regulating acid-base balance and blood pressure.

What does Sodium do?

j02163250 — 2023-04-27 17:11:59 UTC

Sodium is a component found in the salt we flavor our food with. It is an important electrolyte as it helps our nerves send impulses throughout the body, aids our muscles in contracting and relaxing, and regulates fluid balance.

What is it?

j02163250 — 2023-04-27 17:23:35 UTC

Potassium is an essential electrolyte as it helps regulate nerve impulses, muscles contractions, blood pressure and fluid balance

What is it?

j02163250 — 2023-04-27 17:39:18 UTC

Phosphorus is a mineral that plays a plethora of roles within the body. It is a component of teeth, bones, cell membranes, and our genetic material. It also helps regulate the bloods pH, muscle contractions and nerve impulses. Phosphorus is another mineral that is regulated by the kidneys.

Do I need to restrict my phosphorus?

j02163250 — 2023-04-27 17:49:58 UTC

Depending on the stage of CKD your doctor may suggest restricting phosphorus intake. When the kidney's aren't functioning properly there will be a buildup of phosphorus within the blood. Excess phosphorus in the blood will result in calcium being pulled out of the bones and into the blood. Excess calcium and phosphorus in the blood can be problematic as they can leave deposits in the heart, vessels and lungs, and thus a stroke or heart attack may occur.

If no restriction is necessary it is recommended that women 19 years and older consume 700mg of phosphorus.

What foods are high in phosphorus?

j02163250 — 2023-04-27 17:53:07 UTC

Processed cheese
Dairy products
Processed meats
Organ meats
Breaded or fried meat, chicken or pork

What is considered a fluid?

j02163250 — 2023-04-27 18:04:02 UTC

Beverages
Soups
Gelatin
Ice cream

What foods are lower in phosphorus?

j02163250 — 2023-04-27 18:07:52 UTC

Fruits
Vegetables
Sherbert
Almond milk (unfortified)
Cottage cheese
Apple Juice
Cranberry Juice
Lean beef, pork, and veal
Chicken
Turkey
Fish

*When on a phosphorus restriction: try limiting protein sources to 3 ounces*

Handout on phosphorus content of foods

j02163250 — 2023-04-27 18:32:05 UTC

Powerpoint presentation

j02163250 — 2023-04-28 19:08:26 UTC