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Diet During Renal Failure and after Kidney Transplant

by Dr Mohan Krishnarao Kale(more info)

listed in nutrition, originally published in issue 188 - November 2011


Diet for the Renal Patient
In patients with chronic kidney disease or/on dialysis, the purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients. The special diet is important because dialysis alone does not effectively remove all waste products. These waste products can also build up between dialysis treatments. Most dialysis patients urinate very little or not at all. Therefore, fluid restriction between treatments is very important. Without urination, fluid will build up in the body and lead to excess fluid in the heart, lungs, and ankles. In patients with chronic kidney disease, one has to make changes in his diet, including:

  • Limiting fluids;
  • Eating a low-protein diet;
  • Restricting salt, potassium, phosphorous, and other electrolytes;
  • Getting enough calories if one is losing weight;

The recommended diet needs change as the kidney disease gets worse. Daily calorie intake needs to be high enough to keep healthy and prevent the breakdown of body tissue.


diet for renal failure
Carbohydrates
If one is overweight or have diabetes, he or she needs to limit the amount of carbohydrates he or she eats. Otherwise, carbohydrates are a good source of energy for your body. If your health care provider has recommended a low-protein diet, you may replace the calories from protein with fruits, breads, grains, and vegetables. These foods provide energy, as well as fibre, minerals, and vitamins.

Fats
Fats can be a good source of calories. Make sure to use monounsaturated and polyunsaturated fats (olive oil, Sunflower oil, canola oil, safflower oil) to help protect arteries..

Proteins
Low-protein diets may be helpful before dialysis/ renal transplant. A moderate-protein diet (1 gram of protein per kilogram of body weight per day) is recommended. In fact, a high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended after dialysis/ renal transplant. This will help you replace muscles and other tissues that you lose. People on dialysis should eat 8-10 ounces of high-protein foods each day. Protein is needed to maintain muscles, aid in building resistance to infections, and repair and replace body tissue. As your body breaks down protein foods, waste products called urea are formed. As kidney function declines, urea builds up in the bloodstream.  Eating too much protein may cause urea to build up more quickly. This will make you feel sick. Eating less protein will be helpful in reducing blood urea levels. Examples of foods high in protein are  meat, poultry, milk products and eggs where as foods low in protein includes fresh beans (pinto, kidney, navy), grains and vegetables.

Calcium and Phosphorous
Calcium and phosphorous, two other important minerals in the body, are also monitored closely. Even in the early stages of chronic kidney disease, phosphorous levels in the blood can become too high. This can cause low calcium (this causes the body to pull calcium from your bones, which can make your bones weaker and more likely to break) and itching. One has to limit the amount of dairy foods that he or she eats. This includes milk, yoghurt, and cheese. Some dairy foods are lower in phosphorous, including tub margarine, butter, cream cheese, heavy cream, ricotta cheese, brie cheese, sherbet, and non-dairy whipped toppings. Fruits and vegetables contain only small amounts of phosphorous. You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body.

Phosphorus is a mineral that works with calcium to keep your bones healthy and strong. Phosphorus is needed by the body for building and maintaining bones and teeth and for normal nerve and muscle function. When kidney function declines, the body has a difficult time keeping phosphorus and calcium in balance. As a result of this imbalance, the body cannot get rid of excess phosphorus (phosphorus levels increase) and the body cannot take in enough calcium (calcium levels decrease). To try and correct this imbalance the body will 'steal' calcium from the bones, which makes the bones weak. Problems associated with high phosphorus levels include itchy skin, bone and joint pain, and brittle bones.

Foods that are high in phosphorus include cola drinks, peanut , butter, cheese, sardines, chicken/beef liver, nuts, caramels, beer, ice cream etc. whereas lower phosphorus food substitutes include broccoli, non-dairy milk substitute, sherbet, non-cola soda, zucchini squash and hard candy.

Fluids
Kidneys help to control the amount of fluid that leaves your body. If your kidney disease progresses, your kidneys may be unable to regulate the removal of fluid from your body and as a result your doctor may ask you to limit your fluid intake. Too much fluid may cause swelling, shortness of breath, or high blood pressure. In the early stages of chronic kidney disease, you do not need to limit how much fluid you drink. As your kidney disease becomes worse, or when you are on dialysis, you will need to watch how much you drink. In between dialysis sessions, fluid can build up in the body. Do not eat too much of foods that contain a lot of water, such as soups, Jell-O, popsicles, ice cream, grapes, melons, lettuce, tomatoes, and celery.  Use smaller cups or glasses and turn over your cup after you have finished it.

To decrease the amount of fluids, these tips may help you.

  • Drink only when thirsty. Do not drink out of habit or to be social;
  • Eat less salt so you will feel less thirsty;
  • Suck on ice chips. (Measure small units into a cup);
  • Brush your teeth three to four times a day; this is to prevent your mouth from drying out;
  • Suck on a lemon wedge;
  • If you have diabetes, control your blood sugar;
  • Chew sugarless gum or suck on sugarless hard candy;
  • Take your medications with sips of fluid;
  • When dining out, ask your beverage to be served in a child-size glass.

 Measure how much fluid your favourite cup or glass holds so you will be better able to monitor the amount of fluid you drink

  • After measuring out the total amount of fluid you can drink for the day, place the water in a container. During the day drink only from this container so you can keep an eye on the amount of fluid you have consumed.
  • Tips to keep from becoming thirsty include:
  • Avoid salty foods;
  • Freeze some juice in an ice cube tray and eat it like a popsicle (you must count these ice cubes in your daily amount of fluids);
  • Stay cool on hot days.

Sodium
Reducing sodium in your diet helps you control high blood pressure, keeps you from being thirsty, and prevents your body from holding onto extra fluid. A low-salt diet is usually needed. Sodium is needed by the body for many functions such as controlling muscle contractions, balancing fluids, and controlling blood pressure. Healthy kidneys remove excess sodium in the urine. As kidney function declines, sodium and fluids may accumulate in your body. Fluid retention may cause swelling in your eyes, hands, and/or ankles. To keep your sodium level in balance, one has to limit the sodium in diet.

Low Sodium Alternatives
Season with a variety of spices like garlic, lemon and oregano instead of table salt.
Look for products with less than 100 mg of salt per serving. Do not use salt when cooking and take the salt shaker away from the table. Do not use salt substitutes because they contain potassium.

Potassium
People with chronic kidney disease need to limit their potassium. Normal blood levels of potassium help keep your heart beating steadily. However, too much potassium can build up when the kidneys no longer function well. Dangerous heart rhythms may result.   Potassium helps to keep your nerves and muscles, especially your heart, working properly. Potassium is found in many food groups, including fruits and vegetables.  The kidneys are responsible for helping to keep the correct amount of potassium in your body. It can be very dangerous if your potassium level is too high. Foods that are high in potassium include fruits, vegetables, bananas, broccoli, chocolate, oranges,  potatoes,  coffee (limit to 2 cups per day), prunes mushrooms,  bran , raisins,  nuts & dried fruit, collard, dandelion, mustard, and beet), apricots., whereas, low-potassium foods include apples, beans (green or wax), rice, cucumber , noodles, pears, onions, cake, watermelon, lettuce, cereals, cranberries, carrots,  bread and bread products. It is important to remember that almost all foods contain potassium. Serving size will determine whether foods are a low, moderate, or high potassium level. A large serving size of a low potassium food can become a high potassium food.

Iron
Patients with advanced kidney failure usually need extra iron. Many foods contain extra iron (liver, beef, pork, chicken and kidney beans, iron-fortified cereals).

Diet after Kidney Transplant
During renal failure one may experience many limitations on the types of foods he could eat before transplant; several of these dietary restrictions may not apply after transplant surgery. Because of the new freedom to indulge in many different foods, and an increased feeling of hunger due to medications, it is easy to see why excessive weight gain is a common problem for many transplant patients. To promote healing after surgery, one should eat more lean meat, poultry, fish and low-fat dairy products, and also include a variety of grains, fruits, and vegetables for adequate calories, vitamins and minerals. Two common long-term problems for transplant patients are weight gain and high cholesterol levels. The medications lead to excess weight gain. If you do need to watch your weight, it doesn't mean you have to eat less food -- just be more selective about the foods you do eat. By limiting fat in your diet and eating foods high in fibre, you may be able to control high cholesterol levels. In order to monitor weight gain after transplant surgery, one has to develop a nutritional plan. This plan will be determined by your weight, blood work results, kidney function and medications.  It's important to eat a healthy diet after receiving a kidney transplant. Good eating habits help prevent health complications from post-transplant medications.

A Healthy Diet Can

  • Keep blood sugar levels within normal limits, which prevent diabetes. Blood sugar can go up after a transplant;
  • Keep blood cholesterol levels within normal limits, which keeps the heart healthy. Cholesterol levels can become elevated after a transplant;
  • Prevent excessive weight gain. Some patients gain too much weight after a transplant;
  • Help keep blood pressure normal directly after the transplant, through appropriate salt intake;
  • Provide enough calcium to keep your child's bones strong and support growth. Patients taking prednisone after transplant need more calcium.

Planning a Healthy Diet
A healthy diet meets the following guidelines:
Low in Sugar

  • Limit juice, soda and other high-sugar drinks to less than 8 ounces a day;
  • Limit candy and dessert-type foods to one serving or less a day. Read labels to determine how much of the food is considered a serving;
  • Don't add sugar to foods or drinks such as cereal and tea;
  • Choose low-sugar versions of healthy foods, such as regular milk instead of chocolate milk or plain yoghurt instead of flavoured yoghurt.

Low in Fat

  • Limit butter, margarine, red meat, fried foods, poultry skin, bacon, sausage, full-fat dairy products, eggs, mayonnaise and junk food;
  • Choose skinless poultry and fish more often than red meat;
  • Serve red meat no more than three times a week. Choose cuts with 'loin' or 'round' in the name and keep serving sizes to 3 to 4 ounces of cooked meat. Cut all visible fat from the meat and discard.
  • Choose low-fat or non-fat dairy products;
  • Choose low-fat or non-fat versions of dressings, dips and spreads, such as margarine, mayonnaise, salad dressing and sour cream;
  • Limit foods like chips, crackers and cookies. Try baked or low-fat versions of your favourites.

High in Fiber

  • Serve fibre-rich foods such as fruits, vegetables, whole grains, legumes and lentils;
  • Serve two to four pieces of fruit a day. Choose fruit instead of juice. A serving of fruit is equal to a small or medium-size piece or 1/2 cup;
  • Serve three to five servings of vegetables a day. A serving is equal to 1/2 cup cooked or raw vegetables or 1 cup raw leafy vegetables;
  • Provide whole grains every day. The goal is three servings a day or more of whole wheat bread, pasta, couscous, tortillas, pita bread, oatmeal, and wheat or oat cereals. Look for whole wheat flour instead of enriched wheat or enriched white flour on the ingredients list. Try grains such as quinoa and amaranth;
  • Serve beans and lentils three times a week or more. You can serve them plain or add them to salads, stir-fries, soups, chilli and burritos.

Sodium or Salt
Many people experience high blood pressure or fluid retention following a kidney transplant. If fluid retention or high blood pressure are problems, the dietician will incorporate low-salt foods in meal plan. While the phosphorous and potassium concerns mentioned above are generally corrected within a month or two, a low-sodium diet may need to be followed indefinitely.

Moderate in Sodium
Although the recommended limit varies with age, most patients should get no more than 1.5 to 2 grams (1,500 to 2,000 milligrams) of sodium a day. Use the food labels to help guide you. One teaspoon of salt equals 2,400 milligrams of sodium. In most cases, this restriction can be relaxed four weeks after transplantation. Talk with your child's dietician for guidance.

  • Limit the amount of salt you add to food during cooking. Use herbs, spices, lemon juice or vinegar to flavour foods instead;
  • Don't use a salt shaker at the table;
  • Limit salty foods such as chips, crackers, French fries, lunch meats and hot dogs;
  • Limit processed foods such as frozen meals, processed cheese, sauce or powder flavour packets for noodles or rice, soups and canned vegetables. Processed foods often contain large amounts of salt.

Adequate in Calcium
Try to meet your child's calcium needs with foods. Supplementation may be necessary but isn't appropriate for all patients. Talk with your child's doctor and dietitian for guidance.
Great sources of calcium include milk, yogurt, cheese and calcium-fortified beverages such as soy milk and orange juice - each has about 300 milligrams per serving. (A serving is equal to 8 ounces of milk or yogurt or 1 ounce of cheese.) Dark green vegetables, such as spinach and broccoli, are also good sources of calcium.

Diet Restrictions
There is no longer a restriction on potassium, phosphorus, protein or dairy intake after a transplant. This applies to patients who were on a protein-restricted diet before the transplant as well. Ghee, Sugar should be avoided.

Special Nutrients
Some patients have low levels of potassium, phosphorus and magnesium in their blood. These patients often need supplements to raise blood levels of these minerals. In addition to supplements, your child should eat foods rich in these minerals.

Potassium
Some transplant medications may cause potassium level to dramatically increase or decrease. This is a serious condition, but fortunately, it usually does not last long.

Potassium-Rich Foods

  • Fruits - Bananas, cantaloupe, dates, dried apricots, honeydew melon, kiwi, mango, nectarine, oranges, papaya, prunes, raisins, Grapes and grape juices should be avoided;
  • Protein-Rich Foods - Chicken, flank steak (lean), halibut, peanuts, peanut butter, red snapper, salmon, sole, trout, tempeh, tofu, turkey;
  • Cereals - All Bran cereal, bran flakes;
  • Vegetables - Artichoke, avocado, cabbage, spinach, tomato, tomato juice, vegetable juice;
  • Starchy Vegetables - Potato with or without skin, sweet potato, yam, winter squash;
  • Beans and Legumes - Black-eyed peas, kidney beans, lentils, lima beans, refried beans, pinto beans;
  • Dairy Products - Milk, yoghurt.

Phosphorous
As new kidney begins to function, body is able to rebuild bone mass that may have been lost during renal failure. While these 'hungry bones' are busy gaining strength, blood phosphorous level could drop quite low. One is encouraged to eat foods high in phosphorous, such as low-fat dairy products.

Phosphorus-Rich Foods

  • Dairy Products - Cheese, custard, frozen yoghurt, ice cream, milk, pudding, yoghurt;
  • Protein-Rich Foods - Beans, chicken, eggs, fish, lentils, nuts and peanut butter, red meat, pork, turkey;
  • Other Foods - Caramel and chocolate (limit portion and frequency because of their sugar content).

Magnesium-Rich Foods

  • Grains and Cereals - 100 percent bran cereal, bran flakes, brown rice, oatmeal (instant or regular), soybean flour, wheat germ, whole wheat bread;
  • Beans and Legumes - Black beans, kidney beans, lima beans, navy beans, pinto beans, refried beans, lentils;
  • Protein-Rich Foods - Almonds, beef, cashews, fish, peanuts and peanut butter, poultry, sunflower seeds, tofu, walnuts;
  • Vegetables - Avocado, beet greens, broccoli, okra, spinach, swiss chard;
  • Starchy Vegetables - Potato with skin;
  • * Fruits - Bananas, figs, pineapple, raisins.

Comments:

  1. suresh said..

    dear sir, my suresh pondicherry
    sir kidney transplant finnesh date apr - 14 2012 i want dips

    * what is the narmal food
    * low or no porten
    * i am sugar and pp
    plase tell me

    suresh.s


  2. RITA DORROUGH said..

    MY FRIEND IS 56 YRS OLD. HE HAD A POLYCYSTIC KIDNEY. HE WAS BLESSED WITH A TRANSPLANT 3 YEARS AGO. MY QUESTION TO YOU IS HOW MUCH WHOLE MILK CAN HE DRINK IN A DAY. RIGHT NOW HE IS DRINKING A LITTLE BIT MORE THAN 1 GAL. A DAY. IS THAT TO MUCH? PLEASE GET BACK TO ME ASAP. THANK YOU FOR TAKING THE TIME. RITA


  3. ADOLFO CHAVEZ said..

    I've always heard that kidney transplanted persons should not drink soda at all because it damage or shortens the life of the new kidney. Is that true?


  4. Dr. M. K. Kale said..

    Dear ADOLFO CHAVEZ: Kidney transplanted persons or persons with renal failure should not drink any kind of beverages like cola, soda , they are fortified with phosphorous, affect calcium levels, Blood pressure, Excessive beverages may damage or shortens the life of the new kidney.


  5. Dr. M. K. Kale said..

    Dear Suresh
    You can consume adequate foods proteins, vegetables, eggs, milk, fish, beans fruits, normal freshly prepared food etc. You should reduce sugar, salt and fat intake as transplant medicines may induce diabetes, or may elevate blood pressure and sugar level , if taken in excess. No junk foods.

    Dear RITA DORROUGH
    You should avoid excessive milk, you can consume up to 700-800 ml (fat seperated milk)istead of whole milk. You can consume other milk products like Yogurt or buttermilk


  6. Dr. M. K. Kale said..

    verified and answered


  7. ARUN KUMAR PATHANIA said..

    sir, i am 31 yrs old and my kidney tx commenced on 3rd june 2013 at pgimer chandigarh. on discharge from hospital my s.creat was 1.6.
    now my s.creat is 1.2-1.3 . urea is 30.6, potassium- 4.05, glucose-78.5(random)
    sodium 143.4, cholestrol-215, ast-44,alt-106, calcium-9.26, phosphorus- 2.13, protien-7.33

    please advice me a suitable diet chart.(indian diet chart)
    thanks regards


  8. bhavesh said..

    sir, i am 33 yrs old and my kidney transplant on 21 june 2001 at manipal hospital.now my s.creat was 1.8 so plz advice me for my diat


  9. ALVINA said..

    Am 31years old! I want to know a proper diet I should take so that my s.creatinine level does not rise! It was 158 after my transplant, after 1 year 7 months it has become 203! I'm very worried!


  10. kavita tapkit said..

    Hi sir I want to lose weight.pls help me with diet


  11. Amrita panda said..

    sir.I am Amrita 31 years old ,my kidney transplant was done on 17.01.2014.After transplant i am following all guidelines given by my doctor,still i am having urinary infection .sir please suggest any remedy.


  12. Sanjoy dey said..

    Sir, I am Sanjoy dey.kidney transplant 03 Jan 20 14 at Desun Kolkata. Now my s.creat-1.8, urea-29,Sodium-146, pota-3.75, sugar fasting-96, recently I have done graft biopsy, result-(cni), please suggest me I am worried


  13. Evelyn WALL said..

    My husband has been on dialysis for two years and was told today that he would not be considered as a candidate for dialysis that his potassium levels were too high. Before this he was told it was a weight issue and no mention of blood levels, electrolytes.It seems like no one can tell us what are the requirements to get on list for a transplant. He is 51 years of age, diabetic, high blood pressure and has had a heart bypass. DAVITA can only hand me paper work on foods to avoid, no menus or how to become a qualified candidate. I am willing to hire a dietitian, get on an exercise program that would assist him for a chance of survival. Could you please advise us on the prerequisites, blood levels, weight considerations and anything that would preclude him from this opportunity i.e., medications, mental state. Thank you for your assistance.


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About Dr Mohan Krishnarao Kale

Dr Mohan Krishnarao Kale PhD is Professor (Pharmacology) at Sharad Pawar College of Pharmacy, Wanadongri, Nagpur, (INDIA) 441 110.   His highest Qualifications include  M. Pharm (Pharmacology) PhD. He has 27 years of administrative and Teaching experience  and is a recognized PhD Supervisor RTM  at Nagpur University, MJRP University  Jaipur and Sant Gadgebaba Amaravati University. He is the recipient of the prestigious "MPA Award" from Maharashtra Pharmacist Association, Mumbai for contribution to Pharmacy Profession. (8th  Feb.2009). He has published and received three best poster presentation awards  at  National Conventions. Dr Kale’s areas of research include: Oxidative Stress and the Thyroid,  Kidney failure and future drug development, Diabetic Complications etc. He has published many research articles in national and international journals and a book titled Pharmacology and Toxicology published by VBD Printers, Nagpur.
His associations with professional organizations include: Vice-President, APTI. Maharashtra branch. (2008-2011);  Secretary, Pharmaceutical Society of India (2003-2011);  Secretary NYSS - NCP alumni association , Secretary RTMNU - UDPS alumni association.
Dr Kale may be contacted via kalemkpharm@gmail.com

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