HRONICRENALFAILURE

DIET
JesalShah*
ConsultantDietician,Mumbai*

Chronicrenalfailure
(

CRF
)isadiseaseinwhichthekidneysgraduallystopworkingoveraperiodoffewyears.
Inahealthybody,thekidneysfilterwasteandotherimpuritiesfromtheblood.InpeoplewithCRF,toxins
thatthekidneysnormallyeliminateinurineslowlybuildupinthebody.Themostcommonlymeasuredof
thesetoxinsareureaanitrogenwasteproductandcreatinine.Theamountoftoxinsinthebloodroughly
indicateshowwellthekidneysareworking.InCRFthenephrons(functionalunitofkidneys)aregradually
andprogressivelydestroyedandtheremainingnephronshypertrophy(increaseinsize)tomaintainnormal
functioningofthekidney..Withthedestructionof80%ofnephrons,thefunctionsareaffectedseriouslyand
thepatientgoesintouremia(presenceoflargeamountsofendproductsofproteinmetabolismsuchasurea,
creatinine,uricacidinblood)characterizedbynausea,vomiting,headache,diminishedvisionandattimes
convulsions.
Signsandsymptoms:The

symptomsassociatedwithCRF
areprogressiveweakness,shortnessofbreath,lethargy,fatigue,weightloss,anorexia(lossofappetite),mouth
ulceration,metallictaste,frequenthiccups,increasedachesandpainsinjointsduetoosteodystrophy(bone
disease),increasedordecreasedurineoutputdependingonthestageofCRF.
Causesandrisks:Aprimarykidneydiseasemay
causeCRF
.Itmayalsobeduetootherdiseasesthataffectkidneyssuchasdiabetes,highbloodpressure,
glomerulonephritis(theswellingoftheglomeruluswhichisthepartofthekidneysconsistingofbloodvessels
andnervefibres),polycystickidneys(aconditioninwhichthekidneysbecomeenlargedandgrowcysts),
uropathy(anyconditionthatblockstheflowofurine)orcancerofthebonemarrow.
SincemanydiseasesleadtoCRF,thediagnosesof
diseasescausingCRF

canvary.Thereareafewcommonabnormalitiesassociatedwiththecondition.Forinstance:Urinalysismay
showprotein,redbloodcellsordifferenttypesofcasts(structuresmadewhenmineralscollectonthewallsof
thekidney).Abloodsamplemayshowelevatedcreatinineandureanitrogenwhicharebothtoxins.Levelsof
erythropoietinahormoneproducedbythekidneysmaybelow.Levelsofserumpotassium,phosphorus,
Parathyroidhormone,magnesiummaybehighwith/withoutlowlevelsofcalcium.Malnourishmentcan
occur.Treatmentinvolvesdialysisatregularintervalswithultimatelyrenaltransplant.
PRINCIPLESOFDIETARYMANAGEMENT
Becauseuremiaisseeninadvancedrenalinsufficiency,thedietmusttakeintoaccountnotonlytheprotein
contentbutalsotheacidbasebalanceandfluidandelectrolytebalancetoo.
Howeverintheworldofmodernscientificinventions,dialysishasprovedtobeaboon.Inthistechnique,the
toxinsfromthebodyareartificiallyclearedbyasemipermeablemembraneeitherfromtheblood
(hemodialysis)orfromtheabdomen(peritonealdialysis).Thedietarymodificationmusttakeintoaccountthe

followingconsiderations.
Toprovideadequatecalories
Toregulatetheproteincontentofthediet
Toregulatesodium,potassiumandfluidintake
Torestrictphosphateandsupplementthedietwithcalcium,iron,traceminerals,ascorbicacidandtheB
complexvitamins,
Toaimforpalatability(taste).Mostdietsfailtoachievetheiraimssimplybecausechildrenareunableor
unwillingtotoleratethem.
Toavoidstarvationandtofeedthechildrenfrequently.Renalfunctiondeterioratesandbloodurealevelsrise
rapidlyowingtotissuebreakdownunderconditionsofstarvation.
Energy:Energyisderivedfromfoods,whichcontaincarbohydrates,proteinsandfats.Sufficientenergy
shouldbeprovidedinthedietorelsethebodytissueswillbebrokendowntoprovideenergy.Thisshouldbe
avoidedasalltissuesaremainlyproteininnatureandifbrokendowntheyincreasetheureaandcreatinine
levels.
Protein:Thebodyreservesproteinsforgrowth,maintenanceandrepairofbodytissues.Itisimportantfor
everycellinthebody.Itispresentinalmostallthefoodsbutthequantityandqualityvaries.Proteinsofhigh
biologicalvalueor'goodquality'arefoundmainlyineggs,milk,meat,fishandpoultry.Proteinsoflower
biologicalvaluearefoundinpulses,cereals,nuts,oilseedsandinsomevegetableslikegreenpeasanddried
beans.Normally0.81.0gm/kgofbodyweightproteiniseffective.
Sodium:Sodiumrestrictionisnecessarywhenthebodyretainssodiumandwatercausingoedemaor
'swelling'.Sodiumisfoundinalmostallfoodsbutindifferentamounts.Proteinfoodsarenaturallyhighin
sodium.Somevegetablesandseafoodsarealsohighinsodiumcontent.Fruitsingeneralhavealowcontentof
sodium.
FOODSTUFFSHIGHINSODIUM
Bakingsoda
Salt
Ajinomoto
Saltedwafers,popcorns,saltedbiscuits.
Papadsallvarieties.
Saltedpickles,chutneys,currypowdercommercial.
Commercialsaladdressingsandsauces.
Soupcubes.
Softdrinkscontainingsodiumbenzoate.

Bakeryproducts,bread,biscuits.
Nutssuchassaltedcashewnuts,pistachio,walnuts,peanuts.
Commercialcheese.
Preservativecontainingfoods.
Cannedandtinnedfoods.
Seafood,chicken,dryfish,bacon,ham.
Meatandyeastextractslikemarmite.
ProprietarydrinksBournvita,chocolatedrinks,Horlicks.
Milkandcurds.
Pulsesandlegumesallvarieties.
Vegetablessuchascauliflower,snakegourd,beetroot,carrot,corianderleaves,fenugreek(methi)leaves,
lettuce,spinachpalak),amaranth,radish

Potassium:InpatientswithCRF,theabilitytoeliminateexcessiveamountsofpotassiumisdecreased.Ifthe
potassiumlevelinthebloodiselevated,itcausescomplications.Potassiumisfoundnaturallyinalmostall
foodsofbothplantandanimalorigin.Saltsubstitutesinthemarketmaycontainpotassiumandlabelsshould
bechecked.Twomethodsofreducingpotassium(leaching)inthefoodsaregivenbelow:
Method1:Wash,peelandcutvegetablesintosmallpieces.Soakinwarmwaterfor23hours.Discard
water.Addlargevolumeoffreshwaterandcookvegetables.Discardwater.
Method2:Peelvegetablesandcutintosmallpieces.Bringtoaboilinalargequantityofwater.Discard
waterandcookinalargevolumeoffreshwater.Discardexcesswater.
Foodslowinpotassium:
(group1)

Rice,semolina(rawa)
Vegetablessuchascucumber,ridgegourd
(turai),snakegourd(padwal),tinda,broad
beans,
beetroot,fenugreekleaves(methi),green
mango,
pinkradish,bottlegourd(dudhi).
Fruitsuchasapple(1/4),pineapple(1/4),
guava,papaya,pear.
Chickenandmeatboiledinexcesswatertwice
anddrained.

Eggwhite.
Tea.
Foodsmoderateinpotassium:
(Group2)

Riceflakes,cornflakes,bambinovermicelli.
Vegetablessuchascarrot,cauliflower,lady
finger,tomatoes,Bittergourd,onions,cabbage,
whiteradish,pumpkin,brinjal,Frenchbeans.
Curd
Watermelon,grapes.

Foodshighinpotassium:
(Group3)

Barley,ragi,wheatflour.
Allpulses
Allleafyvegetablessuchasamaranth,
corianderleaves,drumstickleaves,spinach;
potato,colocasia,sweetpotato,yam,drumstick,
Greenpapaya,swordbeans.
Milk,fishespeciallysardines
Nutssuchascashewnuts,almonds,etc;
oilseedssuchaspeanuts.
Condimentsandspices,jaggery.
Fruitssuchassweetlime,mango,banana,
chickoo,apricots,dates,figs,Melons,oranges,
pears
Brownsugar,coffee,cocoapowder,chocolate.

Fluids:Theamountoffluidsallowedusuallydependsontheurinaryoutputandthebody'sneed.Fluid
allowanceisdifferentforeachindividualandhastobedecidedbythephysiciandependingonthepatients
condition.Fluidintakeandurinaryoutputshouldbecarefullyrecorded.Fluidsincludewater,milk,curds,tea,
coffee,sambhar,rasamandanyotherliquidfoodconsumed.
Othermineralsandvitamins:Ifapatienthasabnormallevelsofphosphateandcalcium,phosphateintake
shouldberestrictedtopreventorslowdowntheimbalancebetweencalciumandphosphorusintheblood.
Sincemostofthefoodcontainphosphorus,aphosphatebinderisusedtopreventitsabsorption.Bcomplex
vitaminsarebeneficialandaregenerallysupplementedalongwithvitaminCandiron.
POINTSTOREMEMBER:
Calorieintakeshouldbeadequateinordertopreventtissuelossandalsoforproteinbuildup.About40
50cal/kgperdayaresufficient.
Atleast50%ofprescribedproteinshouldbeofhighbiologicalvalueandshouldbedistributedinallthe
mealsforbetterutilisation.
Vegetablesandpulsesshouldbetakenafterleachingpotassium.
Lowpotassiumfruitsshouldbeeatenonceortwiceaweek.
Saltshouldberestrictedincaseofoedema.
Fluidsshouldberestrictedtotheprescribedamounts.
Spicesandcondimentsshouldbeusedinsmallquantities.
Foodshighinsodiumandpotassiumshouldbeavoided.
Riceproductsaremuchbettertoleratedthanwheat.Thereforegivericeflakes,itemspreparedoutofrice
flour,riceporridge,sagoporridge,sagovada,sagokhichdi,maida,arrowroot,sugar,boiledsweets,unsalted
butter,unsaltedmargarinecouldbeused.Thesefoodshaveaverylowcontentofsodium,potassiumand
proteinbutprovideenergy.
Fruitjuices,preservativesshouldbeavoided.
Methodsthatshouldbeadoptedforcookingaresteaming,roasting,pressurecooking,stirfrying,
microwaving.
Fruitsrecommendedforpatientsareguava,apple,pineapple,papaya,pear.

20gmproteindietforachildweighing20kg.
Weightofthechildapprox20kg
Protein(1gm/kg)=20gm
Meal

Menu

Breakfast
8:00am

Milk100ml(cowsmilk)
2mediumsizedidli/1smalldosa/1katorivegetablenoodles/1katoriupma/2
khakras(madefromriceflour)

Midmorning
10:30am

2smallalootikkis*/2sagovadas/1vegetablecutlet

Lunch
12:30pm

1katoririce/1chappati
katorivegetable(group1)
katoripotato*
75mlcurds

Teatime
4:30pm

Milk100ml/buttermilk1glass(100mlcurds)
2spinachpuris*/1katoririceupma/1katorirussiansalad*/1
katoridoodhihalwa
or
Fruitcustard
or
Sameasmidmorningsnack

Dinner
8:00pm

Sameaslunch

DailyAllowance:
Sugar75gms
0il40gm
milk200ml
potato100gm
vegetable(group1)100150gm
Sago(sabudana)100gm
Nutritivevalueoftheabovemeal:
Calories1300cal
Protein2122gm
Potassium140mg
Sodium140mg