Diet and Kidney Disease: Helping you stay in charge
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Why have I been given this booklet? This booklet is designed for people who are under the care of a renal consultant (kidney doctor) and have chronic kidney disease (CKD) and aims to: • Help you understand how your kidneys work and what happens when they stop working properly • Support you in understanding general health eating guidelines in relation to the renal diet • Introduce you to the dietary changes that some patients with CKD make • Introduce you to the work of the renal Dietitian and their role in managing patients with kidney disease. How to use this booklet First, make sure you are comfortable, have set aside about 20 minutes to take your time reading the booklet and possibly have a drink or snack ready before you start. This booklet is different from others you may have seen because it aims to be more interactive. You can continue to use this booklet by adding additional information as you progress through your treatment journey. Throughout this booklet, you may see four different symbols. They are there to help highlight important information, encourage you to make your own notes about the renal diet, and to think about how the information can be used to help you. This is not a test – it’s about helping you to understand your condition and the role diet plays in it.
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Find a pen or a pencil to complete this booklet in the spaces provided. Responses to some frequently asked questions may help answer some of your own, but don’t forget, if the answer to your question is not in this booklet, ask your Dietitian; Pharmacist; Nurse; Doctor.
You may feel there is a lot of information to take in. Remember this is not a test – these boxes are here to help highlight some important points. Activities may help you to think about how the information provided could be useful and how it relates to you
The Kidneys Most people have 2 ‘bean shaped’ kidneys positioned one either side of the body towards your back, under your ribs, and above your waist. The kidneys are part of the body’s ‘plumbing’ system and act as a filter. Each kidney has a tube like drainage system, called a ureter, to take urine produced in the kidney to the bladder. The bladder also has a tube like drainage system, called the urethra, to allow us to pass the urine out of the body. Together all these parts make up the urinary system. Page 4
The main job of the kidneys is to make urine so the body can get rid of waste products from the blood along with excess fluid. Waste products are made after the body has broken down and digested the food we eat into simple pieces that can be used for energy, growth and repair. This waste is then present in the blood, which the kidneys ‘filter’, and we get rid of in the urine. Imagine the work of the gold miners in the gold rush, over a century ago, sieving for gold in the river beds of California, America. Your kidneys act like the sieve used to search for gold. Blood is pumped to the kidneys by the heart and they filter out all the waste and excess fluid (like the sand and grit falling out of the sieve) and leave the ‘good’ things from the food we eat in the blood so the body can used them (like the gold left in the sieve).
The Kidneys:
3 help control blood pressure
3 keep bones healthy and strong
3 help make red blood cells, which are important to carry
oxygen around the body to help it work properly. Page 5
What happens when the kidneys do not work properly? CKD is a life long medical condition that can be treated but not cured, unless a kidney transplant is given. It happens when the kidneys don’t work as well as they should. Kidney disease can develop for a variety of different reasons. What happens when my kidneys are not working? • Level of waste products (toxins) can build up in the body that the kidneys are unable to flush away • Excess fluid can gather in your body known as oedema (o-dee-ma) • Blood levels of certain minerals can increase, such as potassium and phosphate – see page X for more information on minerals • Blood pressure can increase, causing extra strain on blood vessels causing them to weaken • Anaemia (an-ee-me-a), shortage of red blood cells, can develop.
Will I feel different? As your kidney disease progresses you may experience a variety of symptoms such as; • A decrease in appetite • Taste changes • Nausea (feeling sick) • Swelling around the feet and ankles Page 6
• Itchy skin • Less energy (tiredness) • Shortness of breath
Have any of these symptoms affected you? Make a note of any you have experienced or are concerned about...
So‌‌what does diet have to do with the kidneys? The next part of this information explains, but first of all we need to know a bit about what a health balanced diet should look like. Page 7
What is a healthy balanced diet? Eating a balanced diet is important for good health, it is important you maintain a healthy weight for your height (neither underweight nor overweight). If you are having any problems maintaining a healthy weight, then please ask to discuss this with your renal Dietitian. The ‘Eatwell Plate’ shows how much of what you eat should come from each different type of food known as ‘food groups’. If your diet looks similar to this plate then you are well on the way to a balanced and healthy diet. Bread, rice, potatoes, pasta and other starchy foods
Fruit and vegetables
Meat, fish, eggs, beans and other non-dairy sources of protein
Milk and dairy foods Food and drinks high in fat and/or sugar
Breads, other cereals and potatoes – Try to include one of these foods with each of you meals, preferably wholegrain varieties (e.g. whole-wheat bread, brown rice, oats or whole grain breakfast cereals). Fruit and vegetables – Aim to eat at least 5 portions of a variety of fruit and vegetables each day (unless advised otherwise by your renal dietitian). A portion is around 3 heaped tablespoons Page 8
of cooked vegetables (e.g. peas or carrots), 2 small pieces of fruit (e.g. 2 satsuma or 2 plums) or 1 medium sized piece of fruit (e.g. apple or banana), or half a large piece of fruit (e.g. half a grapefruit) or a small glass of unsweetened fruit juice (150ml). Milk and dairy – Try to include 2-3 servings per day. A serving is a small pot of yogurt (150ml), a glass of milk (200ml), or a small, matchbox size piece of cheese (30g). Meat, fish and alternatives – Try to include 2 servings per day. Alternatives to meat, chicken or fish include beans, lentils, nuts and pulses. A serving is 4 tablespoons of pulses, half a large tin of baked beans, a small piece of cooked meat the size of a deck of cards (75g). Aim for 2 portions of fish per week, including 1(75g) portion of oily fish (e.g. sardines, mackerel or salmon). Foods containing fat and sugar – These foods should only form a small part of your total daily intake. Write down everything you eat in one day and compare your intake to the ‘Eatwell Plate’ on the opposite page.
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Fancy a break? There has been quite a lot of information and reading so far, if you feel you need a break, why don’t you come back to the booklet later and look at some more information about diet and CKD. Do I need to make changes to my diet when I have CKD? When your kidneys are not working properly levels of waste products (toxins) can build up in the blood making you feel unwell. Making changes to your diet can help to reduce the levels of this waste and help you to feel well and stay as healthy as possible. Your blood levels of certain waste products and minerals (see below for more information on minerals) will be closely monitored each time you attend clinic and, if there is a need to change your diet in any way, your renal dietitian will discuss this with you. Here are a few dietary terms you may hear or already know: Minerals Minerals are naturally occurring chemicals found in food. They are important substances required in small amounts by the body to make sure it works efficiently and we can go about our normal everyday business. They do not provide any energy but they help us to convert the food we eat into energy. We cannot survive on minerals alone but without them the body would not work as well and it may be harmful to you. Page 10
Potassium (you may see this written as its chemical symbol – K_) Potassium is a mineral found in lots of foods and is needed in the body to help your muscles function. Any excess would normally be removed by the kidney; however when you have CKD the level of potassium can build up and can cause potential danger to your heart. Examples of some foods high in potassium are crisps, chocolate, tomatoes and bananas.
Phosphate (you may see this written as its chemical symbol – PO4) Phosphate is found in a wide variety of foods. This mineral works closely with calcium to build strong bones. High phosphate levels can cause weakening of your bones and cause longterm damage to the blood vessels. Symptoms include itching, joint pain and red eyes. Some people do not feel any symptoms if phosphate is high, so it is important to control it before any damage is done. Examples of some foods high in phosphate are cheese, milk and yogurts. Page 11
Fluid The kidneys are responsible for controlling fluid levels in your body. As CKD progresses you will find that the amount of urine you pass becomes less and you may find extra fluid can gather in the body, known as oedema. The symptoms of this include swelling (particularly around ankles and face), high blood pressure and shortness of breath. You will be advised how much fluid is right for you, depending on how much urine you pass each day.
Salt A diet high in salt can lead to a build up of fluid and high blood pressure. A ‘no added salt’ diet should be followed by the general population however this is really important when you have CKD as high blood pressure can further damage your kidney. Extra fluid can make you feel uncomfortable and thirst can be difficult to manage if you have to be careful with the amount of fluids you take in your diet. See the next page for some tips on how to reduce your salt intake.
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How can I reduce my salt intake? • Try to avoid adding salt at the table • Use only a small amount of salt in cooking to flavour your food if needed at all • Do not use salt substitutes as these can raise your potassium levels • Try to reduce the amount of salty foods in your diet such as tinned foods, ready meals, smoked foods or salted snacks such as crisps and salted nuts • Choose alternative seasonings in your cooking such as black pepper, mixed herbs, parsley, rosemary and garlic It is useful to check the amount of salt in foods by checking the labels; this may be referred to as sodium. As a guide per 100g food:• 1.5g salt is high (0.6g sodium) • 0.3-1.5g salt is medium (0.1-0.6g sodium) • Less than 0.3g salt is low (0.1g sodium) For more information on salt you may wish to visit the following websites: www.bda.uk.com/foodfacts/salt.pdf or www.nhs.uk/livewell/goodfood/pages/salt Page 13
What does a renal Dietitian do? The renal dietitian may be someone who you have not yet seen. They are trained to manage dietary changes required due to CKD. If you are referred to, or asked to see, the renal Dietitian, you will be asked about your usual dietary intake (called a ‘diet history’). From this, the Dietitian can calculate the type and amount of the different foods you are currently eating and the types and amounts that could help you stay well and have a healthy a diet as possible. The Dietitian will also consider your food preferences, weight, any other medical conditions and recent blood test results. Putting all this information together allows the Dietitian to decide what nutritional care is suitable for you, and together, you can make a plan which best suits your individual needs. Not all people with kidney disease will need to make changes to their diet and the advice you have been given may change as your kidney function alters. Dietitians are of course friendly and approachable so asking any questions you are not sure of should never be a problem. As well as having the opportunity to have a face to face consultation with the Dietitian you will also be provided with contact details should you have any questions regarding your renal diet.
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How do you think the renal Dietitian might be able to help you? You may want to jot down any notes, or questions, you already have
Remember you are an individual and what you need to change is dependent on your blood results and stage of CKD. Your renal Dietitian will advise you if any dietary changes are required.
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Frequently asked questions
Do I need to follow a special diet forever? Everyone should be following a healthy diet whether they have CKD or not. You should try to follow a balanced and healthy diet (see Eatwell plate on page x). Reduce salt where possible, however, any other dietary restrictions will be discussed as required by your Dietitian. Remember you are an individual and your diet may change with time; there is no such thing as a ‘set renal diet’. If you are advised on any renal dietary restrictions these may change depending on your blood results and stage of CKD. Your Dietitian will advise you if any changes need to be made to your current diet.
Do I see a Dietitian every time I come to clinic? No, your doctor will usually refer you to see the Dietitian. You and your Dietitian will agree follow up appointment times for clinic as required and provide you with contact details so you can easily get in touch if you have any questions regarding your renal diet.
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What do I do if I have more questions? This booklet does not provide all the answers; it’s only natural to have questions. Please feel free to speak to your specialist kidney Dietitian; Nurse; Doctor; or Pharmacist if you have any other questions. Family and carers are also important – don’t forget they may have questions as well and it may be worthwhile contacting your renal team for more information. There is lots of information and advice available, especially on the internet. Some of the information you might find useful but remember, everyone is individual and may not follow the same diet, take the same tablets or need the same treatment. Make sure you discuss issues with your specialist kidney Dietitian; Nurse; Doctor; or Pharmacist to make sure that advice is right for you and your needs. Other places you might like to look for information are: The kidney patient guide http://www.kidneypatientguide.org.uk The U.K. National Kidney Federation http://www.kidney.org.uk NHS Renal Patient View https://www.renalpatientview.org/infoLinks.do
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Notes Date Comment
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Personal Details Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . My Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . My Dietitian is: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dietitians contact details: . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................................................... ...................................................... Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Copies of this information are available in other languages, formats or large print upon request. We will try to make this information as accessible as possible to individuals with disabilities to allow them to access this service. If you have any comments or suggestions on how this information can be improved in the future please contact the Renal Dietetic Team, Western Infirmary, Glasgow. Tel: 0141 211 2026.
This booklet was developed by the Dietetic Service, NHS Greater Glasgow and Clyde 2012 Design by GND. Email: info@weareGND.com No part of this book may be reprinted or reproduced or utilised in any form or by electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.