Chronic Kidney Disease(CKD) and renal failure.

According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), an estimate 4.5% of adults 20 years of age and older have Physiological evidence of chronic kidney disease (7.4 million adults), determined as moderately to severely decreased glomerular filtration rate.  Increased serum levels of inflammation contribute to development protein-energy malnutrition in renal patients (Mehrotra and Kopple, 2001).  Because most people with renal disease also have cardiovascular disease and many have diabetes, a multifactorial approach is important. 

The purpose of the kidney is:

1.       Excretion of waste product of metabolism.

2.       Homeostasis

*Acid-base balance.  The kidneys regulate the pH by eliminating excess H ions concentration.  Potassium and phosphate requires renal control as well.

*Blood pressure

*Plasma volume

                3.  Hormone secretion

                4.  Carnitine synthesis to carry fatty acids for heart and skeletal muscle fuel.

                5.  Glucose homeostasis.

                6.  Prostaglandin impacts renal hemodynamic and salt and water excretion.

When the kidney starts reducing its output as indicated by a lowering GFR, changes in the diet can help maintain the status of the blood within acceptable limits.  By reducing salt and sodium in the diet, the fluid balance is easier to maintain.  Protein may need to be limited as well as phosphorus depending on the current lab values.  A registered dietitian can help you with a meal plan that takes into account the needed restrictions and your personal food preferences.  A health coach can help you adjust to these changes.

Glomerular Filtration Rate(GFR) is used to indicate the severity of the disease.

Stage 1, kidney damage, normal or increased kidney Function, the GFR is 130 to 90 mL/min;

Stage 2, mild kidney damage and decreased kidney function the GFR is from 90 to 60 mL/min;

Stage 3, moderate and  decreased kidney function the GFR is 60 to 30 mL/min;

Stage 4, severe decreased kidney function the GFR is 30 to 15 mL/min.

Stage 5 is kidney failure; (kidney transplantation may be recommended), GFR 15 to 0 mL/min.

Early nutritional intervention may delay or prevent rapid progression of disease in some patients.   Subjective Global Assessment (SGA)  and other nutritional indicators, such as body mass index (BMI) , handgrip strength (for measures of muscle mass) waist circumference, serum albumin and serum creatinine, may be a good approach to provide useful information about the nutritional status of CKD patients.

Stage 1 CKD,  blood flow through the kidney is increases (hyperfiltration) .  The person in stage 1 usually has no symptoms.

Stage 2 CKD, if a person finds out that they are in state 2 is usually because they were being tested for another disease such as diabetes and high blood pressure (the two leading causes of kidney disease).

Stage 3 CKD A person with this stage has moderate decreased in the GFR.  This can occur after about 7 years of having diabetes.  As kidney function declines, uremia occurs.  Complication of kidney disease such as high blood pressure, anemia, and early bone disease may occur.  Protein needs to be limite to ,8 g/kg body weight.