Although this blog might buck the trend in terms of length, the topic is important, since about 45% of those over age 65 older have some chronic kidney disease (CKD) that, if untreated, could lead to “End Stage Kidney Disease” (ESRD) and the hemodialysis that accompanies this condition.
For many, simple changes in the way we eat can stop the progression of CKD.
CKD is one of the most prevalent and expensive chronic conditions in the United States. Approximately 26- million people have CKD and it is estimated that over 17% of the costs in the fee-for-service component of Medicare are for mild to moderate CKD related issues (2012 US Renal Data System). If dialysis and kidney transplants (ESRD) are added to the total costs, almost 25% of Medicare expenditures are on CKD and ESRD.
In the most basic sense, kidneys serve as a blood filtering organ. Indeed, blood flow through the kidneys is one of the highest of all organs, with over 20% of blood flow from the heart going directly to them. The kidneys serve to filter out wastes from daily metabolism and ingested foods, and in doing so, they help regulate and maintain a proper fluid and chemical balance to produce urine.
During normal metabolism and health, kidneys operate with a large filtration rate (glomerular filtration rate, GFR) range. At this level, kidneys are able to filter wastes including protein breakdown products and water. The filtration rate of certain molecules (albumin or creatinine, which can be tested by simple blood tests) can be measured to estimate GFR. As we age, GFR may decrease a bit.
However, chronic kidney disease is recognized when GFR and the ability to filter out waste reaches a certain level that is below normal GFR. End stage renal disease (ESRD) is stage five, and usually means the kidneys are operating at less than 15% of normal GFR.
The importance of nutrition in the development and progression of CKD is clear. High blood pressure and diabetes are recognized as being the cause of two thirds of the cases of CKD as both put undue strain on kidneys. In many cases these can both be controlled by an awareness of what and how much of certain foods should be consumed.
Typical ESRD patients require weekly hours of being hooked up to a dialysis machine, which literally filters the blood through a series of different devices. I have heard dialysis being comparable to running a half marathon with the same amount of fatigue.
In between dialysis session patients must keep their fluid intake, salt, and other mineral intakes low to avoid fluid buildup in the body. As the fluid builds up in the body between dialysis sessions, fatigue and other issues may arise. Excessive fluid buildup can impair heart and lung function and lead to death.
What can you do to prevent or slow kidney disease?
Recommendations for prevention of diabetes and hypertension apply. Eat a healthy diverse diet with fresh prepared meals, avoiding high salt, high fat processed foods, eat vegetables and fruits, and get some exercise – 30 minutes a day will do it.
If you are diagnosed with CKD, the first step is to follow the advice of your doctor. It might also be wise to consult with a Registered Dietitian well versed in renal nutrition. While each stage of CKD has some specific nutrient requirements, diets in the earliest stages focus primarily on consumption of a normal, heart healthy diet.
Recommendations for a renal friendly diet include consuming the amount of calories to that normally required for the level of activity, observing sodium and potassium intakes to keep within heart healthy guidelines, restricting the amount of phosphorus consumed and enjoy certain fruits and vegetables, grains, and likely restrict protein. If you have high blood pressure, sodium intake levels are critical and must not exceed those recommended by your health providers.