Chronic kidney disease

What is chronic kidney disease?

Chronic kidney disease (CKD) is a condition that occurs when the kidneys are damaged and not working as effectively to filter the blood. The kidneys play may important roles, such as removing waste from the body and balancing fluid levels, as well as producing vitamin D. When the kidneys are not functioning as well, this causes a build up of waste products such as urea, creatinine and uric acid, which can lead to complications. Around 10% of the population has some stage of CKD (1). 

 

Symptoms (2)

There are some symptoms of CKD to be aware of, but usually these do not appear until further disease progression, when the kidneys are failing, and protein is building in the urine. This includes:

  • Increased urination, especially during the night & possibly blood in urine
  • Unintentional weight loss or lack of appetite
  • Poor sleep
  • Swelling of the legs, ankles, feet and hands, as well as puffy eyes
  • Fatigue and trouble concentrating
  • Dry, itchy and flaky skin
  • Muscle cramps

 

Stages of Chronic kidney disease

To determine the stage of CKD that someone is at, a blood test is taken to check for their estimated Glomerular Filtration Rate (eGFR). This considers the creatinine levels in the blood, with the persons weight, age and gender. The less the kidneys work, the lower the eGFR number.

A urine test can also be carried out check the levels of substances called albumin and creatinine in your urine – known as the albumin: creatinine ratio, or ACR. A level of ACR more than 3mg/mmol is diagnostic of CKD.  

For both eGFR and ACR, a higher stage indicates more severe kidney disease (3). The eGFR measurement may be inaccurate in those who have a much higher or smaller muscle than the average person of their age, sex and ethnic origin (4).

Risk factors

 If you have or are at risk of type 2 diabetes, high blood pressure, or have a family history of CKD, this increases the risk – so it is important to get an annual test (2). Approximately 1 in 3 adults with diabetes (and 1 in 5 adults with high blood pressure) may have CKD (5).

 

Treatment/Management

Unfortunately, there is no current treatment for CKD. However, diet and nutrition can play a big role in the different stages of CKD, helping to improve health outcomes and reduce further decline of kidney function. Depending on what stage of CKD a person is at, requirements may vary.

It is important to try to prevent (or manage) type 2 diabetes and high blood pressure, as these are the biggest risk factors. This is because these conditions damage the blood vessels in the kidneys. Maintaining a healthy and balanced diet with regular physical activity is important, as this can help with the above.

Simple changes to your eating will help to control your blood pressure, blood glucose levels and reduce your risk of heart disease.  This can help protect your kidneys from further damage and help you to feel well. These include:

  • Reducing blood sugar levels through diet and exercise
  • Controlling blood pressure – managing salt intake is important
  • Taking medications as required
  • Avoiding smoking and minimising/avoiding alcohol

 

Key areas of nutrition to consider

Protein intake

Since too much protein can cause a build up of excess waste, you may be advised to follow a protein limit. As kidney disease increases, protein limitation may increase. However, it is still important to consume enough protein to prevent muscle wastage. Reducing animal protein and increasing plant protein can help, as this is easier for the kidneys to filter, due to a lower level of urea production. Protein portions are specific to the stage of CKD, so it is important to speak to a renal dietitian to assess your needs.

Sodium levels

A higher level of salt (sodium) intake can strain the kidneys, leading to complications such as shortness of breath, swelling and an increase in blood pressure. A low sodium diet is important to prolong kidney function – discussing this with your kidney dietitian will provide you informed and practical advice on making sustainable changes.

Potassium and phosphorus levels

Depending on the stage of CKD you are at and your blood results, we may need to restrict (or possibly increase) the level of these minerals. This is because the kidneys are responsible for filtering these minerals in the blood. However, restriction is not often necessary at earlier stages of CKD, so it is important to check with your renal team and dietitian, for the correct advice of restriction and if it is needed. (6)

 

Myths around CKD

Kidney damage is caused by alcohol intake

In reality, there are many things that can lead to kidney damage – with diabetes and high blood pressure being the most common. Drinking alcohol does not directly influence kidneys, but can increase the risk especially with a high intake. However, a moderate and low intake of alcohol is ok.

If you are at risk of CKD, you cannot change this

No! In fact, there are many dietary and lifestyle changes that can be made to reduce the risk of development, or further worsening of CKD. This is why seeing a renal nutritionist can make all the difference!

You will need dialysis if you have CKD

Not everyone who develops CKD will need dialysis. As CKD is a progressive disease, dialysis is often only needed when the kidneys have lost almost (or all) function – this is at stage 5, when eGFR is at 15 or less.

If you are looking for nutrition support with CKD, reach out to us today and we can team you up with our renal dietitian to ensure you are doing what you can to prolong your kidney health for the future!

To book a 1-1 consultation with a renal dietitian, click on the link HERE

By Reema Patel, Registered Dietitian at Dietitian Fit & Co