2) CHRONIC RENAL FAILURE
Chronic kidney disease (CKD) slowly gets worse over time. In the
early stages, there may be no symptoms. The loss of function
usually takes months or years to occur. It may be so slow that
symptoms do not occur until kidney function is less than one-tenth
The final stage of chronic kidney disease is called end-stage
renal disease (ESRD). The kidneys no longer function and the
patient needs dialysis or a kidney transplant. Chronic kidney
disease leads to a buildup of fluid and waste products in the
body. This condition affects most body systems and functions,
including red blood cell production, blood pressure control, and
vitamin D and bone health.
Diabetes and High blood pressure are the two most common causes
and account for most cases. Other causes may include birth defects
of kidneys, medications or drugs, autoimmune disorders,
trauma, kidney stones or infection, or even reflux nephropathy (in
which the kidneys are damaged by the backward flow of urine into
Symptoms may include general ill feeling and fatigue, generalized
itching (pruritus) and dry skin, headaches,
weight loss without
trying to lose weight, appetite loss, nausea, bone pain,
drowsiness and confusion, numbness in the hands, feet, or other
areas, muscle twitching or cramps, breath odor, excessive thirst,
frequent hiccups, menstrual periods stop (amenorrhea), insomnia,
swelling of feet and hands and vomiting.
When you have chronic kidney disease, you need to make changes in
your diet, including:
• Limiting fluids
• Eating a low-protein diet (this may be recommended)
• Restricting salt, potassium, phosphorous, and other electrolytes
• Getting enough calories if you are losing weight
The purpose of this diet is to maintain a balance of electrolytes,
minerals, and fluid in patients who are on dialysis. The special
diet is important because dialysis alone does not effectively
remove all waste products. These waste products can also build up
between dialysis treatments.
Most dialysis patients urinate very little or not at all.
Therefore, fluid restriction between treatments is very important.
Without urination, fluid will build up in the body and lead to
excess fluid in the heart, lungs, and ankles.
*If you are overweight or have diabetes, you may need to
limit the amount of carbohydrates you eat. Otherwise,
carbohydrates are a good source of energy for your body.
Fruits, breads, grains, and vegetables provide energy, as
well as fiber, minerals, and vitamins.
*Fats can be a good source of calories. Make sure to use
monounsaturated and polyunsaturated fats (olive oil,
canola oil, safflower oil) to help protect your arteries.
*Low-protein diets may be helpful before dialysis. Once
you start dialysis, you will need more protein. In fact,
a high-protein diet with fish, poultry, pork, or eggs at
every meal may be recommended. This will help you replace
muscles and other tissues that you lose.
*Calcium and phosphorous are also monitored closely. Even
in the early stages of chronic kidney disease,
phosphorous levels in the blood can become too high. This
can cause low calcium (this causes the body to pull
calcium from your bones, which can make your bones weaker
and more likely to break) and itching. Fruits and
vegetables contain only small amounts of phosphorous so
can be taken liberally.
*You may need to take calcium supplements to prevent bone
disease, and vitamin D to control the balance of calcium
and phosphorous in your body.
*Tips to keep from becoming thirsty include:
1. Avoid salty foods
2. Freeze some juice in an ice cube tray and eat it like a
popsicle (you must count these ice cubes in your daily amount of
3. Stay cool on hot days
*Reducing sodium in your diet helps you control high blood
pressure, keeps you from being thirsty, and prevents your
body from holding onto extra fluid.
*Normal blood levels of potassium help keep your heart
beating steadily. However, too much potassium can build
up when the kidneys no longer function well.
*When eating fruits choose peaches, grapes, pears,
cherries, apples, berries, pineapple, plums, tangerines,
and watermelon. Limit or avoid oranges and orange juice,
Kiwis, raisins or other dried fruit, bananas, cantaloupe,
honeydew, and prunes.
*When eating vegetables choose broccoli, cabbage,
carrots, cauliflower, celery, cucumber, eggplant, green
and wax beans, lettuce, onion, peppers, watercress,
zucchini, and yellow squash. Limit or avoid asparagus,
avocado, potatoes, tomatoes or tomato sauce, winter
squash, pumpkin, avocado, and cooked spinach
*Patients with advanced kidney failure usually need extra
iron. Many foods contain extra iron (liver, beef, pork,
chicken, lima bean and kidney beans, iron-fortified
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