Practical Approaches To Nutritional Therapy For Chronic Kidney Disease (CKD)

What You Need to Know About Chronic Kidney Disease (CKD)

In recent years, the incidence of chronic kidney disease has been increasing globally, and the public generally lacks knowledge on the prevention and treatment of this disease. According to its etiology, it can be divided into three types: primary, secondary, and hereditary. CKD is a disease closely related to lifestyle. An unreasonable lifestyle, especially an unreasonable dietary structure will accelerate the progress of chronic kidney disease and promote the occurrence of various complications.

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Risk factors for the progressive development of CKD include hyperglycemia, hypertension, urinary protein (including microalbuminuria), and hypoalbuminemia, in addition to anemia, hyperlipidemia, high phosphorus, old age, malnutrition, and uremia The accumulation of toxins will also promote the development of chronic kidney disease. According to the observation of outpatients and inpatients with CKD in the Department of Nephrology in our hospital in the past 3 years, the proportion of patients with hyperuricemia is relatively high. Current studies have shown that hyperuricemia (HUA) is a common complication of chronic kidney disease (CKD). It is an important risk factor for the progression of renal function in CKD patients. Therefore, the level of blood uric acid UA should be actively controlled to delay the progression of CKD.

Nutritional therapy plays an important role in the integrated treatment of chronic kidney disease. The principle of dietary supply is sufficient calories, low-salt, high-quality, low-protein, and a balanced diet of potassium, phosphorus, and vitamins. Scientific and reasonable nutritional therapy can delay the progress of renal failure, delay the start of dialysis, reduce the accumulation of "toxins" in the body, correct various metabolic disorders, and improve nutritional status, thereby reducing symptoms of patients, improving the quality of life, and increasing patient survival. Studies have shown that from the third stage of CKD, phosphorus intake should be limited, that is, 600-800mg/d, because high phosphorus is an independent risk factor for CKD death, and it is also easy to cause discomfort symptoms such as skin itching in patients; when GFR drops to 20 -25ml/(min.1.73m2), the patient's urine output decreases, the ability of the kidney to excrete potassium decreases, and hyperkalemia is prone to occur, so the intake of potassium should be strictly limited.

The importance of "blanching water"

"Blanching water" is putting the preliminary processed raw materials in a boiling water pot until they are half-cooked or fully cooked, and then taking them out for further processing. "Nan" is called "Zhao" in Guangdong. After "blanching water" processing, the color of vegetables will be more vivid, the peculiar smell of meat will be reduced, and the cooking time will be shortened. Especially for CKD patients, the benefits of "blanching" processed foods are particularly important!

(1) Vegetables and fruits are cut first, then soaked, and then "blanched" for processing and eating. After processing in this way, part of the potassium in the vegetables will be removed, thereby reducing the risk of hyperkalemia and increasing the types of fruits and vegetables that patients can choose, not just limited to low-potassium vegetables and fruits. Moreover, the color of vegetables processed by "blanching water" is better, which can easily arouse the appetite of patients and improve their quality of life.

Foods with low potassium content (less than 150mg of potassium per 100g of food):

Including loofah, vegetable melon, wax gourd, etc.;

Foods with moderate potassium content (150mg to 250mg of potassium per 100g of food):

Including Chinese cabbage, leeks, cauliflower, lettuce, etc.;

Foods with high potassium content (more than 250mg of potassium per 100g of food):

Including citrus, bananas, fungus, mushrooms, kelp, and potatoes.

Warm reminder: Do not drink vegetable soup, and avoid excessive intake of sodium and potassium.

(2) Lean meat, fish, and other high-quality proteins are marinated and "blanched" or eaten after stewing and discarding the soup. This can not only reduce the intake of purines, but also reduce the content of phosphorus, which is very suitable for elderly patients with chronic kidney disease A cooking method, such as boiled lean meatballs, or stir-fried shredded meat can be marinated with starch before "blanching", which is not only good for chewing but also ensures the intake of high-quality protein (the intake depends on the patient's height, weight and specific calculation based on factors such as the stage of kidney disease).

The degree of phosphorus reduction after "blanching" processing is related to factors such as the amount of water used, the size of the ingredients, the cooking time, and whether the skins are peeled. The method of controlling blood phosphorus by restricting protein intake may do more harm than good. You should refer to the phosphorus/protein ratio in the food to choose foods with high protein content but less phosphorus content. Generally, foods with a ratio of less than 12mg/g are low-phosphorus foods, such as egg white, commonly known as egg white, which contains high protein, and a phosphorus content is only 1.4mg/g.

The method of "blanching water" further reduces the intake of phosphorus. Studies have shown that the processing of "blanching water" can reduce the phosphorus in vegetables by 51%, and the phosphorus in meat foods can also be reduced by 38%.

The absorption rate of phosphorus in animal protein is about 50%, the absorption rate of phosphorus in plant protein is 30%, and almost all the phosphorus in food additives will be absorbed, so the intake of inorganic phosphorus in processed food should be strictly limited.

(3) Staple food "blanching water" processing. For patients who eat part of the staple food of wheat starch, after "blanching" rice and noodles to make rice and noodles, part of the phosphorus content can be reduced. Most of the staple foods of wheat starch have been processed with water during the production process, so the phosphorus content is relatively low.

(4) After "blanching water" processing, the content of oxalic acid in food can be reduced. Patients with chronic kidney disease have a high incidence of renal anemia and renal bone disease. It is necessary to minimize the impact of oxalic acid on the absorption of calcium and iron in the human body. At the same time, increase the intake of foods rich in calcium and heme iron in the diet.

for more information：ali.ma@wecistanche.com