Once a patient is diagnosed, it is important that they make changes to their diet to manage their disorder and prevent further deterioration
Chronic kidney disease is a condition where your kidney is not functioning correctly. Your kidneys filter your blood and remove waste from the body. The kidneys also regulate blood pressure and manages the balance of electrolytes, so it plays an essential role in your overall health.
While kidney disease can be a genetic disorder that affects people from a young age, there are also lifestyle issues, which can lead to the condition. Reasons for the onset of kidney disease include high blood pressure, high cholesterol, kidney inflammation and infections. Another key reason is diabetes, which is a common cause here in the UAE.
There are a number of different symptoms that could indicate you’re suffering from kidney disease. These include swollen ankles, feet or hands, feelings of nausea and shortness of breath. Fatigue and blood in your urine could also be indicative of a deeper underlying problem. Dr Najla Darwish, Clinical Dietician at Nephrology Department, Dubai Hospital, Dubai Health Authority (DHA), says it’s important to seek medical advice from a professional, so that you can take steps towards preventing further deterioration and health issues. DHA has a multidisciplinary approach to treating patients with chronic kidney disease. It enlists social workers, psychologists, dialysis professionals and dieticians, who work as part of a team to improve the patient’s health.
While all the different elements of healthcare are important in the treatment of patients with chronic kidney disease, diet is particularly significant.
Dr Darwish says that, if you suffer from chronic kidney disease, “You should avoid fried food, restrict salt intake and fat intake. At the same time, you should control your weight and blood sugar. When you’re overweight, it has a negative effect on your metabolism and your kidney function lowers. Obesity also increases the risk of damaging the kidney.”
Another significant aspect is hydration. It’s recommended that individuals with kidney disease avoid sugary soft drinks and drink plenty of water. “It’s also important to drink enough water, according to your body’s requirements,” says Dr Darwish. “I usually recommend between two and three litres per day.”
When patients with chronic kidney disease consult a dietician, they will have a blood test to measure a number of factors. “We look at the phosphates, calcium levels, urea, creatinine, electrolytes and polyelectrolytes in the blood. We need to keep these balanced by controlling the patient’s dietary intake.” A balanced level of electrolytes is important if the sufferer is to avoid detrimental side effects.
“There will be an abnormality of electrolytes in the blood, which can sometimes cause weakness. In certain cases, patients will not be able to walk well and they will feel heavy. They may also experience difficulty breathing,” she says.
Most of us realise the nutritional and health benefits of a well-managed diet. Too much salt and sugar can lead to high blood pressure, obesity and even heart disease. Yet, in terms of some of your body’s more complex requirements, such as potassium levels, changes to your diet can have beneficial results.
“For example, some fruits are high in potassium, so I would suggest that the patient eats less oranges, bananas and mangoes if their potassium levels are too high. Dates are also high in potassium.”
Each week, between 230 and 240 patients are treated with dialysis at Dubai Hospital. While some have kidney transplants, many require dialysis several times a week. Dialysis filters out waste from your blood. Yet it can also remove proteins.
“If your body doesn’t receive enough protein, then it will start to break down muscle to take the protein it needs. This can cause weight loss, fatigue and it can increase your likelihood of contracting infections and viruses. Therefore, it is necessary to ensure that individuals have the correct level of protein. Vegetarian sources of protein include soy products, beans, eggs and nuts. Meat, such as chicken and beef, as well as fish are also rich in protein.
DHA’s approach to nutrition goes beyond merely advising on what foods are healthy and what quantities people should eat. Patients are educated on all aspects of food, ranging from how to prepare a healthy diet to what alternatives are available for patients with particular tastes. “If the patient, for example, doesn’t like green vegetables, we advise them of an alternative. Maybe we will suggest different ways of preparing them. We usually try to find at least two types of vegetables that the patient likes. There are alternatives as well, such as making vegetables into a soup,” says Dr Darwish.
“I provide patients with diet advice for one month and I check their progress with monthly blood tests. I also monitor the patient’s body weight before and after dialysis.
“For most patients I change their diet monthly but for some, I make changes every two weeks. This is usually for patients who have issues, such as morbid obesity. If the plan is suitable for the patient and I get the correct outcomes, then I will not change their diet. It’s best to offer the patients choices and variety because you cannot follow the same diet for one month. My focus tends to be on the quantity that people consume, she says.”
Dr Darwish believes that in most cases, a healthy and balanced diet will provide you with the necessary vitamins and nutrients. Yet she also acknowledges that in some cases, it’s helpful to prescribe supplements. “Some geriatric patients cannot eat that much. You also have to see how weak they are and which foods they cannot chew. In this case, we can give them supplements to ensure that they get all of the vitamins and minerals they require. If they can eat well then there is no need to prescribe supplements for them. However, if the patient can’t eat or they have an issue, such as lactose intolerance, we can prescribe some supplements. This also tends to be the case for patients who are eating well but have low haemoglobin levels — we give them supplements for one or two months to give them balance,” she says.
Dietary changes for individuals suffering from chronic kidney disease is important. In some cases it can even reduce the regularity with which people are treated with dialysis. For Dr Darwish, it’s a simple philosophy: “My goals are to keep the patient’s electrolytes balanced, to prevent any malnutrition and ensure that the patient eats healthy food and has a healthy lifestyle,” she says.
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