Relationship The Diet of Patients With Chronic Kidney Disease

ABSTRACT

One of the basic pillars of treatment in kidney disease is diet. Proper nutrition greatly improves the prognosis and slows down the evolution of kidney failure, therefore it is important to take care of the diet in all stages of the disease, although the diet varies depending on the stage of the disease in which the patient is and the substitute treatment or not chosen.

Throughout the disease process, you should eat with little salt, control fluids, reduce protein intake in pre-dialysis, monitor the intake of potassium foods in advanced stages and on dialysis.

It is important to achieve an adequate nutritional status through a diet that meets calorie, vitamin and mineral requirements and reduces the work overload on the kidney. We must find the right balance to maintain a diet low in protein, in order to reduce the symptoms of uremia, but at the same time, the lack of protein does not cause malnutrition. The majority of CKD patients without any replacement therapy do not meet the intake recommendations or nutritional goals, regardless of gender and PEW status, considering renal function as a limiting factor.

INTRODUCTION

The kidneys are responsible for eliminating waste substances from the blood and regulating fluids in our body. In severe kidney diseases, the kidneys stop doing these functions normally, so we must control both the intake of fluids and some foods. According to (F., 2009) chronic kidney disease (CKD) is a serious public health problem worldwide since it presents high morbidity and mortality as a consequence of cardiovascular disease (CVD) associated with loss of function renal. CKD can go unnoticed for many years for most individuals who suffer from it, even for the health team, since the early stages are usually asymptomatic. The prevalence of CKD in the world ranges from 8-16 (V, Garcia Garcia, Isekik, Nacker, & Plattner, 2012) and there is talk of an “epidemic” of CKD since the number of cases increases annually.

In Mexico, more than 26 thousand patients are on dialysis treatment and it is estimated that by 2020 that number will increase by at least 50%. The prevalence of individuals on chronic dialysis in Mexico was 663 patients per million inhabitants in 2013 and has registered a constant increase since 2004 as a consequence of the increasing incidence and increased survival on dialysis. (Situation of Terminal Chronic Renal Insufficiency, as a basis for a proposal for early detection of Chronic Kidney Disease, 2008). It mentions (Coresh, 2018) that the subjects most susceptible to developing CKD are carriers of the following conditions: advanced age, diabetes mellitus (DM), arterial hypertension (HBP), CVD, obesity, those who have first-degree relatives who suffer from this pathology, those with nephrourological antecedents, such as recurrent pyelonephritis or lithiasis.

They point out (V, Garcia Garcia, Isekik, Nacker, & Plattner, 2012) that the main cause of CKD and admission to dialysis in the world is diabetic nephropathy. CKD is frequently associated with other comorbidities such as CVD and diabetes, which is why this disease has high morbidity and mortality.

DEVELOPING

At present, it is recommended to classify CKD based on the cause, glomerular function (established from the glomerular filtration rate (GFR)) and the presence of glomerular damage: pre-dialysis, dialysis, hemodialysis and kidney transplantation (evaluated from urinary albumin (UA)) (Stevens P, 2013) Identifying the cause of CKD is essential for the doctor to predict the evolution and the nutritionist can guide the choice of dietary treatment. Above all, pay attention to several particularities such as: controlling the amount of proteins, since they subject the kidney to excessive work but are necessary to be very well nourished, with greater emphasis on lean meats, eggs and fish; reduce potassium since if it accumulates in the blood, the risk of presenting heart disorders increases, with greater emphasis on legumes (only once a week), vegetables and fruits since most contain high potassium content, with soaking and double cooking techniques, as far as phosphorus is concerned, it is part of hard tissues such as bones and teeth, it is important in maintaining pH and for all cellular functions that require energy. Its accumulation in kidney patients, not being able to eliminate it, can cause hyperparathyroidism among other problems, so it is important to control its consumption.

Phosphorus is also present in proteins, it is very important to reduce phosphorus because a long-term high blood level significantly affects the bones: avoid the consumption of whole grain products, nuts and any type of soft drink. Ensure the consumption of calcium and vitamin D since they are essential to protect the bones, moderately consume whole dairy products and finally control the intake of sodium (salt) and fluids. Sodium favors the retention of fluids that the kidney cannot eliminate, it is recommended to cook with little or no salt, season with aromatic herbs and spices, drink water depending on the amount that is urinated: ½ liter + amount excreted as required the case personally.

Protein nutritional recommendations for the kidney population are adjusted according to the stage of the disease. In patients in stages 3-4, diets of moderate protein restriction are recommended, between 0.6-0.8 g / kg / day, due to its association with positive effects such as preservation of renal function, improvement of the lipid profile, of insulin resistance, metabolic acidosis and phosphate load.

Dietary treatment in stages 4-5 of CKD includes the restriction of two important minerals in this pathology, potassium and phosphorus. However, in this study the intake is above the recommendations.

A high sodium intake is associated with increases in blood pressure and proteinuria, hyperfiltration is induced; For this reason, sodium intakes that are less than 2,400 mg / day are recommended in CKD.

CONCLUSION

Early detection of chronic kidney disease is a priority to prevent the global epidemic of this disease with devastating consequences for the patient, family and all health services. The two parameters used for its early detection require joint work between doctors and biochemists, since, on the one hand, the doctor must make the appropriate request for the parameter to be evaluated and, on the other, the biochemist must ensure the quality of the measurements that makes. However, we could not put aside the importance of the fundamental role of the presence of the nutritionist, since he evaluates the nutritional aspects to achieve an adequate nutritional status and preserve kidney function.

The glomerular filtration rate estimated by formula is recommended for the evaluation of renal function as a tool for physicians, while the detection of albuminuria is indisputable as an early marker of kidney damage as a basic operation in the laboratory and due to the significance of the diet as a treatment for malnutrition in CKD.

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