©2010 DaVita Inc. All rights reserved. 1 Nutrition and Kidney Disease Sara Colman, RD, CDE DaVita.com Nutrition Project Specialist

1©2010 DaVita Inc. All rights reserved.

Nutrition and Kidney Disease

Sara Colman, RD, CDEDaVita.com Nutrition Project

Specialist


What this talk means to you tomorrow

• What you eat matters to your health in chronic disease prevention and treatment

• Diet goals change with stages of chronic kidney disease (CKD) and dialysis

• What you do now makes a difference tomorrow


Today’s Discussion

• What to eat to prevent kidney disease

• What is a kidney diet?• Making changes in eating habits• Healthy foods to include• Tools and resources• Questions and answers


Audience Question #1

Which one best describes the way you eat?A. Regular, no restrictionsB. Heart healthy dietC. Diabetic dietD. Low sodium dietE. Kidney diet



Have you ever had to make changes in the way you eat due to your health?

A. Yes, I made changes for health reasonsB. No, I never needed to make changesC. I should but haven’t made changes yet



Which one are you most interested in knowing about nutrition and kidney disease?

A. How much protein to eatB. Healthy foods for a kidney dietC. Phosphorus and potassium guidelinesD.Sodium and fluid guidelines


1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2008

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System


2008

Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

2008


0

1

2

3

4

5

6

7

1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06

Year

Per

cen

t w

ith

Dia

bet

es

0

2

4

6

8

10

12

14

16

18

20

Nu

mb

er w

ith

Dia

bet

es (

Millio

ns)Percent with Diabetes

Number with Diabetes

Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2008

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics


Nutrition and chronic disease link


Maria• Married with four

children ages 7, 9, 12, 15

• High blood pressure

• At risk for kidney and heart disease


High in…

• Fiber• Potassium• Calcium• Magnesium

Low in…

• Sodium• Fat

Lower systolic (upper number) blood pressure 11 points

Could lead to…

Prevention: DASH* Diet Dietary Approaches to Stop Hypertension

*Free booklet available at www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf*NOTE: Not recommended for people with advanced kidney disease


Nuts &Seeds

4-5servings

Vegetables4-5

servings Fat-free/Low-fat

Dairy Products2-3

servings

Fruit4-5

servings

6 oz orless

-lean meat-poultry

-fish

Grains6-8

servings

Dash Diet: Dietary Approaches to Stop Hypertension

Limit fats, oils, sweets and added

sugars


Most people don’t

recognize a portion

Clean plate vs satisfied

Is more really better?

Portion Distortion


Common Portion - References


Laverne• Retired widow,

two grown daughters, 5 grandchildren

• Type 2 diabetes• High blood

pressure• Stage 3 CKD


Diet in Early Kidney Disease

Important Nutrients

• Sodium• Protein• Phosphorus (stage 3)• Calories

Focus on…

Individual Differences

• Size• Stage of CKD• Nutrition• Lab results

Diet Goals

• Weight• Good nutrition• Management of

• Blood pressure• Glucose


Tips to Decrease Sodium Intake

Eat out less (especially Fast Food)

Cook at home with low-sodium ingredients

Read labels

1000-3000 mg

sodium/dayfor ALL

kidney diets

Cut out: • Salt• High-sodium condiments• Processed, cured foods

Add: • Herbs• Spices

• Lemon• Vinegar


Common Sodium SourcesThe following has.. This much sodium

1 slice of bread 110 – 175 mg

1 cup ready-to eat cereal 0 – 360 mg

½ cup canned vegetables 140 – 460 mg

1 cup tomato or V-8 330 mg

1 tsp salt 2100 mg

2 oz natural cheese 110 – 450 mg

2 oz processed cheese 600 mg

1/3 cup salted nuts 120 – 200 mg

3 oz canned tuna 230 – 350 mg

3 oz ham 1020 mg


All stages – if malnourished

• Eat additional protein

Protein Intake

50% High Quality Protein Sources

Example:A 150 lb

(68kg)

• 55 grams• 1 cup milk• 1 egg or 2 egg whites• 4 oz meat• 3 – 4 vegetables• 6 servings of grains

Stages 1 - 3

• Eat protein for good healthDRI*:

*DRI = Dietary Reference Intake


Benefits of Carbohydrate Counting

• Has biggest effect on blood sugar (compared to protein and fat)

• Helps improve glucose control• Increases awareness of carbohydrate

intake• Requires more self-monitoring and

decision making• Easier than some of the complicated

diabetes meal planning methods


Carbohydrate Counting

• Which food groups have Carbs?• How much carbohydrate to eat at

each meal or snack?• What is a serving/choice/exchange?• How much carbohydrate is in a

serving?• Label reading for carbohydrates


Goals for Glucose Control

American Diabetes AssociationRecommends the following ranges:

Glucose

•Pre-meal: 90-130 mg/dL

•2 hours after eating: <180 mg/dL

HbA1C: < 7%


When to Monitor Glucose

• Daily before each meal and bedtime

• Hypoglycemia or hyperglycemia

• During insulin adjustment periods

• Changes in exercise, diet, meal times

• 1-4 times a day, 3-4 days a week

• Before breakfast• Before and 2 hour

after the largest meal• Medication changes• Changes in exercise,

diet, meal times

Type 1 Type 2


Alex• Married, high school

teacher, 2 teenage sons

• High blood pressure• Stage 5 kidney

failure• Training to start

dialysis


Diet in CKD Stages 4 - 5Focus on…

Individual Differences

• Size• Nutrition• Lab results

Important Nutrients

• Calories• Protein• Sodium• Phosphorus

• Fluid• Potassium• Calcium

Diet Goals

• Management of• Blood pressure• Glucose• Minerals• Fluid

• Weight loss prevention

• Nutrition


Stage 5 -On dialysis

• Eat MORE protein

All stages – if malnourished

• Eat additional protein

Protein Intake

50% High Quality Protein Sources

Example:A 150 lb

(68kg)

• 41 – 48 grams• ½ cup milk• 1 egg or 2 egg

whites• 2 oz meat• 2 – 3 vegetables• 5 – 6 servings of

grains

• 82 grams• ½ cup milk• 2 eggs or 4 egg

whites• 6 oz meat• 3 vegetables• 8 servings of

grains

Stage 4 or 5 -Not on dialysis

• Eat LESS proteinDRI*:



• Usually not restricted

• Changes in medications that increase potassium

• Stop using salt substitute and products that have potassium chloride added (check labels)

• Learn about highest potassium fruits and vegetables—have these less frequently and in smaller portions

• Learn about other high potassium foods to limit

CKD Stages 1 – 3 CKD Stages 4 and 5

Potassium and CKD


Common Potassium SourcesThe following has.. This much potassium

1 medium baked potato 925 mg

1 medium sweet potato 540 mg

½ cup cooked spinach 290 mg

½ cup fresh tomato 210 mg

1 cup cantaloupe 430 mg

1 medium banana 420 mg

1 orange 240 mg

½ cup beans 360 mg

1/3 cup nuts or seeds 120-310 mg

1 cup milk or yogurt 360-490 mg

3 oz meat, poultry, fish 200-400 mg


• Usually not restricted

• 800 to 1000 mg/day for most patients

• Lower protein diets decrease phosphorus

• Phosphate binders may be needed

• Ask your doctor to check phosphorus level and discuss the results

• Learn about and limit highest phosphorus foods

• Processed foods and phosphate additives—read labels

• Early phosphorus control may delay bone disease

CKD Stages 1 – 2 CKD Stages 3 – 5

Phosphorus and CKD


High Phosphorus FoodsThe following has.. This much phosphorus

1 oz meat 65 mg

2 tablespoons peanut butter 100 mg

½ cup milk 110 mg

1 cup Hawaiian Punch 115 mg

1 oz cheese 100 – 150 mg

½ cup beans (pinto, lima) 125 mg

2/3 cup bran flakes 150 mg

Fast food small cheeseburger 176 mg

3 tablespoon (1 oz) sunflower seeds

328 mg

Fast food sausage & egg biscuit 490 mg


• 1200 – 1500 mg/day based on DRI*

• May need vitamin D3

• Not to exceed 2000 mg/day, including calcium-based binders

• Activated vitamin D

• PTH control important

CKD Stages 1 – 4 CKD Stage 5

Calcium



Healthy Fats High Quality Proteins Fiber

• Omega 3’s• Sardines• Salmon• Mackerel• Trout• Fish oil

supplements• Monounsaturated

fats• Olive oil• Canola oil• Flax seed oil

• Egg white• Fish• Lean meats & poultry

• Fruits• Berries• Apples

• Vegetables• Broccoli• Green beans• Cabbage• Summer squash

• Bread, cereals & grains

Healthy Foods to Eat


Anti-inflammatory,

high antioxidantsVitamin C Vitamin E Beta-carotene

• Fruits• Apples• Blueberries• Cherries• Cranberries• Raspberries• Red grapes• Strawberrie

s

• Vegetables• Cabbage• Cauliflower• Garlic• Onion• Red

peppers

• Fruits• Grapefruit• Lemon• Strawberrie

s• Tangerine

• Vegetables• Bell

peppers• Broccoli• Greens• Cabbage• Celery• Zucchini

• Oils• Canola• Sunflower• Wheat germ• Vegetable

• Fruits• Apricots

• Vegetables• Carrots• Leafy greens• Broccoli• Romaine

lettuce• Green

Peppers

Eat the Rainbow for Good Health red, orange, yellow, green and purple


Educate

• Learn about foods

• Best to have• What to limit

• Use existing Kidney Education

Support

• Educate family and friends

• Join a support group

• Start a recipe/meal exchange

Vary Meals

• Experiment with new herbs and spices in familiar foods

• Explore unfamiliar foods

• Try new recipes

Commit to Change

• Start small• Acknowledge

successes• Keep

records/food diary

• Focus on benefits and motivation sources

Making Diet Changes


Kidney Friendly Recipes

• Websites*• Newsletters• Books• Kidney organizations

Possible Sources

Online Meal Planners and

Trackers• DaVita Diet Helper*

Diet and Nutrition Education

• Videos• Magazine articles

Kidney Diet Tools and Resources

Kidney Community

• Blogs• Discussion forums*

*Available at www.davita.com


Takeaway: What this means to you tomorrow morning

• What you eat at each meal now makes a difference in your future health

• Diet goals change with stages of chronic kidney disease (CKD) and dialysis

• You can make small gradual changes that really add up


Thank you!

Documents

©2010 DaVita Inc. All rights reserved. 1 Nutrition and Kidney Disease Sara Colman, RD, CDE DaVita.com Nutrition Project Specialist