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Suggest diet plan for a person with chronic kidney disease

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Posted on Thu, 7 Jul 2016
Question: Ki need to be on a low phosphorous and Uric acid diet due to chronic kidney disease stage 3. I'm considering a detox weight loss program that elinates meats breads and dairy They get their protein from legumes which are high in phosphorous. What are your thoughts about tofu or yogurt as a source? On the diet they have 2 smoothies a day including a total of 26 gram a day what is the recommended daily need for protein for female 75 yo and 333# . Challenging questions and if they aren't appropriate for you to consider I understand
doctor
Answered by Kathy Shattler (1 hour later)
Brief Answer:
Welcome to HCM. I have reviewed your questions

Detailed Answer:
Good afternoon,
Sorry for the delay. I was away from my computer and iPhone. Yes, these are all questions that should ultimately be dealt with by a visit with a Registered Dietitian in your home state of Kansas. Since there is licensure in Kansas, I will tell you how to get in touch with someone who can help you individualize your meal plan, answer your questions and provide support. If you google eatright.org you can look up RDs in your area by zip code.

However, I am not going to leave you without some guidelines on your question.
First, I would not try any detox weight loss program unless the program has been reviewed and approved by a physician and/or dietitian. It can be very dangerous for you.

No detox diet has any evidence based benefits except for keeping your bowels regulated so stool doesn't build up.

You asked how much protein you need.For adults with Chronic Kidney Disease CKD but without diabetes and not yet on dialysis, dietary protein of 0.6 g protein/kg body weight to 0.8 g protein/kg body weight per day is recommended. There is evidence that low protein intake (0.70 g protein/kg/day, with adequate energy intake) slows the decline of glomerular filtration rate (EBNPG-CKD, 2010).

You gave me your current weight, but no height. I cannot calculate ideal body weight. I don't know usual body weight. But, if I were to calculate .8 gm/pro per kg of current body weight it would be 121 grams. That is too high. Again, seeing a Registered Dietitian who can gather a complete history would be more helpful.

Furthermore, under medications,it says, see notes and the company never gave me any notes.

Phosphorous limitation:
800 to 1,000 mg/d or 10 to 12 mg phosphorus per gram of protein when serum phosphorus > 4.6 mg/dL or intact parathyroid hormone is elevated (Stages 3-4)

HIGH PHOSPHORUS FOOD TO LIMIT OR AVOID

Beverages
ale
beer
     chocolate drinks     cocoa
     drinks made with milk
canned iced teas     dark colas
           
Dairy Products     cheese     cottage cheese
     custard     ice cream
     milk/non-dairy creamer     pudding
     cream soups     yogurt
           
Protein     carp     crayfish
     beef liver     chicken liver
     fish roe     organ meats
     oysters     sardines
           
Vegetables: Dried Beans and Peas           
      baked beans     black beans
     chickpeas/garbanzo beans     lentils
     kidney beans     northern beans
     limas     split peas
      pork ’ n beans     
      soybeans     
           
Other foods XXXXXXX cereals     brewer’s yeast
     caramels     nuts
     seeds     wheat germ
     whole grain products     
What are medications for phosphorus control?

Your doctor may order a medicine called a phosphate binder for you to take with meals and snacks. This medicine will help control the amount of phosphorus your body absorbs from the foods you eat. There are many different kinds of phosphate binders. Pills, chewable tablets, powders, and liquids are available. Some types also contain calcium, while others do not. You should only take the phosphate binder that is ordered by your doctor or dietitian.

What do I do if my phosphorus level is too high?

When your phosphorus level is too high, think about your diet and substitute lower phosphorus foods for a while. Talk to your dietitian and doctor about making changes in your diet and ask about your phosphate binder prescription.

Yogurt is on the high phosphorous list.

Soft tofu: 8 g protein, 114 mg phosphorus, 150 mg potassium and 10 mg sodium.
Firm tofu: 10 grams protein, 152 mg phosphorus, 186 mg potassium and 15 mg sodium.
Extra firm tofu: 12 g protein, 155 mg phosphorus, 225 mg potassium and 95 mg sodium

To answer and provide the support you need, this is what a Dietitian needs to know:
Food and nutrient intake (Stages 1 through 5 chronic kidney disease (CKD) nutrition prescription guidelines for people who are not on dialysis (NKF-K/DOQI, 2000; NKF-K/DOQI, 2002; NKF-K/DOQI, 2003; Fouque, 2007; KDIGO 2009; McCann 2009; EBNPG-CKD 2010):

Protein
Glomerular filtration rate (GFR) < 50 mL/min/1.73 m2: kg of body weight x 0.60 g/kg – 0.80 g protein/kg of body weight
If diabetic nephropathy is present: kg of body weight x 0.80 –0.90 g pro/kg (EBNPG-CKD, 2010)
Energy
Adults with CKD, not on dialysis: 23 to 35 kcal/kg (EBNPG-CKD, 2010)
Overweight adults with CKD and diabetes, not on dialysis: 1,780 to 1,823 kcal (EBNPG-CKD, 2010)
Sodium: less than 2.4 g/d
Potassium: less than 2.4 g/d (Stages 3-4 CKD)
Phosphorus: 800 to 1,000 mg/d or 10 to 12 mg phosphorus per gram of protein when serum phosphorus > 4.6 mg/dL or intact parathyroid hormone is elevated (Stages 3-4)
Calcium: total elemental intake (including dietary calcium, calcium supplementation, and calcium-based binders) should not exceed 2 g/d (Stages 3-4)
Fluid: The need for a fluid restriction is determined by medical status, blood pressure control, physical findings (fluid accumulation), and any alterations in urine output (McCann, 2009).
Vitamins/Minerals
Dietary Reference Intake (DRI) for B-complex and vitamin C
Vitamin D: supplementation recommended if 25-hydroxyvitamin D level less than 30 ng/mL (EBNPG-CKD, 2010)
Iron: oral or intravenous supplementation recommended if serum ferritin below 100 ng/mL and transferrin saturation below 20% eg, diet history; diet experience; and intake of macronutrients and micronutrients such as energy, protein, sodium, potassium, calcium, phosphorus, and others) as appropriate
Intake changes
Taste alterations
Previous modified diet order and instruction
Nutrition-related knowledge, beliefs, and attitudes (eg, readiness to change nutrition and lifestyle behaviors)
Factors affecting access to food and food/nutrition-related supplies (FH-6) (safe food/meal availability, safe water availability [FH-6.3], appropriate meal preparation facilities
Medications (prescription and over-the-counter) (eg, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics), dietary supplements (vitamins, minerals, protein, etc), herbal or botanical supplement use
Nutrient-drug interactions
Behavior, including pica
Reassessment of Food/Nutrition-Related History

After the assessment and nutrition diagnosis, the following are addressed:

Stages 1 through 5 chronic kidney disease (CKD) nutrition prescription guidelines for people who are not on dialysis
Protein
Glomerular filtration rate (GFR) < 50 mL/min/1.73 m2: kg of body weight x 0.60 g/kg – 0.80 g protein/kg of body weight
If diabetic nephropathy is present: kg of body weight x 0.80 –0.90 g pro/kg
Energy
Adults with CKD, not on dialysis: 23 to 35 kcal/kg (EBNPG-CKD, 2010)
Overweight adults with CKD and diabetes, not on dialysis: 1,780 to 1,823 kcal (EBNPG-CKD, 2010)
Sodium: less than 2.4 g/d
Potassium: less than 2.4 g/d (Stages 3-4 CKD)
Phosphorus: 800 to 1,000 mg/d or 10 to 12 mg phosphorus per gram of protein when serum phosphorus > 4.6 mg/dL or intact parathyroid hormone is elevated (Stages 3-4)
Calcium: total elemental intake (including dietary calcium, calcium supplementation, and calcium-based binders) should not exceed 2 g/d (Stages 3-4)
Fluid: The need for a fluid restriction is determined by medical status, blood pressure control, physical findings (fluid accumulation), and any alterations in urine output (McCann, 2009).
Vitamins/Minerals (need for)
Dietary Reference Intake (DRI) for B-complex and vitamin C
Vitamin D: supplementation recommended if 25-hydroxyvitamin D level less than 30 ng/mL
Iron: oral or intravenous supplementation recommended if serum ferritin below 100 ng/mL and transferrin saturation below 20%

So, my dear, to provide you an accurate and safe recommendation or answer to your question requires that you spend the time and effort with an RD to get the help, assistance, support you need to prevent your kidneys from declining further, to lose that weight safely and to address ALL pertinent issues related to your kidneys not just phosphorous.

Medicare will pay for these visits. I highly recommend you take my referral and find a local licensed RD in your state close to you to work on these issues, increase your quality of life and get comprehensive care, which from your question I can see you did not receive.

No, this question is not too complicated for me. It is too complicated for a gp format on a forum such as this with no information to work with.

So, yogurt is out because of the phosphorous and with soy products you must read labels as they are all different and somehow you are under the assumption you just have to watch phosphorous and protein. I hope you see now from my answer there are many more things to watch in your diet than just phosphorous and protein and trying to lose weight along with following a renal diet for stage 3 all requires far more education than you have obviously received. Plus, you are restricting purines due to the uric acid.

I feel for your challenge. But receiving a quickie answer is not going to work for you. I am formally referring you to a RD, LD in your state of residence to receive the care, education and support you need and deserve.

My very best wishes to you and your challenges. XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
Kathy
Kathy Shattler

Dietitian & Nutritionist

Practicing since :1985

Answered : 890 Questions

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Suggest diet plan for a person with chronic kidney disease

Brief Answer: Welcome to HCM. I have reviewed your questions Detailed Answer: Good afternoon, Sorry for the delay. I was away from my computer and iPhone. Yes, these are all questions that should ultimately be dealt with by a visit with a Registered Dietitian in your home state of Kansas. Since there is licensure in Kansas, I will tell you how to get in touch with someone who can help you individualize your meal plan, answer your questions and provide support. If you google eatright.org you can look up RDs in your area by zip code. However, I am not going to leave you without some guidelines on your question. First, I would not try any detox weight loss program unless the program has been reviewed and approved by a physician and/or dietitian. It can be very dangerous for you. No detox diet has any evidence based benefits except for keeping your bowels regulated so stool doesn't build up. You asked how much protein you need.For adults with Chronic Kidney Disease CKD but without diabetes and not yet on dialysis, dietary protein of 0.6 g protein/kg body weight to 0.8 g protein/kg body weight per day is recommended. There is evidence that low protein intake (0.70 g protein/kg/day, with adequate energy intake) slows the decline of glomerular filtration rate (EBNPG-CKD, 2010). You gave me your current weight, but no height. I cannot calculate ideal body weight. I don't know usual body weight. But, if I were to calculate .8 gm/pro per kg of current body weight it would be 121 grams. That is too high. Again, seeing a Registered Dietitian who can gather a complete history would be more helpful. Furthermore, under medications,it says, see notes and the company never gave me any notes. Phosphorous limitation: 800 to 1,000 mg/d or 10 to 12 mg phosphorus per gram of protein when serum phosphorus > 4.6 mg/dL or intact parathyroid hormone is elevated (Stages 3-4) HIGH PHOSPHORUS FOOD TO LIMIT OR AVOID Beverages ale beer chocolate drinks cocoa drinks made with milk canned iced teas dark colas Dairy Products cheese cottage cheese custard ice cream milk/non-dairy creamer pudding cream soups yogurt Protein carp crayfish beef liver chicken liver fish roe organ meats oysters sardines Vegetables: Dried Beans and Peas baked beans black beans chickpeas/garbanzo beans lentils kidney beans northern beans limas split peas pork ’ n beans soybeans Other foods XXXXXXX cereals brewer’s yeast caramels nuts seeds wheat germ whole grain products What are medications for phosphorus control? Your doctor may order a medicine called a phosphate binder for you to take with meals and snacks. This medicine will help control the amount of phosphorus your body absorbs from the foods you eat. There are many different kinds of phosphate binders. Pills, chewable tablets, powders, and liquids are available. Some types also contain calcium, while others do not. You should only take the phosphate binder that is ordered by your doctor or dietitian. What do I do if my phosphorus level is too high? When your phosphorus level is too high, think about your diet and substitute lower phosphorus foods for a while. Talk to your dietitian and doctor about making changes in your diet and ask about your phosphate binder prescription. Yogurt is on the high phosphorous list. Soft tofu: 8 g protein, 114 mg phosphorus, 150 mg potassium and 10 mg sodium. Firm tofu: 10 grams protein, 152 mg phosphorus, 186 mg potassium and 15 mg sodium. Extra firm tofu: 12 g protein, 155 mg phosphorus, 225 mg potassium and 95 mg sodium To answer and provide the support you need, this is what a Dietitian needs to know: Food and nutrient intake (Stages 1 through 5 chronic kidney disease (CKD) nutrition prescription guidelines for people who are not on dialysis (NKF-K/DOQI, 2000; NKF-K/DOQI, 2002; NKF-K/DOQI, 2003; Fouque, 2007; KDIGO 2009; McCann 2009; EBNPG-CKD 2010): Protein Glomerular filtration rate (GFR) < 50 mL/min/1.73 m2: kg of body weight x 0.60 g/kg – 0.80 g protein/kg of body weight If diabetic nephropathy is present: kg of body weight x 0.80 –0.90 g pro/kg (EBNPG-CKD, 2010) Energy Adults with CKD, not on dialysis: 23 to 35 kcal/kg (EBNPG-CKD, 2010) Overweight adults with CKD and diabetes, not on dialysis: 1,780 to 1,823 kcal (EBNPG-CKD, 2010) Sodium: less than 2.4 g/d Potassium: less than 2.4 g/d (Stages 3-4 CKD) Phosphorus: 800 to 1,000 mg/d or 10 to 12 mg phosphorus per gram of protein when serum phosphorus > 4.6 mg/dL or intact parathyroid hormone is elevated (Stages 3-4) Calcium: total elemental intake (including dietary calcium, calcium supplementation, and calcium-based binders) should not exceed 2 g/d (Stages 3-4) Fluid: The need for a fluid restriction is determined by medical status, blood pressure control, physical findings (fluid accumulation), and any alterations in urine output (McCann, 2009). Vitamins/Minerals Dietary Reference Intake (DRI) for B-complex and vitamin C Vitamin D: supplementation recommended if 25-hydroxyvitamin D level less than 30 ng/mL (EBNPG-CKD, 2010) Iron: oral or intravenous supplementation recommended if serum ferritin below 100 ng/mL and transferrin saturation below 20% eg, diet history; diet experience; and intake of macronutrients and micronutrients such as energy, protein, sodium, potassium, calcium, phosphorus, and others) as appropriate Intake changes Taste alterations Previous modified diet order and instruction Nutrition-related knowledge, beliefs, and attitudes (eg, readiness to change nutrition and lifestyle behaviors) Factors affecting access to food and food/nutrition-related supplies (FH-6) (safe food/meal availability, safe water availability [FH-6.3], appropriate meal preparation facilities Medications (prescription and over-the-counter) (eg, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics), dietary supplements (vitamins, minerals, protein, etc), herbal or botanical supplement use Nutrient-drug interactions Behavior, including pica Reassessment of Food/Nutrition-Related History After the assessment and nutrition diagnosis, the following are addressed: Stages 1 through 5 chronic kidney disease (CKD) nutrition prescription guidelines for people who are not on dialysis Protein Glomerular filtration rate (GFR) < 50 mL/min/1.73 m2: kg of body weight x 0.60 g/kg – 0.80 g protein/kg of body weight If diabetic nephropathy is present: kg of body weight x 0.80 –0.90 g pro/kg Energy Adults with CKD, not on dialysis: 23 to 35 kcal/kg (EBNPG-CKD, 2010) Overweight adults with CKD and diabetes, not on dialysis: 1,780 to 1,823 kcal (EBNPG-CKD, 2010) Sodium: less than 2.4 g/d Potassium: less than 2.4 g/d (Stages 3-4 CKD) Phosphorus: 800 to 1,000 mg/d or 10 to 12 mg phosphorus per gram of protein when serum phosphorus > 4.6 mg/dL or intact parathyroid hormone is elevated (Stages 3-4) Calcium: total elemental intake (including dietary calcium, calcium supplementation, and calcium-based binders) should not exceed 2 g/d (Stages 3-4) Fluid: The need for a fluid restriction is determined by medical status, blood pressure control, physical findings (fluid accumulation), and any alterations in urine output (McCann, 2009). Vitamins/Minerals (need for) Dietary Reference Intake (DRI) for B-complex and vitamin C Vitamin D: supplementation recommended if 25-hydroxyvitamin D level less than 30 ng/mL Iron: oral or intravenous supplementation recommended if serum ferritin below 100 ng/mL and transferrin saturation below 20% So, my dear, to provide you an accurate and safe recommendation or answer to your question requires that you spend the time and effort with an RD to get the help, assistance, support you need to prevent your kidneys from declining further, to lose that weight safely and to address ALL pertinent issues related to your kidneys not just phosphorous. Medicare will pay for these visits. I highly recommend you take my referral and find a local licensed RD in your state close to you to work on these issues, increase your quality of life and get comprehensive care, which from your question I can see you did not receive. No, this question is not too complicated for me. It is too complicated for a gp format on a forum such as this with no information to work with. So, yogurt is out because of the phosphorous and with soy products you must read labels as they are all different and somehow you are under the assumption you just have to watch phosphorous and protein. I hope you see now from my answer there are many more things to watch in your diet than just phosphorous and protein and trying to lose weight along with following a renal diet for stage 3 all requires far more education than you have obviously received. Plus, you are restricting purines due to the uric acid. I feel for your challenge. But receiving a quickie answer is not going to work for you. I am formally referring you to a RD, LD in your state of residence to receive the care, education and support you need and deserve. My very best wishes to you and your challenges. XXXXXXX Shattler, MS,RDN