Living With Chronic Kidney Disease

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Living with chronic kidney disease (CKD) can often be challenging and distressing, especially if the disease is progressing and you're faced with the possibility of dialysis. Even in situations like this, there are ways to get in front of the disease and protect your kidneys from further harm. This not only involves making healthier lifestyle choices—including maintaining a special diet, exercising, and quitting cigarettes, if you smoke—but building a support team able to help you negotiate the daily demands of living with CKD.

Diet

From the moment you are diagnosed with CKD, you should make every effort to ensure your diet places the least amount of stress on your kidneys and your body as a whole.

While the nutritional goals can vary based on your stage of disease, the aims are more-or-less the same: namely, to control the amount of protein, sodium, potassium, and phosphorus you consume each day. If your kidney impairment gets worse, you may need to limit other nutrients as well.

Low-Sodium DASH Diet

In the early stages of CKD, many doctors will recommend a DASH diet, which emphasizes portion control; the healthy consumption of vegetables, fruits, and low-fat dairy; and the moderate intake of whole grains, fish, poultry, and nuts.

Originally conceived as a means to control high blood pressure, the DASH diet (the acronym for dietary approaches to stop hypertension) has since been adjusted to address the nutritional limitations of people living with stage 1 to stage 4 CKD.

The aim of the diet is to limit the intake of nutrients that the body is less able to eliminate in urine. Because your kidneys cannot efficiently process these substances (or the byproducts they create), you need to ensure that you only eat as much as your kidneys can handle while still meeting your recommended daily nutritional goals.

For a low-sodium DASH diet, daily nutritional goals break down as follows:

Total fat27% of calories
Saturated fat6% of calories
Protein18% of calories
Carbohydrate55% of calories
Cholesterol150 mg
Sodium2,300 mg
Potassium4,700 mg
Calcium1,250 mg
Magnesium500 mg
Fiber30 g


Based on your daily caloric intake, recommended daily servings per food group break down as follows:

Food Group1,200
calories
1,400
calories
1,600
calories
1,800
calories
2,000
calories
2,400
calories
3,000
calories
Grains4 to 55 to 6666 to 810 to 1112 to 13
Vegetables3 to 43 to 43 to 44 to 54 to 55 to 66
Fruits3 to 4444 to 54 to 55 to 66
Low-fat dairy2 to 32 to 32 to 32 to 32 to 333 to 4
Meats, poultry, or fish3 or less3 to 4 or less3 to 4 or less6 or less6 or less6 or less6 to 9 
Nuts, seeds, or legumes3 per week3 per week3 to 4 per week4 per week4 to 5 per week11
Fats/oils1122 to 32 to 334
Sweets and added sugar3 or less per week3 or less per week3 or less per week5 or less per week5 or less per week2 or less per week2 or less per week
Maximum sodium intake2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day

Generally speaking, women need anywhere from 2,000 to 2,400 calories per day, depending on whether the lead a sedentary or an active lifestyle, respectively.

Men should aim for 2,400 to 3,000 calories per day, based on their level of activity.

Serving sizes can vary by food group and are outlined in guidelines provided by the National Heart, Lung, and Blood Institute (NHLBI).

Stage 5 CKD Diet

When you are diagnosed with stage 5 CKD (meaning that you require dialysis or a kidney transplant), your diet needs to change in order to accommodate the role that dialysis will play.

Your diet must undergo six key changes:

  • Increase your protein intake to between eight and 10 ounces daily to maintain lean muscle mass and support immune function. Focus on lean meats, poultry, fish, eggs, and low-fat dairy.
  • Reduce your salt intake to no more than 2,000 mg per day to better control your blood pressure. Remember that "low-sodium" doesn't mean zero; it means less than 140 mg per serving. If you want to avoid sodium, look for products labeled either "no-salt" or "very low-sodium" (meaning less than 35 mg per serving).
  • Lower your phosphorus intake to prevent blood acidity (acidosis). Stay away from whole grains, dry beans, peas, nuts, cocoa, coffee drinks, and sodas. Instead, increase your intake of fruits, vegetables, refined grains, and rice, while restricting your intake of dairy to a half-cup per day. 
  • Restrict your potassium intake to prevent a condition called hyperkalemia, which can damage the heart. Focus on eating fruits and vegetables with low potassium such as apples, berries, broccoli, cabbage, carrots, eggplant, grapes, green beans, lettuce, onions, peaches, pears, pepper, pineapple, plums, radish, tangerines, and zucchini.
  • Increase your carbohydrates to between six and 11 servings daily if you either need to gain weight or are struggling to maintain your weight. Cereals and bread made from refined grains are excellent sources.
  • Restrict fluids to avoid pulmonary edema, the potentially serious build-up of fluid in the lungs. The amount may vary based on whether you are undergoing hemodialysis or peritoneal dialysis. To reduce thirst, avoid salty foods or suck on frozen cubes of juice.

In some cases, enteral nutrition ("tube feeding") may be needed to support your regular diet. This is especially true if there is muscle wasting caused by the inadequate intake of protein. Tube feeding—in which a tube is inserted into a nostril or through the abdomen to deliver liquid food directly to the stomach—may provide better control of nutritional intake and can even be performed at night when you are sleeping.

At this stage in your disease, it is important to work with a dietitian experienced in advanced CKD. You can either ask your doctor for a referral or find one in your area through the free online locator offered by the Academy of Nutrition and Dietetics.

You can also find delicious, kidney-smart recipes by downloading the free My Food Coach by NKF smartphone app offered by the National Kidney Foundation.

Dietary Recommendations for Children

Since poor growth and weight gain are the two major concerns for children living with CKD, diet is usually not restricted unless needed. If it is, the primary goal is to restrict the intake of phosphorus. This is most easily accomplished by cutting back on dairy products and entirely cutting out processed and packaged foods.

If undergoing dialysis, your child may not feel like eating. Despite this, you need to encourage regular eating to sustain health and growth while undergoing treatment and awaiting a kidney transplant.

If this is not possible, tube feeding may be needed. Iron supplements may also be prescribed to prevent anemia.

Lifestyle

Two of the essential aspects of coping with kidney disease are likely not a surprise, as they are central to virtually all wellness journeys.

Exercise

Exercise is central to maintaining your good health if you have CKD. It not only helps build lean muscle, it can lower your blood pressure, control your blood sugar, and increase your energy levels.

The National Institute of Diabetes and Digestive and Kidney Diseases (NDDKD) recommends that people with CKD perform 30 minutes of physical activity per day adjusted to their fitness level, age, and weight. A routine program should involve both aerobic activities (such as walking, cycling, swimming, or jogging) and resistance training (such as free weights, isometrics, or resistance bands).

As 2015 study from Australia concluded that just 150 minutes of moderate-intensity exercise performed weekly preserved lower limb strength in people with stage 3 or stage 4 CKD compared to those who remained sedentary, who typically lost muscle mass.

If your aim is to lose weight, consider working with a fitness expert experienced in metabolic syndrome. Start by calculating your ideal weight and estimating the number of calories you would need to consume daily to achieve your weight loss goals. By establishing your goals and working with someone who can guide and encourage you, you will be more likely find the weight-loss workout that's right for you.

While there are no specific exercise requirements for children with CKD, every effort should be made to encourage physical activity to aid in muscle growth and control blood pressure. It is important, however, to always speak with your child's doctor before embarking on any exercise, sports, or athletics program.

Smoking Cessation

The facts are clear: Cigarette smoking can accelerate the progression of CKD by causing the further constriction of the blood flow to the kidneys.

If you are a smoker with CKD, you need to stop. Doing so will help you better control blood pressure, including renal hypertension.

While it may take several attempts to finally kick the habit, the cost of smoking cessation aids is covered by most insurance plans. Under the Affordable Care Act, you are fully covered for up to two quit attempts per year along with four individual, group, or telephone counseling sessions. With the exception of Medicare, all FDA-approved cessation medications are covered for up to a 90-day supply (and sometimes more).

For their part, Medicare recipients are entitled to nicotine nasal spray, nicotine inhaler, Zyban (bupropion), and Chantix (varenicline) free of charge. All other drugs can be obtained through Medicare Part D drug benefits. Your local health department may also offer free cessation aids.

Dialysis

Living with kidney disease can have more than its share of challenges. This is especially true if you are faced with the prospect of dialysis. As unnerving as the procedure may seem, dialysis may allow to you return to work, school, and other normal activities. 

There are several things you can do to prepare for (or better cope with) dialysis:

  • Know your options. In addition to clinic-based hemodialysis, there is another form of dialysis, known as peritoneal dialysis, which can be performed at home. There are also home hemodialysis machines and peritoneal dialysis cyclers that allow you to dialyze yourself while asleep.
  • Check out your clinic options. You can compare facilities, quality ratings, hours of operation, and other features at the Dialysis Facility Compare website offered by Medicare.
  • Prepare for emergencies. Speak with your dialysis center in advance about what you would need to do in the event of a storm, power outage, or natural disaster. If you dialyze at home, have no less than two weeks' worth of dialysis supplies on hand, as well as a portable generator in the event of an electrical outage. You should also speak with your nephrologist or dietician about an emergency meal plan should you not be able to make an appointment.
  • Plan ahead for travel. Yes, you can travel when undergoing dialysis as long as you identify and make a confirmed appointment with a center at your destination. Be sure to pack any drugs and medical supplies in your carry-on luggage (not your checked baggage). You should also bring extra food with you in the event your flight is delayed. Contact your airline in advance about your special needs and to better avoid delays at security.
  • Know your rights. The Centers for Medicare and Medicaid (CMS) established a Bill of Rights governing the right and responsibilities of people undergoing dialysis. If you believe your rights have been violated or your health has been compromised by a dialysis center, you can lodge a formal complaint online through the non-profit National Forum of ESRD Networks.

Emotions

Stress is common when living with any chronic illness, CKD included. It not only increases the risk of depression, it contributes to high blood pressure and makes controlling your blood sugar all the more difficult. To this end, you need to find a strategy to better manage stress, both proactively and whenever it strikes.

Exercise combined with proper sleep hygiene, to ensure that you get a full seven to eight hours of sleep per night, is always a good place to start. To encourage ample, uninterrupted sleep, always go to bed at the same time and avoid TV, reading, electronic gadgets, and stimulants like coffee before bedtime.

During the day, set aside time each day to relax by yourself. You can even use the time to explore mind-body therapies—like meditation, deep-breathing exercises (pranayama), and guided imagery— as a means to decompress each day. Others find it useful to practice gentle yoga or Tai chi, both of which incorporate gentle movement with mindfulness.

However, if you find that you are struggling with depression and are unable to cope, ask your doctor for a referral to a qualified therapist or psychiatrist in your area. In addition to undergoing one-on-one or group counseling, you may benefit from medications that can help treat acute bouts of depression.

Social Support

If you or family member has been diagnosed with CKD, it is important to find the education and support needed to better normalize CKD in your life. The best place to start is by building a working relationship with your doctor in which you are a fully participating partner.

By educating yourself and becoming an expert in CKD, you can teach family and friend about the disease and ensure that everyone is working together toward a common goal. This may include:

  • Making sure everyone knows what foods can and cannot be eaten
  • Ensuring that medications are taken on time and as prescribed
  • Becoming workout partners to encourage routine exercise
  • Monitoring blood sugar if diabetes, if needed

The more people who participate in these tasks, the less isolated you will be.

Beyond functional support, it is just as important to find emotional support if you feel overwhelmed by the diagnosis. In addition to family and friends, you can seek one-on-one peer counseling by calling the National Kidney Foundation's Peers program at 855-NKF-PEER (855-653-7337) or by submitting an online request. Within a week of your request, you will be connected to a trained peer counselor who is either living with the disease or is caring for a family member with CKD.

Having someone who knows what you are going through can make all the difference when adjusting to life with CDK.

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