Actions From Insight: Your Kidney Friendly Nutrition Plan

Actions From Insight: Your Kidney Friendly Nutrition Plan

[00:00:00] Welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from insight as we keep you up to date on current clinical and diagnostic topics in cardiovascular, metabolic, endocrine, and wellness medicine. 

[00:00:19] Living with chronic kidney disease, or CKD, can feel like an emotional and physical challenge, but you don't have to go it alone. Whether you're a patient who's been diagnosed with CKD or a provider navigating the complexities of diagnosis and management of patients with CKD, understanding the right diet and lifestyle choices can make all the difference in your healthcare journey.

[00:00:41] I'm Dr. Mason Latsko, a researcher by training with a passion for learning, and today's episode is with Patti Bianchi,

[00:00:49] Registered Dietitian and Certified Diabetes Educator.

[00:00:52] Today, we'll be discussing CKD, including the causes and risk factors for CKD, and focusing on lifestyle changes, such as [00:01:00] sodium, potassium, and protein intake, to prevent the progression of CKD.

[00:01:04] Welcome, Patty. Thank you for joining me today.

[00:01:07] Thanks for having me, Mason.

[00:01:09] So Patty, before we jump into chronic kidney disease more specifically, let's talk about the kidneys in a healthy patient and how they actually act as a filtration system for the body.

[00:01:21] Sure. So the kidneys are two bean shaped organs, each about the size of a fist. And the main role of the kidneys is to maintain what we call homeostasis. So let's talk about the many functions of the kidneys. So primarily, they act like a filter to remove waste.

[00:01:39] and extra fluid from your body inside each kidney are up to a million nephrons or filtering units which remove waste from the blood and regulates blood pressure and volume. So they filter about 200 quarts of blood every 24 hours. Some major compounds that the kidneys remove are [00:02:00] one urea, two uric acid from

[00:02:02] and three drugs and other metabolites.  as we mentioned, your kidneys also regulate blood pressure by controlling the body's sodium levels through a very complex system called the renin angiotensin aldosterone system,

[00:02:17] Your kidneys are also responsible for making red blood cells by making a hormone called erythropoietin. Erythropoietin tells the bone marrow to make red blood cells.

[00:02:28] Yet another function of the kidneys is to make the active form of vitamin D and balance calcium and phosphorus in the body. Lastly, the kidneys help maintain pH levels by reabsorbing and producing bicarbonate from your urine, which helps to neutralize acids.   

[00:02:50] a very busy organ. so it makes sensewhy chronic kidney disease can have such detrimental effects on the body.

[00:02:57] Early stages of CKD usually [00:03:00] happen with no symptoms, so very few people even know they have it until it's very advanced. Patty, can you share some statistics on how prevalent CKD is in the general population?

[00:03:11] Sure. Thanks, Mason.

[00:03:12] So CKD affects more than one in seven U. S. adults And unfortunately, one in three individuals over the age of 65 have chronic kidney disease, and nine in ten adults who have CKD or chronic kidney disease are not aware that they have the disease.

[00:03:29] Yeah, I always found that stat to be quite striking and a little bit frightening, right, that 10adults don't know that they have CKD. So clearly, you know, let's, let's raise the awareness and help better identify who is at risk. Patty, can you share a little bit about the common causes of CKD?

[00:03:48] Sure. So those who have diabetes and hypertension or high blood pressure are the,at greatest risk. for kidney disease in the United States. [00:04:00] So high blood sugar from diabetes damages your kidneys and reduces their ability to filter waste and fluid from your blood.

[00:04:08] Over time, this creates and causes kidney disease. Often the first sign of kidney disease from diabetes is a protein in your urine. When the filters are damaged, a protein called albumin, which we're going to talk more about later, passes out of your blood and into your urine. Unfortunately, hypertension, or high blood pressure,

[00:04:31] is the second most common cause of kidney disease after diabetes. 

[00:04:35] When you have high blood pressure, the force of your blood flowing through the tiny blood vessels in your kidneys can cause damage. Your kidneys may not work as well to remove wastes and extra fluid from your body. Extra fluid in the blood vessels may then raise blood pressure even more, creating this dangerous cycle.

[00:04:55] So high blood pressure can also even be a symptom of [00:05:00] kidney disease as well.

[00:05:01] So basically one in three people with diabetes have kidney disease and about one in five people with high blood pressure have kidney disease.  

[00:05:12] Thanks, Patty. So, knowing that the kidneys are a well oiled machine meant to filter blood, and damage to your kidneys can allow protein to leak out into the urine, what common laboratory tools can we utilize to assess patients for CKD?

[00:05:29] So while early kidney disease has no signs or symptoms, there are simple blood and urine tests that can tell you how well your kidneys are working.

[00:05:38] EGFR, or estimated glomerular filtration rate is a blood test that's used to assess kidney function, while urine albumin creatinine ratio is a urine test that's used to assess kidney damage. EGFR, oruses creatinine, which is a waste product from the normal breakdown of muscle [00:06:00] tissue and the digestion of dietary proteins. A normal EGFR is 60 or greater. and the urine albumin creatinine ratio, is a urine test that measures the amount of albumin, which we mentioned earlier, which is a type of protein in your urine, compared to the level of creatinine. So having too much albumin may mean your kidney's filtering units have been damaged.

[00:06:25] A UACR test is often used to detect early stage kidney damage. especially in people at higher risk, such as those with diabetes or high blood pressure. The normal range is considered to be less than 30 milligrams per gram.  

[00:06:43] Great, so here at Quest we offer the kidney profile which includes the urine albumin creatinine ratio, or the UACR, and the EGFR using creatinine. Keep in mind the Cadego guidelines updated in 2024 to suggest that there is a, an [00:07:00] enhanced EGFR using both creatinine and cystatin C in the equation for those individuals at greater risk, such as those with a UACR greater than 30 milligrams per gram and those with an EGFR less than 60. And we talk more about that EGFR as well as individuals who may benefit from getting that EGFR in a separate episode called Instant Insights, looking specifically at CKD diagnosis. 

[00:07:28] Thanks, Patty, for helping set the stage for how to assess chronic kidney disease. Now let's jump into how do we address it. Say you're a patient, you've received a diagnosis for CKD. What do we do from your perspective as a nutritionist to help prevent disease progression?

[00:07:45] Sure. So when you have kidney disease, it is important to watch what you eat and drink because your kidneys cannot remove waste products as well as they should. So a kidney friendly nutrition, plan can help you stay healthier and [00:08:00] slow damage to your kidneys. It does this by preventing certain minerals from building up in your blood and can also help control high blood pressure and diabetes, which can prevent kidney disease from getting worse.

[00:08:12] So your nutrition plan may change over time, depending on the stage of kidney disease you are in. So, since we know that diabetes and high blood pressure are the two most common causes of CKD, it's key to improve blood sugars, which will slow further damage, and control blood pressure levels with lifestyle changes.

[00:08:33] So, nutritional recommendations for CKD are synonymous with healthy eating guidelines that can help manage other chronic conditions, which include limiting sodium intake. Choosing the right types of fats, such as monounsaturated fats, like nuts, seeds, nut butters, avocado. Going for more plant based foods, like beans and whole grains, that can provide fiber and other antioxidants which promote [00:09:00] kidney health.

[00:09:00] And eating more fruits and vegetables, which we know can help to manage blood pressure levels and maintain a healthy acid base balance. Also limiting animal protein and replacing with plant based proteins. Avoiding excess added sugars, which we know can lead to weight gain and elevated blood glucose levels.

[00:09:20] Since we know that, again, diabetes is a leading risk factor for kidney disease. And also eliminating any processed meats and ultra processed foods, as they are rich in sodium and added sugars.  

[00:09:34] Excellent. So it sounds like many of the dietary recommendations are similar across the board for many other chronic diseases that we speak to on this podcast, right? Cardiovascular disease, glycemic control issues,

[00:09:46] hypertension. So having a diet that is helpfulglobally for individuals with CKD will also benefit heart health and glycemic control, right? So, that's really eye opening as [00:10:00] well. If we focus in a bit, I know that the kidneys are very involved in sodium regulation, And in our Western diet, most of us have way too much salt in our diet.

[00:10:09] So, can you break that one down a little bit for us and tell us exactly what is recommended for individuals with CKD?

[00:10:17] So choosing and preparing foods with less salt or sodium is key. Having too much sodium in your body can make your body retain or hold onto fluid, which makes your heart and kidneys work much harder.

[00:10:30] So over time, this can raise your blood pressure and cause your kidney disease to get worse. So we want to aim for about less than 2, 000 milligrams of salt per day. that's about less than a teaspoon. Cutting back on highly processed foods, things like canned soups, frozen, you know, TV entree dinners, which tend to be loaded with sodium, um, is key and critical.

[00:10:56] So seasoning your foods with herbs and spices [00:11:00] instead of salt, buying fresh foods as much as possible, and trying to really cook your own food instead of buying prepared foods, um, or going out to fast food restaurants, um, or frequenting restaurant establishments. So what also is key to look at is the nutrition facts label.

[00:11:19] So check for sodium on your food packages. A daily value of 20% or more means that that food is high in sodium and probably should be put back on the shelf. So it's important to limit sodium intake in all stages of kidney.   

[00:11:36] Right. And I think on one hand, that makes sense. But on the other hand, I like that you give the recommendation of a daily value of more than 20%, just meaning put it back. It's too high in sodium. Because again, we all know we should eat less salt. But sometimes the interpretation of what does that mean can be really challenging,

[00:11:54] So another thing that you had mentioned earlier was about reducing animal protein. Um, you know, [00:12:00] sometimes this can be a challenge for patients too, because we don't really know what that means, you know, it's relative to each person. So can you speak a little bit about this and specifically what that means for patients with CKD?

[00:12:12] Sure. So As we mentioned earlier,

[00:12:16] reducing animal protein can lessen the burden of the kidneys and promote better overall kidney health.

[00:12:23] So the 2024 KDGO guidelines actually emphasize a preference of plant based proteins over animal based proteins. However, if you consume animal protein, just ensure that you're choosing lean sources like skinless white meat chicken or turkey or fish or even eggs. A cooked portion of animal protein is about three ounces, which is equivalent to about the size of the palm of your hand and thickness of the deck of cards.

[00:12:53] Plant proteins include things like beans, nuts, grains like quinoa, or even soy [00:13:00] products like tofu or edamame. And a portion of cooked beans is about half a cup, and a portion of nuts is about a quarter a cup. The amount of protein you should eat really depends on your body size, your and also your health.

[00:13:16] So in kidney disease stages 1 and 2, the daily recommended amount of lean protein is the same for people who do not have kidney disease. Whereas in kidney disease stages three, four and five and five being not on dialysis though. You should eat less protein to prevent your kidneys from having to work even harder to filter more protein waste.

[00:13:40] KDGO actually states to stick to 0. 8 grams. per kilogram a day of protein intake in adults with kidney disease stages three to five. And again, five being those who are not on dialysis. To clarify, when you're in the early stages of CKD, like stages one and [00:14:00] two, you will have less limits. And what you can eat, and as your kidney disease progresses, going into stages three, four, and five, you may have to limit additional items such as potassium, phosphorus, and even fluids. 

[00:14:15] So let's take a moment and explore that a little bit further because I'll be the first to admit I've never really thought about the mineral content for my food. So could you help us better understand that process?

[00:14:26] So let's talk a little bit more about that. So let's start with potassium. So potassium is a mineral. The body needs to help your nerves. and muscles work appropriately. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Potassium is found in many fruits and vegetables like oranges, spinach, potatoes, and tomatoes.

[00:14:51] So working with a registered dietitian is recommended as they can help you to review high potassium foods to limit in your diet and [00:15:00] also how you can substitute with lower potassium alternatives. Phosphorus is another mineral that helps keep your, bones healthy. When you have chronic kidney disease, phosphorus can build up in your blood and it makes your bones thin, weak, and more likely to break.

[00:15:19] It can also cause itchy skin and also bone and joint. pain. Most people with chronic kidney disease need to eat foods with less phosphorus than they are used to eating. And high phosphorus foods include things like dairy products, meat, beans and dark colored sodas. Your health care provider may also prescribe a medication known as a phosphate binder, which is taken with meals to help lower the amount of phosphorus in your blood.

[00:15:50] Lastly, I want to talk about fluids. So as we mentioned, controlling the balance of fluid in your body is one of the kidneys main jobs as kidney disease [00:16:00] progresses. The kidneys do not get rid of extra fluid as well as they should. So too much fluid in your body can cause high blood pressure. Swelling, and even heart failure.

[00:16:11] And remember, fluid includes all drinks, like water, tea, and coffee.

[00:16:16] You should also count foods with a high fluid content as well, like soup and gravy.    

[00:16:22] Wow, I just learned so much. Um, I think that it's really clear that registered dietitians like yourself have a huge role in better understanding good health for patients with end stage disease, especially chronic kidney disease, because even from the perspective of somebody with a scientific background, there are so many complexities to it that we really just don't think about.

[00:16:42] So thank you for sharing all of that. Now, I know we've touched a lot on nutritional recommendations for CKD, as that's a really  where we can make a change and make a difference. I was hoping to get a sense of the information in the recommendation for exercise techniques.

[00:16:58] Are [00:17:00] CKD or special considerations?

[00:17:05] That's a great question, Mason, because I do think we spend a lot of time talking about some of the nutritional recommendations for chronic kidney disease. Um, but when we're talking about exercise and physical activity, the recommendations are pretty much the same for the general population.

[00:17:20] Um, that being 150 minutes of moderate intensity aerobic exercise per week, and also bringing in strength training at least twice a week. However, something that's really important to consider is that when we're looking at patients with chronic kidney disease, there's a lot going on just like we mentioned the many functions that the kidney that the kidneydoes.

[00:17:42] So basically when we're looking at, um, that population, it's really important to consider special circumstances. So, for example, if someone with kidney disease is dealing with fatigue due to possibly anemia of chronic kidney disease, um, that might be an area where we would recommend [00:18:00] shorter, smaller increments of physical activity.

[00:18:02] You know, it 30 minutes every day. It could be 10 minutes spread out throughout the day in small increments. Also, we can focus on encouraging them to move or walk after their mealtime, whether it's anywhere from two to five minutes, which research is showing, um, can reduce that spike of glucose, um, after meals.

[00:18:24] So really taking it from smaller increments rather than, um, focusing on these large, these larger guidelines.   

[00:18:32] Yeah, I think that's great advice for patients, just to take it literally one step at a time, one day at a time. So thank you so much for sharing that knowledge with us. Before we go, do you have any final takeaways that you want to share?

[00:18:46] So people have different reactions when they learn that they have kidney disease, so it can be difficult to cope with a condition

[00:18:54] that will impact your day to day habits.

[00:18:57] So I definitely encourage patients to don't [00:19:00] hesitate to reach out and ask for help, talk with your spouse, your friends, a social worker, um, anyone that you feel comfortable with, can help you sort out how you're feeling.

[00:19:09] Feeling and help you and your loved ones just understand the best way to support you. You know, there are so many resources out there, Mason, like you mentioned first, um, the National Kidney Foundation is a very popular resource. Also, the American Kidney Fund is another resource that's out there and the American kidney.

[00:19:28] Also has something called the kidney kitchen, which features different recipes for different areas or staging of chronic kidney disease. So if you're looking to reduce your protein intake or possibly avoid potassium, depending on the stage that you're in, you, it breaks down each recipe. Um, so you're able to choose the ones that are best for you in that moment of time.   

[00:19:50] What a great resource. Thanks for sharing that with us and thanks for joining us today. It's always so enlightening to have you on and hear your perspective. So thank you so much for [00:20:00] joining and I look forward to having you next time.

[00:20:03]

[00:20:03] Thank you so much for having me, Mason.

[00:20:06] That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app, and be sure to check out Quest Diagnostics Clinical Education Center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.