WHY?:   Kidneys remove all the chemical waste from the blood.  The chemical waste in the blood comes from two sources. Some are generated from normal - essential - chemical reactions that happen in the body. The other source is the food (and medications) that we consume. As the body uses the nutrients that have been absorbed from the food, more waste is generated.  When the kidneys are diseased their ability to get rid of these chemical waste from the blood is impaired and their level in the blood increases.   In due course, this is likely to cause various complications including making the person feel sick with various symptoms of chronic renal failure.
        Furthermore, once the patient starts dialysis treatment some protein (in the form of amino acids) is lost during dialysis. Such a loss is less during hemodialysis, but of considerable amount during peritoneal dialysis (CAPD, CCPD).

        By carefully modifying the diet the chemical build up could be minimized and the protein loss could be compensated. The dietary modification will involve:

PROTEIN

HOW MUCH PROTEIN CAN/SHOULD I EAT?

            Prior to starting dialysis, as the kidneys are getting worse, patients are advised to restrict their protein consumption.  This is done, so that the toxic waste products of the consumed protein do not build up in the blood and cause various symptoms of kidney failure.

            Once the patient starts dialysis treatment such restriction could be liberalized because
                1.   the toxic waste products of consumed protein could be removed adequately through dialysis
                2.   some protein is lost during the dialysis (more so with peritoneal dialysis), and
                3.   such losses need to be replaced to avoid protein malnutrition

        As long as the blood level of Phosphorus and potassium could be kept within the permissible level there is no need to restrict protein any less than 1.3 to 1.5 grams per Kg of body weight. For an average adult this might amount to 80 to 100 grams of protein per day. (The higher values are needed for those who are on Peritoneal Dialysis.)

PROTEIN AND 'BUN':

            BUN (Blood Urea Nitrogen) is measured and is part of the blood test done once a month (or more frequently) in all patients undergoing dialysis treatment.
            As long as the patient is getting adequate dialysis, (and is not suffering from any ongoing fever, infection or internal bleeding) the level of BUN reflects protein consumption. The higher the protein intake, the greater is the level of BUN. If the BUN levels are below 70 mgs%, although it does not always mean inadequate protein consumption, it is better to review patients protein intake.

PROTEIN CONTENT OF VARIOUS FOODS:

FOOD	QUANTITY	GRAMS OF PROTEIN
MEAT POULTRY FISH EGGS	ONE OUNCE	7 GRAMS
BREAD PASTA CEREAL	ONE SLICE HALF A CUP ONE OUNCE	3 GRAMS
MILK YOGURT CHEESE	ONE CUP ONE CUP ONE OUNCE	7 TO 8 GRAMS
	ONE SLICE OF CHEESE	4 GRAMS
BEANS/COOKED	1CUP	10 GRAMS
VEGETABLES/COOKED	1 CUP	4 GRAMS
FRUITS	?	0 GRAMS

SUMMARY:

  There are many essential minerals in the blood (serum).  These are generally called "electrolytes." Some such electrolytes are:

    These electrolytes play a vital role in regulating activities both inside and outside the cells of various organs like Brain, Heart, Nerves and Muscles.  Any imbalance in the concentration of these electrolytes, therefore, will have wide ranging dysfunction of various organs and symptoms. For the most part, the concentration of these electrolytes is regulated by the kidneys.  When the kidneys are diseased, therefore, wide ranging electrolyte imbalance occurs. 

    Patient who have severe kidney disease requiring dialysis treatment are even more vulnerable due to abnormally high or low concentration of these electrolytes.   Therefore it is important that such patients watch carefully the amount of these electrolytes in their diet.  High,as well, as low concentrations of these electrolytes could be life threatening.

    Some of the causes, consequences and measures that could be taken to avoid severe electrolyte imbalance are as follows:

P

   Foods with high Potassium content:

Foods with relatively LOW Potsssium content: (Please pay attention to the portions as well)

            Phosphorus is an essential mineral in the body and plays an important role in keeping bones healthy. Some of the phosphorus in the blood stays in balance with Calcium.  Maintaining this balance is important for the bones to stay healthy. Kidneys play a vital role in maintaining this balance.  When the kidneys are diseased, they are unable to eliminate excess phosphorus from the blood.  Therefore, phosphorus level in the blood increases, disturbing the balance causing the bones to become brittle. This increases the chances of fractures and bone deformities.  There are other complications of high phosphorus and some of them are as follows:

            1.    Increased itching
            2.   Calcium and phosphorus deposits in the blood vessels
                        causing gangrene of the fingers, toes and skin
            3.    Increased activity of glands in the neck called "Parathyroids."
                        This further aggravates anemia, erosion of the bones and
                        possibly nerve damage
            4.   Muscle weakness
            5.   Joint pain, arthritis and tendinitis
            6.    Fracture of bones

HOW TO KEEP PHOSPHORUS LEVEL NORMAL?

        DIET:     Phosphorus is widely available in most of the food. It is important that the patients with kidney disease (even those who do not need dialysis treatments yet) learn and familiarize themselves with the amounts of phosphorus in the food items that they regularly consume.  Limiting the consumption of high phosphorus containing food is the key to keep the blood level of phosphorus normal.

        DIALYSIS:   Phosphorus is removed from the blood during dialysis.   When the patient receives inadequate dialysis, as it will happen whenever the patient skips the treatment or cuts the treatment time down, phosphorus levels tend to be high.

       PHOSPHORUS BINDERS:   Certain medications can combine with phosphorus and convert them to different compounds that cannot be absorbed from stomach or intestines.  Such medications are called "Phosphorus Binders". Some of the phosphorus binders are listed below.

Phosphorus binders are unlikely to work when not taken with food and snacks.  They also have limited potency and will be inadequate to control blood level of phosphorus if a low phosphorus diet is not followed!