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RUNNING HEAD: NUTRITIONAL REQUIREMENTS FOR PERSONS WITH KIDNEY FAILURE 1

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Nutritional Requirements for Person Living With Kidney Failure

Human beings have two kidneys. Kidneys regulate the volume and composition of blood and remove metabolic wastes in the urine. They also help to control the acid base balance in the human body, activate vitamin D which is essential for absorption of calcium and produce erythroprotein which is needed for the synthesis of red blood cells. Being an important organ in the human body, the kidney requires good care and medical attention. It is prone to infections and complications when not taken care of. The frequency of Chronic Kidney Diseases (CKD), Acute Renal Failure (ARF) and Acute Kidney Injury (AKI) has increased rapidly (Kimmel, Paul and Hiromichi, 45). This has been greatly associated with high or increased intake of protein as it is has a high potential of initiating renal disease. It is a concern to many that high protein intake promotes renal damage by increasing glomerular pressure and hyper filtration. Patients with renal failure represent a heterogeneous group but their nutritional requirements vary depending on their clinical setting. Good nutrition is important to people with Chronic Kidney Disease (CKD) as it gives them energy to do their daily tasks, prevent being infected, help maintain a healthy weight and build muscle and most importantly keep the kidney in perfect condition and prevent it from getting worse. A healthy eaten plan gives a patient the correct and required amounts of: Protein, calories, vitamins and minerals.

The strategy used in nutritional intervention of patients with Chronic Kidney Diseases (CKD) is determined by specific metabolic alternations such as: Resistance of insulin, abnormal clearance of insulin, metabolic acidosis, impairments of the activation of vitamin D3 and renal anaemia. Patients with ARF have the following nutrient requirements:

Protein

Proteins are known to be body building foods which play a great role in the growth of the body Proteins help the body in many ways such as building muscle, repairing tissues and fighting infection. Kidney patients are advised to limit the intake of proteins before they start dialysis but eat more of proteins when they start dialysis. This is because a lot of protein is lost during treatment. There is high protein energy wasting in patients suffering from CKD. This could be due to: Reduced oral intake, restrictive dietary regimen, uremic toxicity(which involves loss of appetite) micro-inflammation, metabolic acidosis, endocrine factors and gastrointestinal factors.

Since there is high wasting of protein energy in these patients, regulation of the intake of protein is very important. It is however important to enquire from a dietician how much protein is required for your body every day. Traditional education for diet requirements in CKD patients has highlighted that it’s possible to delay the need for renal replacement therapy by providing adequate calories and restricting the intake of protein to as low as0.3 grams of protein per day. Recent studies have shown that the provision of protein to an Intensive Care Unit (ICU) patient with the Acute Kidney Infection (AKI) further stimulates the protein synthesis for the whole body. Decisions of how much protein should be taken depend on the stage of kidney disease for a patient (there are five stages of kidney disease), the status of the nutrition and the muscle mass. Some sources of protein include; Red meat: (lamb, beef and veal), pork, poultry (e.g. turkey and chicken), eggs, fish and other sea food.

Calories

Calories are essential in controlling the functioning of the body (Mitch, William

and Ikizler, 20). They however need to be taken in the right proportions; too much intake of calories can cause complications to a kidney patient. Calories help the body to use the protein in food in building muscles and tissues; if calories are inadequate, proteins will only be used to generate energy instead of being used in building muscles and tissues. Calories help CKD patients to maintain a healthy body weight and also provide energy to do tasks and help them to always It’s important that a CKD patient’s meal has calories included in it. Fats such as margarine and oils such as olive oil are known to be good sources of calories. Some patients may be advised to take less or even more calories. This can be achieved by eating extra sweet things such as sugar, jell, candy, honey, syrup and jam.

Vitamins and minerals

Although vitamins and minerals are known to be essential to the human body, a patient with chronic kidney disease needs to limit the intake of foods that give him a lot of vitamins and minerals. It’s important for the patient to consult their doctor or dietician before taking any mineral or vitamin or even herbal supplement because some vitamins and minerals are harmful to people living with CKD. A Chronic kidney disease patient may need to take special types of vitamins and minerals.

Although proteins, calories, vitamins and minerals intake in a CKD patient are very important, there are other nutrients that need to be checked and regulated. These include;

Sodium

Sodium is a salt that is contained in many sources of food. It is present in common salt (table salt). Its role is to regulate fluids in the body and also maintain/ regulate pressure in the blood (Mitch, William and Ikizler, 210). A kidney in good working condition can regulate the amount of sodium in the body but this is not so where the kidney is defective in its functions. In case the kidney has a complication, as in the case of patients living with Chronic Kidney Disease (CKD), sodium and fluid may build up in the body. This could result to high blood pressure and swelling of body parts such as fingers, ankles and eyes (Kimmel, Paul and Hiromichi 96).Sodium can be avoided by avoiding foods like canned foods, processed meat, table salt, seasonings such as soy sauce, and salted snack foods such as chips, canned and dehydrated foods. A dietician can be of great help when choosing foods with less sodium.

Phosphorus

CKD patients especially those in the advanced stages need to limit their intake of phosphorus. Sources of phosphorus include dairy products like milk cheese and ice-cream, peanut butter and nuts, peas and dried beans and beverages such as cocoa and beer. Taking high phosphorus foods may increase the level or amount of phosphorus in the body and the kidneys may be unable to remove the extra amounts of phosphorus. When phosphorus build up in the blood, the blood calcium levels go down and calcium is removed from the bones which makes them weak and tend to break easily. It may also cause calcium build up in blood vessels, heart, muscles, joints and the skin. Long term effects of this could include: Poor circulation of blood, paining bones, skin ulcers, or even damage to the heart and other organs. It is therefore important for every CKD patient to regulate phosphorus intake in the body.

Calcium

Calcium is important for bone, teeth and nail formation. It’s therefore important that CKD patients take enough calcium. Most sources of calcium are known to also contain phosphorus which as we have discussed limits the amount of calcium in the body, Sometimes it might be necessary to take vitamin D supplements to regulate/ control levels of phosphorus and calcium in the body.

Potassium

Another important mineral for patients with Chronic Kidney diseases is potassium. It is found in many sources of food such as some vegetables like potatoes tomatoes, avocados, melons and oranges, dried peas and beans, milk and most salt substituents. Too much or too little potassium in the blood can be harmful to a CKD patient. The amount of potassium needed by a patient varies depending on the level of potassium in the blood: some may need more others less (Kimmel, Paul and Hiromichi, 67).

Patients with kidney disease tend to have low amounts of iron in the body. One major function of the kidneys is the production of red blood cells( Kopple, Joel , Shaul and Kamyar, 65). When the kidneys are not performing properly there is low count of red blood cells in the body. Intake of food such as leafy vegetables increases the amount of iron in the body (Mitch, William and Ikizler, 98).

Good nutrition is important to the human body more so to the body of a person with a kidney disease or disorder. Every kidney patient should be able to identify the kind of diet that doesn’t in any way interfere or affect with the functioning of the kidney. Previous researches have shown that a person with a chronic kidney disease can live even longer than an average person if they take in only the right nutrients to their system. Every kidney patient should consult their dietician on the kind and amount of nutrients they should take in.

Works Cited

Kimmel, Paul L, and Hiromichi Suzuki. Nutrition and Kidney Disease: A New Era ; 24 Tables. Basel a[u.a.: Karger, 2007. Print.

Kopple, Joel D, Shaul G. Massry, and Kamyar Kalantar-Zadeh. Nutritional Management of Renal Disease. Burlington: Elsevier Science, 2013. Internet resource.

Mitch, William E, and T A. Ikizler. Handbook of Nutrition and the Kidney. Philadelphia, PA: Lippincott William & WilkiKopple, Joel D, Shaul G. Massry, and Kamyar Kalantar-Zadeh. Nutritional Management of Renal Disease. Burlington: Elsevier Science, 2013. Internet resource. ns, 2010. Print.