Treating Kidney Failure and Eating Healthy

X.   Monitoring Your Diet

Eating the right foods in the right amounts is very important to your overall health and how well you feel. Getting the right amount of protein and calories is especially important. You need calories to give your body energy and help you maintain a healthy weight. You need protein for building muscles, repairing tissues and fighting infections.

  1. Serum Albumin
    Albumin is a type of protein found in your blood. Your albumin level will be checked periodically by a blood test. If your level is too low, it may mean you are not eating enough protein, or not enough calories. If your albumin continues to be low, you are more likely to develop infections, need hospitalizations or feel poorly.
  2. Normalized Protein Nitrogen Appearance (nPNA)
    This telle if you are eating the right amount of protein. Your nPNA result comes from lab studies that include a urine collection and blood work. Your nPNA helps to check the protein balance in your body.
  3. Cholesterol
    Cholesterol is a type of fat found in your blood. While a high cholesterol level (over 200) may mean you are more likely to have a heart problem, a cholesterol level that is dropping or is below 150 to 180 may mean you are not getting adequate nutrition.
  4. Subjective Global Assessment (SGA)
    SGA is an evaluation your dietitian will do periodically to see if you are well-nourished. The dietitian will ask you some questions and look at the fat and muscle stores in your body. The dietitian will consider:
    1. changes in your weight
    2. changes in your face, arms, hands, shoulders or legs
    3. your food intake
    4. your activity and energy levels
    5. problems that might interfere with eating
  5. Body Weight
    Maintaining a healthy body weight is important. Your doctor and dietitian will tell you what is the right weight for you. If you are losing too much weight, your dietitian will give you recommendations about how to improve your diet. If you continue to lose weight, however, a nutritional supplement may be recommended for you. If you are gaining too much body weight (not fluid weight), your dietitian can give you suggestions about how to safely reduce calories and increase your activity level.

Other Important Lab Values
The following section lists some additional tests that are related to your dietary intake and how well you follow your special diet. Ask your doctor and dietitian about your results on these tests. If your numbers are not on target, ask about how they can be improved.

  1. Potassium
    In patients with chronic kidney disease, the most common cause for an abnormal level of potassium is related to diet. If your level is too high, you're possibly eating too many potassium-rich foods; if it’s too low, you may not be eating enough. Too high or too low a level of potassium in your blood can weaken muscles and slow or stop your heartbeat. The suggested potassium intake will vary from patient to patient. Ask your doctor what your blood potassium level should be and if you need to limit the amount of high-potassium foods in your diet. Your dietitian will tell you what foods are high and low in potassium.
  2. Calcium
    Calcium is important for strong bones. Kidney patients often have an imbalance between calcium and phosphorus, which causes calcium to be pulled from bones. This can lead to bone disease. To help keep your calcium level from getting too low, your doctor may order a calcium supplement and a special prescription form of vitamin D. Ask your doctor what your blood calcium level should be. If your result is not in the right range, ask how it can be improved.
  3. Phosphorus
    A high phosphorus level in your blood can lead to weak bones. Ask your doctor what your phosphorus level should be. If your level is too high, your doctor may recommend that you reduce your intake of foods that are higher in phosphorus and take a phosphate binder with all your meals and snacks.
  4. Parathyroid Hormone (PTH)
    PTH is a hormone that plays an important role in keeping your bones healthy. When calcium and phosphorus are not in proper balance in your blood, the parathyroid glands (four small glands in your neck) produce too much PTH. This causes calcium to be pulled from your bones. Over time, this causes bones to become weak and break easily. Ask your doctor if your PTH is in the right range. If it is too high, your doctor may ask you to take a special prescription form of vitamin D to help control your PTH level.
  5. Hemoglobin and Hematocrit
    These tests tell your doctor whether you have anemia, or a low blood count, which can make you feel very tired. Anemia occurs in patients with chronic kidney disease because their kidneys no longer make enough of a hormone called erythropoietin, or EPO. This hormone tells your body to make more red blood cells. Anemia can make you feel less hungry, and you may not eat enough to stay healthy. Your hemoglobin level should be at least 11 to 12, and your hematocrit should be at least 33 to 36 percent.
  6. Iron
    Iron is also important to red blood cell production. Two tests will be done to measure the amount of iron stored in your body. Ferritin is a form of iron stored in the body. A low ferritin reading (below 100) may indicate an iron deficiency. Transferrin saturation (TSAT) is a different test that shows a release and balance of iron from storage. Your transferrin saturation should be at least 20 percent. If these tests indicate that your iron stores are too low, you will need an iron supplement to help treat anemia.

For more information about anemia, see the NKF booklet, “What You Need to Know About Anemia and Chronic Kidney Disease.”

 

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