-IBIS-1.7.0-
tx
urinary system
kidney failure: chronic
Nutrition

dietary guidelines

» without hemodialysis:

• restrict protein to 10 g per day, or eliminate totally. Glucose is infused or a nasogastric feeding is used. Severely restrict Sodium and Potassium.

» with hemodialysis:

60% carbohydrates

7-12% protein

28-33% fat

• diet high in complex carbohydrates: whole grains, vegetables and fruits

• low in proteins, and medium low in polyunsaturated and monosaturated fats

• Sodium is restricted to 500-1000 g per day depending on accompanying hypertension (see hypertension)

• Potassium is limited to 1.5-3.0 g per day

therapeutic foods:

• apple peel tea (steeped), watercress, melons, greenbeans, potato broth, collards, beets, asparagus in small amounts, parsley in small amounts, grapes, foods that tonify the Kidney (Jensen, p. 63)

fresh juices:

• celery, parsley, and juniper berry tea (Jensen, p. 63)

• celery, parsley, and asparagus (Jensen, p. 52)

• carrot and parsley (Jensen, p. 52)

• pomegranate (Jensen, p. 52)

foods contraindicated:

• asparagus and parsley with extreme kidney inflammation, rutabaga (Jensen)

supplements

• Vitamin A 25,000 IU per day

• Vitamin C 1 g per day

• bioflavonoids 2 g per day

• Vitamin B-complex, especially B6

• Vitamin E 400 IU per day (Kirschmann, 1984)

Chitosan: In a study of patients with chronic renal failure undergoing long-term hemodialysis 450 mg of chitosan 3 times a day for 12 weeks produced multiple benefits. Mean serum cholesterol went down 43% and mean serum hemoglobin increased from 5.8 to 6.8 g/dl in those patients who received the chitosan. Mean urea (from 75 to 45 mM) and creatinine (from 1.001 to 0.875 mM) levels in serum showed significant reductions after 12 weeks of chitosan treatment. Compared with the control group, the treatment group reported significantly improved appetite, sleep and feeling of physical strength. No significant side effects were seen.

(Jing SB. et al. J Pharm Pharmacol 1997;49:72 1-723.)

» drug interaction:

• Sodium, Potassium and triamterene (Dyrenium): triamterene increases urinary Sodium and reduces urinary Potassium

• In patients on chronic dialysis; Vitamin D and heparin: heparin interferes with renal hydroxylation of Vitamin D. Note: this could lead to osteopenia, check 1,25(OH)2 cholecalciferol levels

footnotes

Jing SB, Li L, Ji D, Takiguchi Y, Yamaguchi T. Effect of chitosan on renal function in patients with chronic renal failure. J Pharm Pharmacol 1997 Jul;49(7):721-723.

Abstract: The effects of chitosan have been investigated on eighty patients with renal failure undergoing long-term stable haemodialysis treatment. The patients were tested after a control treatment period of 1 week. Half were fed 30 chitosan tablets (45 mg chitosan/tablet) three times a day. Ingestion of chitosan effectively reduced total serum cholesterol levels (from 10.14 +/- 4.40 to 5.82 +/- 2.19 mM) and increased serum haemoglobin levels (from 58.2 +/- 12.1 to 68 +/- 9.0 g L-1). Significant reductions in urea and creatinine levels in serum were observed after 4 weeks of chitosan ingestion. The feeling of physical strength, the appetite and the sleep of patients in the treatment group had improved significantly after 12 weeks of ingestion, compared with those of patients in the control group. During the treatment period, no clinically problematic symptoms were observed. These data suggest that chitosan might be effective treatment for renal failure patients, although the mechanism of the effect should be investigated further.