According to the National Kidney Foundation, more than 20 million adults have kidney disease, and an additional 20 million others are at risk of developing it (Key, 2013). Kidney disease is the result of damaged nephrons (tiny structures in the kidney that serves as filters). These filters remove waste and extra fluid from the blood. Causes of kidney disease include diabetes, hypertension, and heredity. Renal disease patients have tremendous amounts of restrictions. They are required to make several lifestyle changes, one of the most significant changes being their diet. Dietary practices are a quintessential part of chronic kidney disease management, including patients who are on dialysis. Various dietary restrictions related to consumption of phosphorus, sodium, potassium, fluids, and major nutrients such as carbohydrates and protein are imposed in dialysis patients (Kalantar-Zadeh et al., 2015).
High amounts of phosphorous are linked to poor outcomes in chronic kidney disease. Kidneys remove phosphorous from the body through urine. In cases where kidneys have failed, accumulation of phosphorus in the blood can lead to issues such as pain in muscles, brittle bones, which can break easily, and joint calcification (Kalantar-Zadeh et al., 2015). As a result, dialysis patients are restricted from consuming a diet high in phosphorous because their kidneys cannot excrete it to improve patient outcomes and chances of survival.
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Potassium is an essential mineral required by the body to ensure a normal water balance in cells and body fluids. Every food has some amount of potassium, but some contain high amounts of the mineral. Foods such as bananas and nuts contain large amounts of potassium and therefore, should be avoided by dialysis patients. Healthy kidneys can excrete potassium through urine. However, failed kidneys cannot get rid of the potassium, which tends to accumulates in the blood. Excessive amounts of potassium in the blood can lead to an irregular heartbeat or heart failure. Potassium levels above 6.5 mEq/L are dangerous for dialysis patients. As a result, restrictions in potassium consumption are executed even before the start of dialysis. Several studies suggest that both low and high levels of potassium seem to be dangerous in dialysis patients regardless of dialysis modality (Kalantar-Zadeh et al., 2015).
Sodium is an essential element that plays a significant role in ensuring water balance in the body. However, sodium intake in dialysis patients is restricted because high intake may lead to poorly regulated blood pressure. Besides, it causes excessive thirst that may cause problems with following the recommended fluid restrictions. Research shows that there exists a close link between sodium and hypertension. As reported by Garofalo et al. the association is stronger in patients suffering from renal failure and those undergoing dialysis. Hypertension is a reliable indicator of poor outcomes in patients receiving dialysis. Thus, it is vital that patients have a normal sodium balance and extracellular volume in dialysis patients to prevent hypertension. The sodium balance can be achieved through inter-dialytic weight gain and complete removal of IDWG. However, since IDWG relies directly on the consumption of sodium and thirst, restricting sodium intake is the most effective method (Garofalo et al., 2018).
It is also vital to mention that almost half of all dialysis patients have diabetes. Foods with a high glycemic index are linked to poor outcomes in dialysis patients. Research suggests that dietary glycemic restrictions should be relaxed for patients who have an A1C below 7% (Kalantar-Zadeh et al., 2015). However, carbohydrate and dietary glycemic should be restricted carefully for those with an A1C above 7%. Patients receiving dialysis in most cases produce little urine, and therefore increased fluid intake may burden the heart and lungs. Restricting fluid intake in dialysis is recommended, and each patient's fluid allowance is determined according to urine and an additional 500ml. The extra 500ml accounts for the fluids lost through other organs such as the skin and lungs. The dietary restrictions are aimed at improving patient outcomes (Kalantar-Zadeh et al., 2015).
The dietary restrictions are aimed to improve patient outcomes. Kidneys for dialysis patients are not able to excrete substances such as sodium. Since patients who receive dialysis have diminished kidney function, sodium, potassium, phosphorous, and water intake must be regulated or restricted to prevent accumulation, which may result in death or other complications such as hypertension and heart disease.
References
Garofalo, C., Borrelli, S., Provenzano, M., Stefano, T. D., Vita, C., Chiodini, P., … Conte, G. (2018). Dietary Salt Restriction in Chronic Kidney Disease: A Meta-analysis of randomized clinical trials. Nutrients, 10 (6), 732.
Kalantar-Zadeh, K., Tortorici, A. R., Chen, J. L. T., Kamgar, M., Lau, W.-L., Moradi, H., … Kovesdy, C. P. (2015). Dietary restrictions in dialysis patients: Is there anything left to eat? Seminars in Dialysis, 28 (2), 159–168.
Key, K. (2013). The Gale encyclopedia of diets: a guide to health and nutrition. Detroit: Gale, Cengage Learning.
