Safeguard Your Kidneys

Assoc. Prof. Dr. Eusha A F Ansary, Dr. Maliha Tasnim
Kidney Disease Prevention
Safeguard Your Kidneys

24

Jan 24

Introduction

The National Kidney Foundation (NKF) released the Kidney Disease Outcomes Quality Initiative (KDOQI) nutrition guideline for individuals with end-stage renal disease almost two decades ago. The management of chronic kidney disease (CKD) has undergone significant transformations since NKF’s nutrition regimen was issued.1

“Although dialysis is a life-saving therapy, it can be challenging for patients and families; we’re encouraging researchers to explore innovative ways to improve the quality of life and long-term outcome for these patients.” _ Dr. Paul Kimmel, Kidney Specialist, National Institutes of Health (NIH).2

Factors Inducing Chronic Kidney Disease (CKD)

Factors put kidneys at risk

Kidney function usually declines with age. Individuals can sustain their lives with a solitary kidney if they opt to donate the other kidney to a companion or relative. Underlying conditions that facilitate kidney diseases are a matter of concern.

Diabetes mellitus (DM) and hypertension (HTN) are two such conditions and are considered the primary factors responsible for the onset of renal damage. Additional risk factors to kidney disease are cardiovascular illness and existing familial history of kidney failure.2

Kidney Saving Lifestyle

Controlling blood sugar level and blood pressure are essential for preventing kidney diseases, as well as managing CKD.4

Diabetes Control

According to the American Diabetes Association there is no universally applicable diet effective for all individuals with diabetes. Optimal meal plans are those that are tailored to the specific dietary preferences and metabolic objectives of individuals. In diabetes, the body’s ability to efficiently metabolize carbohydrates is impaired so, a reduced carbohydrate diet is key to manage the disease.5

Lifestyle measures (CKD with DM):

  1. Constant glucose monitoring.
  2. Maintenance of regular diabetic medication.
  3. Regular physical exercise.10
Blood Sugar Monitoring

It is important to be watchful of foods containing high potassium in patients with diabetes. Sometimes, blood glucose level drops dramatically in diabetics. When that happens apple or grape juice are good low potassium drink options to bring blood sugar level to normal range.9

Some suitable meal options for individuals of diabetes with CKD include

CKD and diabetes are both progressive conditions that evolve over time, necessitating adjustments to the dietary regime. It is suggested to consult the nutritionist and follow the given advice.6

Control of HTN

Implementing a wholesome lifestyle can potentially avert the necessity for medication in managing blood pressure.12

‘’You can take many steps to avoid or delay reaching the point of kidney failure. The best thing you can do is control your blood pressure’’ _Paul.2

Blood Pressure (BP) Monitoring

Following steps can be effective interventions for BP Control:

  1. Regular physical exercise.
  2. Limiting salt (sodium) intake.
  3. Quitting smoking.
  4. Sound and sufficient sleep at night: Minimum 6 hours of restful sleep is recommended.
  5. Stress management: Being mindful of the inducing factors for better management of stress.
  6. Regular blood pressure monitoring: Home monitoring of blood pressure is effective. It can ensure the medications and lifestyle modifications are functioning well.12

Kidney Healthy Food

Individuals with renal disease may be required to adhere to a specialized dietary regimen, typically characterized by reduced levels of sodium, phosphorus, and potassium. While this treatment may not directly cure the kidneys, it can contribute to improving their overall health.14 Protein metabolism is important as protein consumption generates waste products in the body.15 Protein limitations will vary based on the specific phase of kidney disease.14

Kidney Healthy Foods
Cooking with minimal quantity of olive oil as a substitute for butter is protective for both kidneys and heart

Daily Fluid Consumption

The amount of water or fluid consumption depends on various factors and differs among individuals. The U.S. National Academies of Sciences, Engineering and Medicine recommends daily fluid intake of 2.7 liters for women and 3.7 liters for men. As a regular habit, consuming optimum level of water can protect from urinary tract infections (UTI), constipation and kidney stone.22

Use of NSAIDs and Kidney Health

Nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to cause several types of kidney damage, such as acute kidney injury (AKI) caused by changes in blood flow; imbalances in electrolytes and acid-base levels; acute interstitial nephritis (AIN), which can be accompanied by the nephrotic syndrome; and papillary necrosis.23

Epidemiological studies have indicated a higher risk of kidney damage in people with CKDwho use nonsteroidal anti-inflammatory drugs (NSAIDs). Current clinical guidelines advise against prolonged use of NSAIDs in individuals with CKD who have a glomerular filtration rate (GFR) of more than 30 mL/min/1.73 m2. For those with a GFR less than 30 mL/min/1.73 m2, full avoidance of NSAIDs is recommended.24

Screening of Risk Factors

1. DM Screening

To confirm the diagnosis of Type1, Type2 and Prediabetes, following tests are recommended:

  1. HbA1C: The HbA1C test quantifies the mean concentration of glucose in the bloodstream throughout the preceding 2 to 3 months. An A1C below 5.7% is counted as normal, between 5.7% to 6.4% is indicative of prediabetes and 6.5% or more implies the patient has diabetes.25
  2. Fasting blood sugar (FBS): The blood glucose concentration is tightly regulated within a narrow range of 4 to 6.5 mmol/l. At times, it may occasionally decrease slightly below this level to 3.5 mmol/l in young infants who refrain from eating overnight.26
  3. Glucose tolerance test.
  4. Random blood sugar test (RBS).
  5. Eye screening for diabetic retinopathy.25

HTN Screening

An optimal blood pressure reading is 120/80 mmHg.27 If one’s reading is high, for diagnosis of hypertension, physicians usually recommend to collect readings from a 24-hour monitor that examines blood pressure throughout the day (Ambulatory Blood Pressure).28

Conclusion

Finally, it is advisable to screen kidney functions regularly since kidney diseases progress silently.2 It may be considered part of primary care monitoring, especially for people with underlying conditions to protect the kidneys and also safe guard against the costly management of kidney disease.

Author of this article:
  • Assoc. Prof. Dr. Eusha A F Ansary MBBS, MD (Nephrology) Associate Professor and Head Dept. of Nephrology, Uttara Adhunik Medical College Former Research Fellow, BIRDEM Member, ACP (USA) Member, International Society of Nephrology
  • Dr. Maliha Tasnim MBBS (SMAMC), Executive Content, Medical Publications, Radiant Pharmaceuticals Limited
Reviewed & Edited by:
  • Prof. Dr. Syed Mahbubul Alam MBBS (DMC) & FCPS (Surgery), Former Principal Dhaka Medical College & Former Head of the Department (Surgery), Sir Salimullah Medical College Dhaka, Editor-In-Chief of The Coronal
  • Dr. Maliha Mannan Ahmed MBBS (BMC), MBA (ULAB) & Masters in Healthcare Leadership (Brown University), Executive Editor of The Coronal
References:
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