Question

Mrs. Kouassi is a 44-year-old African from the Ivory Coast. Although she was diagnosed with hypertension about 11 years ago, it was left untreated. A year ago she was seen in the Emergency Department for fatigue, poor appetite, nausea and vomiting. She complained of shortness of breath, muscle weakness, and swelling of her lower legs. Her blood pressure reached 220/210. She was hospitalized, diagnosed with end-stage renal disease (ESRD), and started on hemodialysis. She currently goes to a dialysis center four times a week. She has not been working since she was diagnosed, and is receiving disability. Mrs. Kouassi is 5 feet 5 inches tall and weighs 145 pounds. When asked about her diet, Mrs. Kouassi states that she tried to follow the renal diet, but it is difficult because she likes to eat African foods such as palm oil and butter, rice, yams, soups, tea and dishes such as Fufu (cooked fine-blended cassava). She also likes fruits and vegetables, especially when they are combined with other foods such as in vegetable pizza.

1. What diseases or conditions can lead to chronic renal failure?
2. What signs and symptoms of chronic renal failure did Mrs. Kouassi exhibit when originally diagnosed?
3. What dietary recommendations are appropriate for Mrs. Kouassi in terms of energy, protein, fat, fluids, sodium, potassium, calcium, and phosphorus?
4. How does hemodialysis help to prevent disease progression?
5. Why are protein restrictions relaxed once dialysis begins?
6. What recommendations would be helpful in teaching Mrs. Kouassi how to incorporate her ethnic foods into a renal diet?

Answer 1

Diseases causing chronic renal failure :

1.) Diabetes

2.) Hypertension

3.) Glomerulonephritis

4.) Congenital Kidney diseases

5.) Polycystic kidney disease

6.) Lupus nephritis (SLE)

7.) Obstruction - Kidney stones, tumors

8.) Repeated urinary infections

Signs and symptoms :

*) Fatigue

*) Poor appetite

*) Nausea, Vomiting

*) Shortness of breath

*) Muscle weakness

*) Swelling of lower limbs

Dietary Recommendations :

You may need to make changes to your diet when you have chronic kidney disease (CKD) like limiting fluids, eating a low-protein diet, limiting salt, potassium, phosphorous, and other electrolytes, and getting enough calories if you are losing weight to keep the levels of electrolytes, minerals, and fluid in your body balanced when you have CKD or are on dialysis.

Carbohydrates -

Carbohydrates must be taken. For a low-protein diet, you may replace the calories from protein with:

Fruits, breads, grains, and vegetables. These foods provide energy, as well as fiber, minerals, and vitamins.

Hard candies, sugar, honey, and jelly. If needed, you can even eat high-calorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas

Proteins -

Low-protein diets may be helpful before you start dialysis based on your weight, stage of disease, how much muscle you have, and other factors

Once you start dialysis, you will need to eat more protein. A high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended.

People on dialysis should eat 8 to 10 ounces (225 to 280 grams) of high-protein foods each day. Addition of egg whites, egg white powder, or protein powder can be done.

Fat-

Fats can be a good source of calories. Make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to protect your heart health.

Calcium and phosphorus :

You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body

You will need to limit the amount of dairy foods you eat, because they contain large amounts of phosphorous. This includes milk, yogurt, and cheese. Some dairy foods are lower in phosphorous, including:

Tub margarine

Butter

Cream, ricotta, brie cheese

Heavy cream

Sherbet

Nondairy whipped toppings

Fluids

In the early stages of kidney failure, you do not need to limit the fluid you drink. But, as your condition gets worse, or when you are on dialysis, you will need to watch the amount of liquid you take in.

Tips to keep from becoming thirsty include:

Avoid salty foods

Freeze some juice in an ice cube tray and eat it like a fruit-flavored ice pop (you must count these ice cubes in your daily amount of fluids)

Stay cool on hot days

Salt or Sodium -

Reducing sodium in your diet helps you control high blood pressure. It also keeps you from being thirsty, and prevents your body from holding onto extra fluid. Look for these words on food labels:

Low-sodium

No salt added

Sodium-free

Sodium-reduced

Unsalted

Potassium -

Fruits and vegetables contain large amounts of potassium, and for that reason should be avoided to maintain a healthy heart.

When eating fruits:

Choose peaches, grapes, pears, apples, berries, pineapple, plums, tangerines, and watermelon

Limit or avoid oranges and orange juice, nectarines, kiwis, raisins or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines

When eating vegetables:

Choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green and wax beans, lettuce, onion, peppers, watercress, zucchini, and yellow squash

Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, avocado, and cooked spinach

Hemodialysis:

Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.

Properly functioning kidneys prevent extra water, waste, and other impurities from accumulating in your body. They also help control blood pressure and regulate the levels of chemical elements in the blood. These elements may include sodium and potassium. Your kidneys even activate a form of vitamin D that improves the absorption of calcium.

When your kidneys can’t perform these functions due to disease or injury, dialysis can help keep the body running as normally as possible. Without dialysis, salts and other waste products will accumulate in the blood, poison the body, and damage other organs.

Protein relation with dialysis :

When protein is ingested, protein waste products are created. Healthy kidneys have millions of nephrons that filter this waste. It’s then removed from the body in the urine.

Unhealthy kidneys lose the ability to remove protein waste and it starts to build up in the blood. Hence a low protein diet is recommended for a renal failure patient.

Dialysis removes protein waste from the blood and a low protein diet is no longer needed. Unfortunately, some amino acids are removed during dialysis. A higher protein intake is needed to replace lost protein.

Incorporating Ethnic food in renal diet :

Assessing cultural issues surrounding food and food preferences may help improve dietary adherence. For effective medical management of patients from different cultural and ethnic backgrounds, it must incorporate more traditional and customary foods in the renal diet meal plan.

Ethnic foods can be assessed for levels of carbohydrate, protein, calcium, phosphorus, potassium and sodium and can be recommended for the patients