Chronic Kidney Disease and Diabetes
Chronic kidney disease (CKD) is a global public health problem with increased rates as a consequence of the epidemic of type 2 diabetes and obesity. The prevalence of diabetes is growing rapidly and is one of the major leading causes of CKD. People with diabetes and CKD are at greater risk of experiencing major cardiovascular procedures.
Most people in USA consume 1.04 g/kg body weight per day as protein, which is more than the 0.8 g/kg body weight per day RDA. For people with diabetes, carbohydrate intake and glycemic control are typically the target of nutritional management, and protein usually comprises 15% to 20% of total daily calories. However, all three macronutrients – protein, carbohydrates and fats – as well as micronutrients, including sodium, potassium and phosphate must be well balanced to maintain an adequate nutritional status.
Nutritional intervention should be individualized with achievable goals that emphasize the importance of lifestyle behaviors conducive to positive outcomes. Meal plans for diabetes and CKD should consider the quality and quantity of proteins, carbohydrates and fats. Protein intake meeting the RDA, or 0.8 g/kg of body weight per day, has shown a reduction in albuminuria and stabilization of kidney function in studies of diabetes and CKD, while allowing patients to remain well nourished. Low protein menu plans are at risk of causing malnutrition.
Conversely, high-protein diets can be a concern because they increase albuminuria and may accelerate loss of kidney function in patients with diabetes. Consequently, people with diabetes and CKD should avoid high-protein diets (≥20% of total daily calories), such as many of the fad diets, shakes and protein powders. Regardless of the level of protein intake, at least 50% to 75% of the protein should be of high biological value (HBV) and mainly from lean poultry, eggs, fish, bean, peas and soy- based proteins. For instance, the DASH diet emphasizes vegetables, low-fat or nonfat dairy products, whole grains, nuts, legumes, fish, eggs and poultry with red meats consumed in only small amounts.
End of Stage Renal Disease (ESRD) and Hemodialysis
The number of people with ESRD receiving hemodialysis is increasing dramatically. Patients with ESRD on dialysis maintenance have high incidence of Protein Energy Malnutrition (PEM). PEM can have various causes, but one of the most important is decreased nutrient intake. In order to maintain a safe dietary protein intake, patients undergoing hemodialysis need 1.2 g/kg body weight/d with at least 50% being HBV such as animal protein meats, fish, salmon, tuna, poultry and eggs. However, such protein choices are also sources of phosphorous and potassium. Egg whites are low in phosphorus and therefore are a good source of HBV protein when phosphorous and potassium are a concern.
Dietary intervention for CKD must be individualized, since CKD changes as it progresses. The role of a Registered Dietitian is very important in the prevention and treatment of CKD, especially since addressing the diabetes epidemic and its complications requires an indispensable shift in lifestyle.