Nutrition in case of renal insufficiency

Note

Please note that this topic is the continuation of our topic: Kidney Disease Diet acts.

The different diets

In the following two different diet forms are presented, which can be carried out in the case of renal insufficiency (kidney failure).

• Potato and Egg Diet
• Sweden diet

The Potato and Egg Diet (KED)

according to Kluthe and Quirin (protein-selective diet)

It is a low-protein and protein-selective diet (only certain proteins from certain foods are allowed) in which the full value of the protein is achieved through protein mixtures. Protein or protein mixtures can be described as full if they contain all essential amino acids in sufficient quantities. The lower the amount of protein that has to be added to achieve this goal, the higher the value.
A mixture of potatoes and egg in a ratio of 3: 2 has the highest biological value. Other cheap protein mixtures are milk and wheat (3: 1) or beans and egg (1: 1). These protein mixtures are to be regarded as the main carriers of the essential amino acids and must make up half of the daily dietary protein.

Depending on the stage of chronic kidney failure, the potato and egg diet can be prescribed with 25 to 30 g protein daily or 40 to 45 g daily.
The diet prescription depends on the creatinine and urea levels in the serum.
With creatinine 3-6 mg / dl and urea 100 to 150 mg / dl, the potato-egg diet with 40 to 45 g of protein is prescribed daily. With creatinine> 6 mg and urea> 150 mg / dl, no more than 25 to 30 g protein may be consumed daily.
This corresponds to a protein intake of 0.4 or 0.6 g per kg of body weight.

Principle of the diet:

Reduce protein intake and add 50% in the form of protein mixtures, mainly a potato-egg mixture.

• Get enough calories. 35 to 37 kcal per kg of body weight.
• use high quality vegetable oils
• Ingestion of water-soluble vitamins, minerals and trace elements as prescribed by a doctor.
• 5 to 6 meals a day
• Depending on the severity of the symptoms, this diet can be prescribed:
  Low Sodium (1200 mg sodium daily this corresponds to 3 g table salt)
  Low in potassium (1600 - 2000 mg potassium daily) or strictly low in potassium (<800 mg potassium Every day)
• Liquid balanced according to the basic rule: amount of urine excretion of the previous day plus 500 ml.
• Also for diabetic a potato and egg diet can be prepared according to a doctor's prescription.

The potato-egg diet offers little variety in the menu design due to the definition of certain food mixtures (mainly potatoes and eggs as protein sources).

Recipes and daily plans for the potato and egg diet can be found in the book by Kluthe and Quirin, Instructions for the potato and egg diet, diet book for kidney patients.

Here you can see an example of the day Potato egg diet.

The Sweden diet according to Bergström (non-protein selective)

The Swedish diet is a low-protein, non-protein-selective diet, which means that the dietary protein can be freely selected within the prescribed amount.
The essential amino acids required for life are not contained in sufficient quantities in this strictly protein-poor diet and must be replaced. This is done by administering amino acid mixtures (10 g / day) or keto analogs (precursors) in the form of tablets, pearls or granules.
These preparations are essential amino acids (EAS) are therefore part of the diet and must be prescribed and taken daily. With the Sweden diet, the eating habits of the patients can be taken into account as far as possible and this diet is usually well accepted.

Principle of the diet:

Reduction of the intake of dietary protein, depending on the severity of the symptoms, to 0.4 g protein / kg body weight (20 to 25 g protein daily) or 0.6 g protein / kg body weight (40 to 45 g protein daily).

• Free choice of protein within the prescribed amount.
• If the total amount of protein is less than 40 g per day, the essential amino acids must be supplied in drug form.
• Highly energetic (35 to 37 kcal per kg / body weight)
• Use of high quality vegetable fats.
• Administration of water-soluble vitamins, minerals and trace elements as prescribed by a doctor.
• 5 to 6 meals a day

Depending on the clinical symptoms, this diet can be prescribed low-sodium, low-potassium, fluid-balanced or as a diabetes diet. Recipes and daily plans can be found in the book “Protein-balanced diet for people with chronic kidney disease” by Kotthoff, Haydous, Beiersmann, Riedel.

Here you can find a daily example of the Swedish diet,

Summary

Diet recommendations for chronic renal failure

Protein:

Low-protein diet with high-quality protein. With serum creatinine <6 mg / dl a lacto-vegetable diet (omit meat and eggs, use dairy products as protein carriers. With serum creatinine> 6 mg / dl strictly protein-poor diet (0.35-0.45 g protein per kg body weight. For example potatoes) Egg diet (KED) as a high-energy basic diet with a ratio of potato to egg protein 3: 2 or the Sweden diet with 15 to 20 g protein from normal food supplemented by essential amino acids in drug form.

Energy:

Energy-rich with 35 kcal per kg of body weight.

Drinking amount:

As long as a normal urine excretion is possible, a daily intake of 2-3 l is recommended in order to excrete the substances that are subject to urine. If the urine excretion is reduced, the amount you drink is calculated from the urine volume of the previous day plus 500 ml.

Sodium:

Restriction to 3 - 5 g of table salt per day. Use very little or no salt for cooking and do not add salt at the table. In the case of sodium depletion, it is necessary to supply salt with food (e.g. broth) or by infusing an isotonic saline solution into the vein.

Potassium:

If the potassium level in the serum is high, a low-potassium diet is necessary.

In the case of potassium depletion (very rarely), potassium may have to be given in the form of effervescent tablets.

Phosphate:

In the case of advanced kidney failure, the intake must be limited to a maximum of 1 g per day and foods rich in phosphate are to be avoided. If the serum phosphate is> 6.5 mg / dl, additional phosphate binders must be given in drug form.

Vitamins, trace elements:

Vitamin D must be given as soon as uncontrollable hyperfunction of the parathyroid becomes apparent despite a low-phosphate diet and phosphate binders. In the case of severe protein restriction and if a low-potassium diet is prescribed, the intake of water-soluble vitamins such as the B complex and vitamin in tablet form is recommended. In the case of existing complaints, iron and zinc in tablet form may also be necessary. The vitamin A level is usually increased in uremia and must not be added.