During this hectic time of diagnosis and management of your new lifestyle, it is helpful to explore CKD and outline a few common symptoms. CKD can be defined simply as the gradual loss of kidney function. Since the body is constantly producing waste, the kidneys play a key role in removing these toxins and keeping your system functioning properly. Tests can be done to measure the specific level of wastes in your blood and determine the level of function of your kidneys. Your doctor can figure out your kidney’s filtration rate and identify your CKD stage based on this measurement.
There are five stages associated with CKD that correspond to how well your kidneys are functioning (see The Stages of Kidney Disease ). During the early stages, people often do not experience any symptoms, and the disease can be very manageable. Kidney disease can even go undetected until it is quite advanced. Many symptoms do not begin to appear until the later stages, when toxins begin to build up in the body from damage to the kidneys. For example, itching, swelling, nausea, vomiting, or changes in urine patterns may be the result of the decreased filtration ability of these organs. That’s why early diagnosis is so crucial and can result in very positive outcomes later on with regard to the disease’s progression.
Although there is no cure for CKD, this disease is completely manageable. Making changes to your diet and lifestyle can help slow the progression of the disease and avoid symptoms that typically begin to emerge later on. These diet and lifestyle changes can even improve your overall health and help you manage associated conditions. As we will explore in the next few sections, there are associated diseases that may have led to CKD or perhaps were a contributing factor. When you begin making changes to your food and daily habits, you will also begin to notice improvement in these associated conditions, including hypertension and diabetes.
It is very possible to live a long, healthy, and happy life while managing this disease, and making the proper changes early on can slow the progression of any adverse symptoms for several years. I hope this book will shed this important light on you and your loved ones, so together we can make positive changes that delay the progression of CKD for a long time to come.
The kidneys are a team of bean-shaped filters with a critical job—they regulate the stability of the entire body. Using different signals from the body, such as sodium content or blood-vessel pressure, the kidneys help regulate blood pressure and keep us well hydrated. For example, have you ever had a busy day and didn’t get a chance to drink as much water as usual? Your mouth was parched, and you felt sluggish. Then, maybe you even noticed that your urine color was a bit too dark. That is the kidneys, keeping as much water in your body as possible and letting out all of the other things you don’t need. When you are well hydrated, your urine is more diluted, because the kidneys realize that you don’t need that much water to be held back, and they let it go through. When the kidneys stop functioning properly, a series of problems can occur. Normal filtration of toxins slows down, and the buildup of these harmful chemicals can cause subsequent reactions in the body, such as rashes, nausea, or vomiting. As kidney function continues to decrease, the body’s ability to remove water from the body and secrete hormones to control blood pressure is also affected, so symptoms like swelling of the feet or high blood pressure may occur. Over time, since the kidneys can stimulate the production of red blood cells from bone marrow, as well as create an active form of vitamin D, reduced kidney function can result in long-term health issues, like anemia or osteoporosis.
Our kidneys work hard, so it’s important to protect them. In fact, they filter between 120 and 150 quarts of blood every day. This process produces 1 to 2 quarts of urine, which is made up of waste products and excess fluid.
Part of the management of kidney disease comes with understanding how you developed it. Preexisting conditions such as diabetes and hypertension are commonly associated with kidney disease and play a key role in decreasing the function of these organs. If you have these conditions, your dietary needs will be different, so it is important to consult with your doctor about what factors to consider as you begin adjusting your diet and lifestyle. In the next few sections, I’ll help you understand the common causes of CKD and what to consider if you are juggling more than one condition.
Diabetes is a disease that alters your body’s ability to either produce or use insulin. Insulin is a hormone released from the pancreas, which pulls sugar from the blood and sends it to the organs that require it for normal functioning. If you have diabetes, there is a good chance that you know all of this information in more detail, and you have been managing it with diet and medical treatment.
However, chronic or uncontrolled diabetes can be very damaging to the kidneys and play a major role in the development of CKD. In fact, diabetes is the leading cause of kidney disease. As mentioned, one of the kidney’s jobs is to filter all the fluid in your body and let out the waste products along with excess water. Imagine this fluid hitting the filter of the kidney repeatedly, all day long. Luckily, our filtration system is typically strong enough to handle that pressure. However, when there are large molecules of sugar in our blood, this increases the pressure put on the filter, and eventually, it can break.
If you have diabetes and are diagnosed with CKD, it is important to work with your doctor and a dietitian to create a twofold diet that (1) avoids the nutrients that should be limited with kidney disease and (2) controls your blood glucose levels. This book will provide specific recipes to help you get started.
Relationships with your health care providers should be based on trust and respect, and the ability to rely on them for guidance and support.
High blood pressure, also known as hypertension, can cause kidney damage and can be caused by kidney damage. Our blood vessels push all of our blood through the body—that blood puts pressure on the walls of our arteries. If the pressure is too high, it can begin to damage the walls of these vessels, especially smaller blood vessels like those found in the kidneys. Blood vessels that run through our kidneys exchange molecules during the filtration process, but damage to these walls can impede the work of the filtration system and cause damage to the kidneys, leading to CKD.
A primary function of the kidneys is to control blood pressure by producing certain hormones. If the kidneys become damaged, their ability to regulate these hormones decreases, and blood pressure can increase. If you are struggling with chronic hypertension or are looking to regulate your blood pressure due to CKD, diet and lifestyle management can help. Many key elements of a kidney-friendly diet also aid in managing hypertension, so it is important to consider this as you determine what kinds of positive changes you can make for your health.
For most individuals with kidney disease, progression of the disease is slow and occurs over a period of years. This is encouraging, because if CKD is caught early, interventions such as regular checkups, medicine, and lifestyle changes can greatly help slow its progression for a better quality of life.
The National Kidney Foundation (NKF) has created guidelines to help doctors identify the five levels of kidney disease. Each stage calls for different tests and treatments and is determined by the glomerular filtration rate (GFR). GFR is calculated using a person’s age, race, gender, and serum creatinine (waste product of muscle breakdown). It is the most effective way to measure the level at which your kidneys are functioning.
This book is designed for individuals with CKD stages 1 through 4, to help slow or avoid the progression to CKD stage 5. Stage 5 may be indicative of kidney failure and the need for dialysis treatment.
Effectively managing CKD requires a combination of dietary changes, lifestyle modifications, and partnership with health care providers. You can increase the chance for positive outcomes by educating yourself about the disease and learning as much as you can about the personal choices you can make as a patient. Knowledge truly is power, so gather all that you can! With CKD, this is especially true when it comes to your diet.
The “CKD 1–4 diet” can be overwhelming at first, but like anything new, once you begin to put it into practice, it will become a natural part of your lifestyle that requires little thought. The basic guidelines of the CKD 1–4 diet are restriction of protein, sodium, potassium, phosphorus, and in some cases, fluids. Based on your blood-work results and other factors, your dietitian and/or health care provider can create an individualized diet prescription for you. The rest is up to you; in fact, how well you comply with these dietary restrictions has enormous influence over the rate of disease progression.
This book focuses on a wide variety of foods that can be included in the CKD 1–4 diet. It provides examples of daily meal plans that are easy and quick to prepare, corresponding shopping lists, and 100 practical recipes to suit everyone’s tastes. We all have good and bad days, and diet slipups may happen. Remember, it’s not about perfection but what you do most of the time that matters!
Stage 1
Slight kidney damage with normal or increased filtration (GFR > 90 mL/min)
Stage 2
Mild decrease in kidney function (GFR = 60–89 mL/min)
Stage 3
Moderate decrease in kidney function (GFR = 30–59 mL/min)
Stage 4
Severe decrease in kidney function (GFR = 15–29 mL/min)
Stage 5
Kidney failure/End-stage CKD (GFR < 15 mL/min)
Like diet, lifestyle choices play a big part in CKD 1–4 management. Engaging in regular exercise, adequate sleep, good weight management, stress reduction, and avoiding cigarettes and alcohol are all healthy lifestyle practices. They can help you manage or reduce your risk of chronic diseases associated with CKD, like diabetes, cardiovascular disease, and high blood pressure. Thoughtful lifestyle choices, especially when practiced consistently, can make a huge difference in how you feel, both physically and emotionally.
Treatment and management of your CKD should involve your health care team, inclusive of renal doctors, nurses, social workers, and a dietitian. These people each offer specific expertise, and together they are a comprehensive professional support system to educate and guide you with your CKD. As experts in the renal field, health care professionals are your best source of information. Encourage them to work together to develop an individualized plan of care that works for you. In order for your health care team to help you best, be open and honest with how you are feeling and the lifestyle and diet choices you’re making. They are there not to judge but to help you make good choices in managing your CKD.
Upon receiving the news of a CKD diagnosis, it is completely normal to experience a wide range of emotions: fear, anxiety, sadness, anger, denial, and others. It’s also common to experience these emotions as you start learning more about CKD, its impact on your life, and what changes you need to implement to help manage it. It can be overwhelming and devastating, and can affect you both physically and emotionally. But we live in a progressive society with countless valuable resources. Health care providers, physicians, social workers, nurses, and dietitians, to name a few, are available to listen, educate, and support you through this new diagnosis. Do not feel you need to deal with this by yourself. Discussing your feelings with family, friends, and other CKD patients may be hugely reassuring and beneficial. Be open and honest with your providers so they can help you or refer you to other resources for support. Support groups and credible Internet sites (see Resources ) are wonderful outlets that can help you learn more about your condition and its treatment, gain perspective on your situation, and put you in touch with others who are in a similar situation and can relate.
Q: There are so many things I can’t eat now—what can I eat?
A: What you should eat and how much is determined by what stage of CKD you are in. Routine checkups and lab work will help determine your food restrictions. This book is a guide that focuses on kidney-supportive foods—and the list is a long one! However, a registered dietitian (RD) can also help you sort out what foods to avoid and, more importantly, what foods you can have. An RD can help you develop personalized diet parameters and create practical individualized meal plans and lists of foods to meet your dietary needs to supplement those discussed in this book. A good RD can answer your questions and empower you to make your own smart and satisfying food choices.
Is there a cure for CKD?
There is no cure for CKD. However, there are many ways to manage the disease and live a long, full, productive life. If you have CKD, it is very important to have regular checkups, take your medication as prescribed, and follow your CKD diet/meal plan to slow the progression of the disease. The one thing you have complete control over is the choice of what and how much you eat. Diet compliance is one of the most important components of your health, as it influences your future health and well-being.
What can cause CKD?
Over time, other chronic diseases, such as diabetes, hypertension, or heart disease, can cause CKD. It can also be genetic or linked to ethnicities such as Native American, Hispanic, African American, or Asian. Age is another factor; people over 60 years old are at a higher risk for CKD.
Absolutely! Exercising at least 30 minutes, five days a week, can help keep symptoms in check and control associated factors, such as diabetes and hypertension.
What is a glomerular filtration rate (GFR) and why do I keep seeing numbers associated with this term?
The GFR is used to measure how well your kidneys are functioning. This number is used along with the amount of creatinine in your blood to calculate what stage of CKD you may be in, so it is important to talk to your doctor about these tests.
How can I tell if my CKD is getting worse?
Many symptoms are not noticeable until the advanced stages of CKD. It is important to begin adopting a kidney-friendly diet and lifestyle before your condition worsens. Regular checkups are helpful and reassuring, as your provider can monitor your levels and answer your questions. If you notice symptoms such as swelling, constant fatigue, changes in appetite, foamy urine, or trouble with concentration, please contact your doctor.
If I have CKD, am I going to need dialysis?
CKD, especially if caught early, can be controlled, and advanced stages can be delayed with proper nutrition and lifestyle changes. In fact, only about 1 out of 50 people who are diagnosed with CKD progress to kidney failure and the need for dialysis. CKD does result in a higher risk for other complications, such as heart disease or stroke; this is one more good reason to work with your doctor and dietitian to manage your diet and medications and prevent any further damage.