please tell me the things that kidney disease patients can eat, recipies are great. please and thanks. Email to a friend
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Home : Kidney & Urologic Diseases A-Z List of Topics and Titles : Nutrition in Children with Chronic Kidney Disease
Nutrition in Children with Chronic Kidney Disease
On this page:
Introduction
Energy
Protein
Sodium
Potassium
Phosphorus
Fluids
Special Problems in the First Year of Life
Keep Track of Test Results
Additional Reading
For More Information
About the Nutrition for Chronic Kidney Disease Series
Introduction
Every child needs good nutrition. If your child has been diagnosed with kidney disease, learning about nutrition is vital because your child鈥檚 diet can affect how well the kidneys work. Always consult with your child鈥檚 health care team before making any major changes in your child鈥檚 diet.
Our kidneys do many things to help maintain our health. To keep the body working properly, the kidneys remove wastes and extra water from the blood. They balance the salts鈥攎ade of sodium, potassium, calcium, and phosphorus鈥攖hat circulate in the blood. And they control the release of natural chemicals called hormones that help make red blood cells, control blood pressure, and keep bones strong.
In the early stages of chronic kidney disease (CKD), the kidneys continue to work. They just don鈥檛 do their job as well as normal kidneys do. Since the decline in kidney function happens slowly, your child鈥檚 body may adapt, and you may not notice any change in the way your child looks or feels. Unfortunately, over time, small changes can build up, and as the kidney disease worsens (CKD stages 4 and 5), your child may develop more symptoms of kidney disease.
As kidney disease progresses, nutritional needs change as well. When the kidneys don鈥檛 work normally, your child鈥檚 health care team may recommend a change in your child鈥檚 diet to protect the kidneys. Health problems from CKD can be prevented or delayed by eating the right foods.
Kidney disease can limit a child鈥檚 growth. Your child鈥檚 health care team will work with you to make sure that your child鈥檚 growth is as normal as possible. As children grow, their nutritional needs change as well. Work with your child鈥檚 health care team to be certain your child gets the right amount of all necessary nutrients. At different times, the team may suggest changes in both the amount and the types of food your child needs to eat. Learning about food choices will help you understand what changes need to be made to ensure that your child is as healthy as possible.
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Energy
Everyone needs energy to grow and be active. We measure the amount of energy in the diet by counting calories. Taking in too little energy can lead to decreased activity, poor growth, and decreased resistance to infection. As your child grows, energy needs change depending on age, height, and weight. Work with the health care team to determine your child鈥檚 daily calorie needs. If your child is not growing as well as possible, your child鈥檚 health care team can provide appropriate ways to add calories to your child鈥檚 diet.
Health care professionals calculate a child鈥檚 daily energy needs using the child鈥檚 weight as part of the equation. For example, a 3-month-old baby requires 49 calories a day for each pound of her body weight. If the baby weighs 8 pounds, she would need 392 calories per day.
8 X 49 = 392
As the baby gains weight, she requires more calories. If she gains 2 pounds, her daily calorie requirement would increase to 490.
10 X 49 = 490
The following chart shows how energy needs change as a child grows. A growing child requires more and more energy, or calories. But the older child does not need as many calories per pound of body weight as an infant needs.
Energy Needs for Children with Kidney Disease
Age Range Calories / Pound / Day
Infant 0鈥? months 49
7鈥?2 months 45
Toddler 1鈥? years 46
Child 4鈥? years 41
7鈥?0 years 32
Adolescents Girls Boys
11鈥?4 years 21 25
15鈥?8 years 18 20
Energy needs will vary and you should discuss any changing needs with your child鈥檚 health care team.
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Protein
Protein is an essential part of any diet. It helps build and maintain muscle, bone, skin, organs, and blood. Some proteins help fight disease and heal wounds. All proteins break down into waste products that must be cleaned from the blood by the kidneys.
Doctors sometimes recommend that patients with CKD eat moderate or reduced amounts of protein. In some patients, however, restricting protein can prevent adequate growth and may lead to malnutrition. For children with kidney disease, the goal is to eat enough protein for growth but to stay away from high protein intake. If your child is on dialysis, your child鈥檚 protein needs will increase, but the amount of this increase will be based on the type and frequency of dialysis.
Talk with your child鈥檚 health care team about the amount of protein and the sources of protein in your child鈥檚 diet. Animal sources such as eggs, milk, cheese, chicken, fish, and red meats contain more of the essential amino acids the body needs. A well-balanced vegetarian meal plan can also provide these nutrients. Your child鈥檚 health care team can suggest ways to make adjustments in eating habits to help meet your child鈥檚 protein needs. The following table has examples of the protein content of some common foods, but your child鈥檚 health care team can customize the list to your family鈥檚 diet habits.
Protein Content of Foods
Food Serving Size
Turkey breast 41 grams/cup
Large hamburger with vegetables and condiments 34 grams/8-oz sandwich
Tuna sub 30 grams/6-inch sub
Cottage cheese 26 grams/cup
Chili con carne 24 grams/cup
Cold-cut sub 21 grams/6-inch sub
Fast food taco 20 grams/6-oz taco
Fish sandwich with tartar sauce and cheese 20 grams/6.5-oz sandwich
Baked beans 17 grams/cup
Chicken nuggets 16 grams/6 nuggets
Yogurt 13 grams/8-oz container
Beef stew 12 grams/cup
Fast food burrito with meat and beans 11 grams/4-oz burrito
Cooked peas 8 grams/cup
Chicken noodle soup 6 grams/cup
Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 16鈥? (www.nal.usda.gov/fnic/foodcomp/Data/SR1... (PDF, 235 KB); accessed October 13, 2005)
Here is a table with the typical protein needs for growing children with kidney disease. A child on hemodialysis needs more protein than a child who has not started dialysis because the dialysis process removes protein from the child鈥檚 blood. Peritoneal dialysis removes even more protein than hemodialysis.
Protein Needs for Children with Kidney Disease
Age Range Grams / Pound / Day
Pre-Dialysis Hemo-dialysis Peritoneal Dialysis
Infant 0鈥? months 1 1.2 1.3鈥?.4
7鈥?2 months 0.73 1.1 1.0鈥?.1
Toddler 1鈥? years 0.5 0.7 0.9
Child 4鈥? years 0.5 0.7 0.9
7鈥?0 years 0.45 0.6 0.8
Adolescents 11鈥?4 years 0.45 0.6 0.8
15鈥?8 years 0.4 Girls Boys 0.6-0.7
0.5 0.6
For example, a 10-year-old boy who weighs 60 pounds would need 27 grams of protein a day before starting dialysis.
60 X 0.45 = 27
Limiting a child to this amount may be difficult because some foods contain that much protein in a single serving. You may need to cut sandwiches in half or serve smaller portions of soups and vegetables.
If this same boy started hemodialysis, his daily protein needs would increase to 36 grams.
60 X 0.6 = 36
On peritoneal dialysis, the boy would need 48 grams of protein a day.
60 X 0.8 = 48
Your child鈥檚 protein needs may vary鈥攄iscuss them with your child鈥檚 health care team.
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Sodium
Sodium is a mineral that is important for many body functions. Sodium is found in ordinary table salt and many seasonings like soy and teriyaki sauces. One teaspoon of table salt contains 2,300 milligrams of sodium. Canned foods, some frozen foods, and most processed foods have large amounts of table salt. Some snack foods like chips and crackers are also high in salt. Too much sodium can increase thirst, raise blood pressure, and cause water retention that may lead to excess weight gain or fluid buildup in the lungs. On the other hand, in some patients, too little sodium can lead to dehydration and poor weight gain. Figuring out how much sodium your child needs is complicated by the kind of kidney problem your child has, your child鈥檚 age, and sometimes other factors. Depending on your child鈥檚 own special needs, your health care team may ask you to either limit or add sodium to your child鈥檚 diet.
Talk with your child鈥檚 health care team about how much sodium your child needs. Look at the sodium content on the nutrition labels of the foods you buy. Choose 鈥渟odium-free鈥?or 鈥渓ow-sodium鈥?food products if you need to reduce sodium in your child鈥檚 diet. Nearly all fresh vegetables and fresh, unprocessed meat are preferable to processed foods. Try alternative seasonings like lemon juice or hot pepper sauce. But avoid salt substitutes that use potassium.
Sodium Claims on Food Labels
Claim Explanation
鈥淪odium-free鈥?Less than 5 mg sodium per serving
鈥淪alt-free鈥?Meets requirements for 鈥渟odium-free鈥?
鈥淟ow-sodium鈥?140 mg sodium or less per serving
鈥淰ery low sodium鈥?35 mg sodium or less per serving
鈥淩educed sodium鈥?At least 25 percent less sodium when compared with the regular version
鈥淟ight in sodium鈥?50 percent less sodium per serving; restricted to foods with more than 40 calories per serving
鈥淯nsalted, no added salt鈥?No salt is added during processing; the product it resembles and substitutes for is normally processed with salt; the label bears the statement 鈥渘ot a sodium-free food鈥?or 鈥渘ot for control of sodium in the diet鈥?
Source: American Dietetic Association, Complete Food and Nutrition Guide, RL Duyff, 1998.
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Potassium
Potassium is a mineral found in many fruits and vegetables like bananas, potatoes, avocados, and melons. It keeps the heart beating regularly and muscles working right. Your child鈥檚 health care team will routinely check your child鈥檚 blood tests to make sure that the potassium level stays in the normal range. If your child鈥檚 potassium begins to rise, talk with your child鈥檚 health care team about ways to limit the amount of potassium in your child鈥檚 diet. Your child may need to avoid some fruits and vegetables. The number and portion sizes of fruits and vegetables may need to be reduced as well. You can reduce the potassium content of potatoes and beans by soaking them in water for several hours before cooking.
Potassium Content of Foods
High-Potassium Foods Lower-Potassium Alternatives
Oranges and orange juice Apples and apple juice
Melons Cranberry juice
Apricots Canned fruit
Banana Strawberries, blueberries, raspberries
Kiwi Plums
Potatoes Pineapple
Tomatoes Cabbage
Sweet potatoes Cauliflower
Cooked spinach Mustard greens
Beans (baked, kidney, lima, pinto) Broccoli
Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 17鈥? (www.nal.usda.gov/fnic/foodcomp/Data/SR1... (PDF, 211 KB); accessed October 13, 2005)
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Phosphorus
Phosphorus is a mineral found in many foods, particularly those high in protein. When your child鈥檚 blood phosphorus level is too high, it pulls calcium from the bones, making them weaker and more likely to break. Too much phosphorus may also make your child鈥檚 skin itch and cause redness of the eyes. High protein foods such as dairy products, meat, dried beans, peas, colas, nuts, and peanut butter are high in phosphorus. Talk with your child鈥檚 health care team about how much phosphorus your child should have in his or her diet.
As kidney disease progresses, it may be necessary to take a phosphate binder with meals such as calcium acetate (PhosLo), calcium carbonate (Caltrate, Children鈥檚 Maalox tablets, Oscal, Tums), or sevalemer hydrochloride (Renagel) to lower the concentration of phosphorus in the blood. These medications act like sponges to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, not all of the phosphorus gets into the blood. Instead, some of it is passed out of the body in the stool.
Phosphorus Content of Foods
High-Phosphorus Foods Lower-Phosphorus Alternatives
Dairy foods (milk, cheese, yogurt) Liquid non-dairy creamer
Beans (baked, kidney, lima, pinto) Sorbet
Nuts and peanut butter Pasta, rice
Processed meats (hot dogs, canned meat) Rice and corn cereals
Cola Popcorn
Canned iced teas and lemonade Green beans
Bran cereals Lemon-lime soda
Egg yolks Root beer
Powdered iced tea and lemonade mixes
Source: United States Department of Agriculture (USDA) National Nutrient Database for Standard Reference, Release 17鈥? (www.nal.usda.gov/fnic/foodcomp/Data/SR1... (PDF, 211 KB); accessed October 13, 2005)
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Fluids
Early in kidney disease, your child鈥檚 damaged kidneys may produce either more or less urine than normal. If your child makes only a small amount of urine, swelling or high blood pressure may develop. If the kidneys produce too much urine, your child is at risk of dehydration. Tell your child鈥檚 health care team if you notice that your child is making either more or less urine or if you notice any swelling in the face, legs, arms, or abdomen.
Once your child鈥檚 kidneys fail and your child begins dialysis, you may need to limit how much your child drinks. The amount people drink is often related to the amount of sodium they eat. If thirst is a problem, you need to speak with your child鈥檚 health care team about ways to control excess thirst.
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Special Problems in the First Year of Life
Because infants grow so quickly, your child鈥檚 health care team will need to follow your child more closely during this critical time. Often a child will need special formulas with extra supplements (calorie enhancers) to be sure that your child gets the right amount of fluid and nutrients. Sometimes an infant can鈥檛 drink the amount of formula he needs to grow, and your physician may suggest that he be fed by tube. While this may sound drastic, experience has shown that tube feeding is often the best way to be sure that your child gets the full supply of fluid and nutrients he needs to promote growth and development. While feeding tubes are most often used in infants, there are situations when older children and adolescents benefit from them as well.
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Keep Track of Test Results
If your child has CKD, your child鈥檚 health care team will order regular blood tests. Many patients find that keeping track of test results helps them see how well they are doing. Ask your child鈥檚 doctor for copies of the laboratory reports and ask to have them explained. Note any results that are out of the normal range. When you learn how to read your child鈥檚 reports, you will see how the foods your child eats can affect laboratory results. Talk with your child鈥檚 health care team about making healthier food choices. You may ask for a laboratory report card from your child鈥檚 health care team on a regular basis.
The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
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Additional Reading
The following fact sheets and brochures, as well as other information, are available on request from the organizations listed. Most of them can also be found online at the web address given.
Dining Out With Confidence: A Guide for Patients with Kidney Disease
Nutrition for Children with Chronic Kidney Disease
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 1鈥?00鈥?22鈥?010 or 212鈥?89鈥?210
Email: info@kidney.org
Internet: www.kidney.org
A Healthy Food Guide for People with Chronic Kidney Disease
American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606鈥?995
Phone: 1鈥?00鈥?77鈥?600
Email: hotline@eatright.org
Internet: www.eatright.org
鈥淪olving the Diet Dilemma for Children鈥?br>
aakpRENALIFE, vol. 17, no. 5 (March 2002)
www.aakp.org/AAKP/RenalifeArt/2002/die...
American Association of Kidney Patients
3505 East Frontage Road
Suite 315
Tampa, FL 33607
Phone: 1鈥?00鈥?49鈥?257 or 813鈥?36鈥?100
Email: info@aakp.org
Internet: www.aakp.org
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For More Information
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1鈥?00鈥?38鈥?299 or 301鈥?81鈥?052
Email: helpline@akfinc.org
Internet: www.kidneyfund.org
American Society of Pediatric Nephrology
Northwestern University
The Feinberg School of Medicine
Pediatrics W140
303 East Chicago Avenue
Chicago, IL 60611鈥?008
Phone: 312鈥?03鈥?000
Fax: 312鈥?03鈥?181
Email: aspn@northwestern.edu
Internet: www.aspneph.com
Food and Nutrition Information Center
National Agricultural Library/USDA
10301 Baltimore Avenue, Room 304
Beltsville, MD 20705鈥?351
Phone: 301鈥?04鈥?719
Email: fnic@nal.usda.gov
Internet: www.nal.usda.gov/fnic
Life Options Rehabilitation Resource Center
c/o Medical Education Institute, Inc.
414 D鈥橭nofrio Drive
Suite 200
Madison, WI 53719
Phone: 1鈥?00鈥?68鈥?777
Email: lifeoptions@MEIresearch.org
Internet: www.lifeoptions.org
National Kidney Disease Education Program
3 Kidney Information Way
Bethesda, MD 20892
Phone: 1鈥?66鈥?鈥揔IDNEY (454鈥?639)
Email: nkdep@info.niddk.gov
Internet: www.nkdep.nih.gov Kidney friendly foods!
Appetizers
Chicken Nuggets with Honey Mustard Dipping Sauce
Sweet 鈥榥鈥?Sour Meatballs
Tortilla Rollups
Breakfast
Apple Cinnamon French Toast Strata
Festive Egg Scramble
Breakfast Burrito
Desserts
Cran-Apple Crumble
Pineapple Rum Cr猫me Cake
Zingy Spiced Pears
Strawberry Pudding
Meats
Stuffed Green Peppers
Homemade Pizza
Poultry
Speedy Chicken Stir-Fry
Salads
Homestyle Macaroni Salad
Seafood and Fish
Foil Baked Pimento Cod Fillets
Soups and Stews
Barley and Beef Stew
Vegetables
Deviled Green Beans
Garlic Mashed Potatoes
Stir-Fry Vegetables
Vegetarian Entrees
Pasta Primavera |
