What You Should Know About Diet and Early Kidney Disease

What You Should Know About Diet and Early Kidney Disease

Therapeutic Nutrition for People With Reduced Kidney Function

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SUPLENA is therapeutic nutritiondesigned to meet the specificnutritional needs of people with early kidney disease. It is an excellentsource of energy—and has the rightbalance of vitamins and minerals.Ask your doctor, nurse or dietitian if SUPLENA is right for you.

Suplena may be recommended:• For days when you’re too tired

or busy to prepare a meal

• As a convenient way to get thecalories and nutrients you need

• If you experience involuntary weight loss

SUPLENA can be used as a handysnack or as a delicious meal on the go. Try Suplena for breakfast or instead of a fast-food restaurant meal.

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What do the kidneys do?Two of the kidneys’ mostimportant jobs are:

• filtering wastes out of the blood

• forming urine to carry these wastes out of the body

As part of this process, the kidneys adjust theamounts of the following in the blood:

• water

• minerals (among them, calcium and phosphorus)

• electrolytes (sodium, potassium, and chloride)

Maintaining the body’s balance of water,minerals, and electrolytes is very complex.

Most of the wastes, minerals, and electrolytesthat the kidneys remove come from the foodswe eat. When protein is digested, a wasteproduct called urea is formed. Urea and otherwastes are combined with water in the kidneysto form urine.

1© 2006 Abbott Laboratories

Your Name: _______________________________________________

Physician/Dietitian/Nurse Name: _______________________________

Physician/Dietitian/Nurse Phone Number: ________________________

This booklet was developed to help people with early kidneydisease or reduced kidney function understand their conditionand the importance of good nutrition in their daily lives.

If you have chronic kidney disease, save this booklet as a handy reference to remind you of how your nutritional needshave changed since your doctor told you that you have reduced kidney function. You should talk to your health careprofessional about the importance of a good diet.

Your physician/dietitian/nurse recommends the following diet:

Diet details ______________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

diabetes, high blood pressure, hereditary kidneydisease, drug side effects, and blockage bykidney stones. People can lose more than halftheir normal kidney function before they start tonotice symptoms of kidney disease. Some ofthese symptoms are nausea, vomiting, tiredness,and loss of appetite.

Why is diet important with reducedkidney function?The work of the kidneys can be made easierby limiting the intake of certain foods,especially those that are high in protein.Following a low-protein diet can help slowdown damage to the kidneys and may delay the need for dialysis treatments.

Your doctor may refer you to a registereddietitian (RD). An RD can individualize a diet based upon the level of kidney functionand other medical conditions (for example,diabetes or hypertension).

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What happens when the kidneysdon’t work normally?Most people have two kidneys—one on theright side of the lower back and the other onthe left. People can live fairly normal lives withonly one healthy kidney. If part of a kidney isdamaged or diseased, the healthy part worksextra hard to make up for the loss.

A damaged or diseased kidney, however, maynot be able to filter enough waste from theblood. If this happens, wastes and electrolytesbuild up in the blood and act like poison.

What is chronic kidney disease?With chronic kidney disease (also called renal disease), the kidneys don't filter enough wastes from the blood. Some people withchronic kidney disease still have the ability to filter the blood and make urine, but withreduced capacity.

Reduced kidney function can result from anumber of causes. The most common are

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•Sufficient calorie intakeIf you don't get enough calories every day, the body will break down muscle for energy(calories), resulting in weight and muscle lossover time. To make sure your calorie needsare being met, your doctor or dietitian mayrecommend increasing the intake of high-calorie,low-protein foods such as margarine and oils,honey, syrups, jam, jellies, and hard candies.

For people with diabetes and reduced kidneyfunction, amounts of fat and carbohydrate can be adjusted so the diet provides enoughcalories and still follows dietary guidelines.

•Protein intakeFoods that contain proteinproduce urea and other wasteswhen they are digested.Normally, these wastes areprocessed by the kidneys and areexcreted in the urine. With reducedkidney function, this excess proteinplaces added stress on the kidneys. Following alow-protein diet can help slow down damage tothe kidneys and may delay the need for dialysis

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What is dialysis?Dialysis is a treatment that does some of thethings typically done by healthy kidneys. It is needed when your own kidneys can nolonger take care of your body’s needs. If aperson has kidney function that is reduced tothe point when the kidneys do not work at all,they will need a machine to do the work theirkidneys once did. These machines are known asdialysis machines and the process by which theblood is filtered through these machines isknown as “dialysis.” Reduced kidney functionmay also be referred to as “pre-dialysis.”

What is a good diet for people withreduced kidney function?People with reduced kidney function have specificneeds that make their diets different than usual.And by eating right and following a special diet as prescribed by your doctor or dietitian, researchhas shown you may be able to prevent or delaythe need to go on dialysis. To help identify betterfood choices, refer to the tables in the back of this booklet. Work closely with your health careprofessional to develop a diet that includes someor all of the following:

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treatments. Some protein is important in the diet,and it should be high-quality protein such as thatfound in eggs, fish, chicken, and meat. High-quality protein provides the right amount ofessential amino acids needed to build, maintain,and repair body tissue.

The amount of protein recommended by your dietitian depends on your body size. This is calculated from your body weight. For example, if you weigh 150 pounds, yourrecommended range would be 40 to 68 grams of protein each day. At least 1⁄2 of this proteinshould come from high quality sources.

A dietitian can tell you exactly how muchprotein and how many servings of high-proteinfoods you should have each day. For example,one ounce of chicken contains 7 grams of protein.See Table 1 on page 12.

•Potassium intakeThe amount of potassium in the diet is usuallynot a problem in the early stages of kidneydisease. However, as the condition progresses,potassium intake may need to be reduced.Potassium is found in fruits, vegetables, milk,cheese, and nuts. See Table 2, page 13.

•Sodium intakeSodium is found in many processed foods andis a major component of table salt. Too muchsodium in the diet can contribute to high bloodpressure. Kidney disease is often associatedwith high blood pressure, which can harm theheart or even cause a stroke. To reduce sodiumin the diet, foods can be seasoned with spicesand herbs instead of salt. See Table 3, page 14.

•Phosphorus intakePhosphorus is a mineral found in cheese, milk, and meat. In kidney disease, the bodycan’t keep a balance between calcium andphosphorus. The result is too little calciumand too much phosphorus in the blood. Doctorsmay prescribe a phosphate binder, a medicinethat helps control the phosphorus level in theblood. See Table 4, page 15.

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Are there other nutritional choices forpeople receiving dialysis?

Many people who aren't able to eat well have found medical nutritional products to beconvenient and beneficial to their diet. Medicalnutritional products are designed to be consumed with regular meals, or occasionally in place of them.

Ross has developed a special medical nutritionalproduct especially for people with reducedkidney function. It is called SUPLENA®,Therapeutic Nutrition for People With ReducedKidney Function.

•Calcium intakeYou need to be sure you are getting enoughcalcium to prevent bone disease, withoutdrinking too much milk or eating too manydairy products. Milk and other dairy productsare rich in calcium, but they also contain a lot

of potassium and phosphorus, whichmay be limited in your diet. Your

doctor may prescribe a supplementto help you get enough calcium.

•Vitamin intakeThe kidneys are important in

metabolizing several vitamins, soselected vitamins need to be supplemented

and the intake of others should be controlled.

If a vitamin supplement is not prescribed, you should ask your doctor or dietitian for arecommendation before taking one.

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for you.

How is SUPLENA different from otherproducts such as Boost®or Ensure®?SUPLENA is made specifically for people withreduced kidney function. It provides the caloriesand energy you need without the higher levels ofprotein and phosphorus found in these otherproducts. And since SUPLENA is from themakers of Ensure, you can be assured that it hasthe right balance of nutrients to meet yourspecific nutritional needs.

How can I find out more about SUPLENA?Ask your doctor, dietitian or nurse if SUPLENA isright for you. They may provide you with asample and/or coupons.

To order SUPLENA, ask for it at your drugstore.If you prefer convenient home delivery, call

What is SUPLENA®?SUPLENA is vanilla-flavored therapeutic nutritionthat is low in protein, sodium, potassium, and

phosphorus. Drinking SUPLENA is aquick, convenient way to help you get

the nutrition you need and keepcontrol of other nutrients that maybe modified in your diet. One can (8fluid ounces) provides 475 Calories

and 7.1 grams of protein. SUPLENAis low in phosphorus, vitamins A and

D, and high in folic acid and vitamin B6. SUPLENAis a great supplement to the diet of people with reduced kidney function.

Your doctor or dietitian may recommendSUPLENA to you for these reasons:

• If your lab values indicate you need less proteinand more calories in your diet

• As a quick and easy meal replacement anytime

• If you have lost weight without trying

SUPLENA is lactose-free, gluten-free, and kosher.

Ask your doctor or dietitian if SUPLENA is right

Sources:1. USDA Nutrient Data Laboratory: USDA National Nutrient Database for

Standard Reference, Release 17. Available at www.nal.usda.gov/fnic/foodcomp. Accessed March 2005.

2. Agriculture Handbook No. 456: Nutritive Value of American Foods in Common Units.Washington, DC: Agricultural Research Service, US Dept of Agriculture, 1975.

3. Pennington JAT: Bowes and Church’s Food Values of Portions Commonly Used, ed 15. New York: Perennial Library Per Library of Congress listing for 1989version, 1989.

Boost is not a registered trademark of Abbott Laboratories

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PROTEIN FOODS_____ oz protein foods per day

Food Group Protein per Serving (grams)

Milk 4 grams per 1/2 cup

Meat, Fish or Chicken* 7 grams per 1 ounce

Breads 2 grams per serving**

Vegetables 1 gram per serving**

Fruits 0.5 grams per serving**

*weight after cooking**serving sizes vary

TABLE 1

FOODS WITH POTASSIUM

Choose these: Instead of these:Foods LOW in potassium Foods HIGH in potassium

Plain tortilla chips Fast food french fries(1 oz = 56mg) (1 large order = 560mg)

Cranberry juice Orange juice(1 cup = 37mg) (1 cup = 472mg)

Alfredo sauce Tomato sauce(1/4 cup = 16mg) (1/2 cup = 400mg)

Green beans, cooked Spinach, cooked(1/2 cup = 100mg) (1/2 cup = 279mg)

Peaches, canned Banana(1/2 peach = 95mg) (1 small = 362mg)

Mashed potatoes Baked potato(1/2 cup = 152mg) (1 small = 610mg)

Low-fat milk Milk shake(1 cup = 397mg) (11 oz = 571mg)

Mandarin oranges Fresh orange(1/2 cup = 99mg) (1 medium = 250mg)

Fruit cocktail Cantaloupe(1/2 cup = 115mg) (1 cup = 494mg)

TABLE 2

Example: 1 slice of bread,1⁄2 cup of rice or pasta

Example: 1⁄2 cup of cookedcarrots, 1 cup of lettuce

Example: 1 small apple,1⁄2 cup of grapes

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FOODS WITH SODIUM

Choose these: Instead of these:Foods LOW in sodium Foods HIGH in sodium

Lettuce salad Canned soupw/dressing (1 cup = 800mg)(small = 225mg)

Cream cheese American cheese(1 oz = 83mg) (1 slice = 313mg)

Popcorn, caramel coated Potato chips(2/3 cup = 56mg) (4-oz bag = 674mg)

Grape juice Tomato juice(1 cup = 8mg) (1 cup = 654mg)

Pork chop Ham (2 oz = 32mg) (2 oz = 697mg)

Cooked cabbage Sauerkraut(1 cup = 6mg) (1 cup = 939mg)

Fast food fish filet Fast food cheeseburger(1 sandwich = 614mg) (1 burger = 1589mg)

Cooked carrots Macaroni & cheese(1/2 cup = 45mg) (from mix)

(3/4 cup = 652mg)

Cake doughnut Danish pastry(1 small = 143mg) (1 large = 503mg)

TABLE 3FOODS WITH PHOSPHORUS

Choose these: Instead of these:Foods LOWER in phosphorus Foods HIGHER in phosphorus

Popcorn Nuts(1 cup = 19mg) (2 oz = 264mg)

Pasta Pizza(1 cup = 94mg) (1 slice = 234mg)Butter & herb sauce(1/2 cup = 54mg)

Chicken Liver (3.5 oz = 140mg) (3.5 oz = 400mg)

Angel food cake Chocolate (1 slice = 9mg) (1 bar = 160mg)

Green beans Pork & beans (1/2 cup = 13mg) (1 cup = 274mg)

Popsicle® Ice cream (1 pop = 0mg) (1 cup = 200mg)

Hamburger Hot dogs(3.2 oz = 120mg) (2 = 170mg)

Crackers Biscuit (8 = 24mg) (1 = 140mg)

TABLE 4

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Sample menu plan with 1 can of SUPLENA® per day Menu based on a diet for 2000 Calories, 50 grams protein,2000mg sodium.

Breakfast:3/4 cup apple juice3/4 cup cornflakes1/2 cup non-dairy creamer1 banana1 slice toast with margarine1 scrambled eggcoffee or tea

Lunch:Turkey sandwich (2 ounces turkey, 2 tsp mayonnaise,

2 slices bread, lettuce and tomato slices)1 ounce unsalted pretzels1/2 cup fruit cocktail3/4 cup cranberry-apple juiceOR8-fl-oz can SUPLENA®

1 apple

Dinner:2 ounces pork roast3⁄4 cup cooked carrots1 baked potato with margarine or sour cream1⁄2 cup applesauce1⁄2 cup grapesiced or hot tea with lemon

Snack:1 slice angel food cake1⁄2 cup raspberry sorbet

Sample menu plan with 1 - 2 cans of SUPLENA® per dayMenu based on a diet for 2000 Calories, 50 grams protein,2000mg sodium.

Breakfast:1 cup hot tea1/2 cup peachesToasted bagel with

2 oz cream cheese1/2 cup oatmeal1/4 cup non-dairy creamer

Lunch:2-oz hamburgerHamburger bunMayonnaise, lettuce, tomato1/2 cup coleslaw1/2 cup raw carrots

and radishes1 cup cranberry juiceOR8-fl-oz can SUPLENA®

1/2 cup pears

Dinner:3 oz grilled chicken1/2 cup cooked broccoli1 cup pasta noodles with

margarine and 2 tsp Parmesan cheese

1 fresh orange1 cup lettuce with 2 tsp

French dressingSnack:

1 slice pound cake1/2 cup grapes1 cup pineapple juiceOR1/2 8-fl-oz can SUPLENA®

For more information about nutrition for people with kidneydisease, please visit these websites:

www.kidney.org National Kidney Foundationwww.davita.com Davita, Inc.www.fmcna.com Fresenius Medical Care, North Americawww.kidneyfund.org American Kidney Fundwww.aakp.org American Association of Kidney Patients

68658/MA

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