There are certain precautions that everyone should take during the sunny and warm summer months. If you have chronic kidney disease (CKD), you’ll need to take a few additional steps to protect your health in the summertime or when visiting warmer climates.
1. Go outside and get moving
Sunny summer days are ideal for going outside and exercising. If you have kidney disease, be sure to check with your doctor before starting a summertime exercise routine. Your physician can help you create an exercise plan that will support your health. Even if you feel tired at times, easy exercises may help you feel better. Walking and yoga are two activities that put only minimal stress on the body. To reap the benefits of having sunlight activate vitamin D in your skin, so spend 10-15 minutes in the sun before applying sunscreen.
2. Keep good fluid balance
Check with your dietitian or healthcare team for guidance about your fluid intake and whether it should be adjusted on days that you spend more time outdoors. Be careful of very cold beverages, which can cause stomach cramps. It’s best to avoid drinking caffeine or alcohol or ingesting large amounts of sugar, as these can actually cause your body to lose more fluid. Try to stay cool by wearing a hat or a wet bandana around your neck to help control your thirst. You might want to carry a small spray bottle filled with lemon water or mouthwash to spray your mouth when you are feeling dry.
3. Save your skin from sun exposure
Everyone should wear sunscreen and apply it liberally. Unprotected sun exposure can cause skin damage. Use a sunscreen with an SPF of at least 15. Remember to reapply your sunscreen every two hours and also right after swimming or exercising. A water-resistant sunscreen will be less likely to come off if you swim or perspire. You can also protect your skin by covering up with a shirt, wearing a hat or sitting in the shade. You may want to soak up some sun before applying sunscreen to activate some of the vitamin D in your skin. Ten to 15 minutes is all it takes.
4. Wear sunglasses
Sunglasses protect your eyes in the same way that sunscreen protects your skin from harmful sun damage. Your sunglasses should block at least 99% of UVB rays and 50% of UVA rays. Wraparound sunglasses and other styles that completely cover the eyes are best.
5. Protect your access if you go swimming
If you are on dialysis and have a vascular access — whether it’s an AV fistula, a graft or a catheter — remember to cover it with a protective dressing when you swim. Ask your nurse which holds up best in water. For those with a central venous catheter (CVC), they should not submerge themselves and the CVC in the water at all. For people on peritoneal dialysis (PD), your healthcare team will show you how to properly clamp your PD catheter shut. The PD catheter should be immobilized to avoid trauma to or tension on the catheter while swimming. The dressing should be changed as soon as you're done with swimming. When going for a swim, do so in the ocean or a chlorinated pool. Avoid bodies of water that aren’t chlorinated, such as ponds, lakes and rivers, which have a greater chance of hosting bacteria that can infect your access.
6. Eat healthy summer foods
Research shows that fruits and vegetables are important for good health, yet most people don’t eat enough. Summer is the perfect time to fill your plate with kidney-friendly foods that are low in phosphorus and potassium. Remember to practice portion control as all fruits and vegetables contain some potassium. Here is a list of fruits and vegetables that can add color and flavor to your kidney diet:
Beef - Allspice, Ginger, Dry Mustard, Sage, Taragon
Pork - Caraway Seed, Garlic, Sage, Thyme
Veal - Bay Leaves, Curry Powder, Ginger, Rosemary, Thyme
Ground Meat - Allspice, Basil, Celery Seeds, Garlic, Dry Mustard
Poultry - Bay Leaves, Curry Powder, Ginger, Rosemary, Tarragon
Fish - Chives, Curry Powder, Dill, Tarragon
Eggs - Celery Seed, Curry Powder, Oregano, Thyme
Soups/Stews - Allspice, Basil, Bay Leaves, Caraway Seed, Celery Seed, Garlic, Onion Powder, Thyme
Sauces - Basil, Rosemary, Tarragon
Pasta - Caraway Seeds
Rice - Basil, Curry Powder,Garlic
Popcorn - Garlic
Asparagus - Caraway Seed
Beets - Caraway Seed
Broccoli - Dry Mustard, Oregano
Cabbage - Caraway Seed, Dill
Carrots - Bay Leaves, Caraway Seed
Cauliflower - Curry Powder, Tarragon
Green Beans - Dill, Dry Mustard
Lima Beans - Curry Powder, Dill, Sage
Potatoes - Ginger, Sage, Thyme
Tomatoes - Basil,Curry Powder, Garlic, Oregano
Salads - Caraway Seeds, Chives, Onion Powder
At work, one of the teams developed a cookbook for Christmas last year to raise money for charity. The cookbook is called "Imagine". In the glossary, there is a section that includes substitutions of ingredients, along with charts, and alternatives. This one that I am sharing is the most useful.
For 1 lb ground beef- use 1 lb ground turkey
1 oz cheddar, swiss or American cheese - 1 oz low fat cheese, 1 oz part skim cheese (Mozzarella).
1 egg - 2 egg whites, 1/4 cup low cholesterol egg substitute.
1 c. whole milk - 1 c. skim milk
1 c. cream - 1 c. evaporated skim milk
1 c. sour cream - 1 c. nonfat sour cream, 1 c. plain nonfat yogurt, 1 c. lowfat cottage cheese plus 1 to 2 tsp. lemon juice, blended smooth.
1 oz. cream cheese - 1 oz. nonfat cream cheese, 1 oz Neufchatel cheese
1 c. butter - 1 c. margerine, 1 c. vegetable oil
1 c. shortening - 7 fluid oz. vegetable oil
1 oz. baking chocolate - 3 Tbsp. cocoa powder plus 1 Tbsp. vegetable oil
roux: 1 part fat 1 part starch - 1/2 part fat to 1 part starch
1 can condensed cream soup - Mix together 1/2 c. nonfat dry milk, 2 Tbsp. cornstarch, 2 tsp. low sodium chicken bouillon, 1/4 tsp. onion powder, 1/8 tsp. garlic powder, 1/4 tsp. basil, 1/4 tsp. thyme, 1/4 tsp. white pepper, 9 oz. cold water
Add the following if desired: 1/4 c. chopped celery or 1/2 c. sliced mushrooms
Heat to boil: stir frequently. Per "can": 215 calories, 1 g fat. 8 mg cholesterol, 200 mg sodium.
If you have been recently diagnosed with kidney disease, you should know what kind of diet is right for you. It is not a low-calorie diet for weight loss, instead it is a diet to help preserve your kidney function. The diet will depend on what stage of kidney disease you have. Generally, during the first four stages of chronic kidney disease (CKD), a proper diet may help slow down the progression of your disease. Stage 5 will require dialysis or transplantation.
Here are some important things to remember:
1. Learn to use non-dairy milk substitutes instead of milk. This is helpful in reducing protein and phosphorus in your diet.
2. If you are diabetic, you need to get enough calories from carbohydrates and fats. The amount of carbohydrates in one slice of whole wheat bread is the same as four teaspoons of sugar. It is the total number of carbohydrates eaten and not the source of the carbohydrates. A diabetic menu includes foods such as sorbet and Cool Whip®, which have carbohydrates just as bread or rice does. The difference is that sorbet and Cool Whip® contain little or no protein. This may increase your diabetes medication. Be sure to consult your doctor about this.
3. Fortunately, there is no limit on foods high in potassium in the early stages of CKD. Often, people must eat high potassium foods, such as orange juice, potatoes, prunes, tomatoes and bananas in the early stages of CKD. As the disease progresses to Stage 5, it may be necessary to avoid high potassium foods. That is why it is important to stay in close contact with your kidney doctor.
4. There is also no limit on fluid intake during the early stages of CKD. However, by the time you need dialysis the kidneys may fail to make urine and eventually stop producing it altogether. Then there is a limit on how much you may drink.
5. Be careful of salty foods like bacon, ham, sausage, fast foods and pizza. These foods can increase your blood pressure.
6. Ask for a referral to a renal dietitian who can help you plan an individualized menu.
7. Some of the symptoms you may experience if you become “uremic,” having too much urea in your blood, are nausea, vomiting, poor appetite, weight loss and bad taste.
WHAT DO THE KIDNEYS DO?
Eliminate waste products, like urea, from the body.
Regulate fluid balance in the body.
Produce hormones that regulate blood pressure, prevent anemia and help keep the bones strong.
Blood tests can be confusing. Below are some important things to know when reading your blood tests:
• Blood urea nitrogen (BUN)
• Normal is 5-25 mg/dl
• Serum creatinine
• A blood test
• Normal is 0.6 to 1.2 mg/dl
• By the time the serum creatinine is 2.0 mg/dl, you have already lost 50 percent
of your kidney function.
• Glomerular filtration rate (GFR)
• This is an estimate of your kidney function
• Normal GFR is 90 to 130 ml/min
The doctor does a 24-hour urine test and a blood test to arrive at this result.
• Hemoglobin A1C
• If you are diabetic, this is very important to know.
• Normal is four percent to six percent.
• This blood test tells the average blood sugar over the past 2-3 months.
THE FIVE STAGES OF CKD
If you have Stages 1 through 4, you may be able to help yourself delay or prevent the progression of your kidney disease.
Stage 1 – GFR more than 90 with persistent protein in the urine.
Stage 2 – GFR 60-89 with persistent protein in the urine (mild disease).
Stage 3 – GFR 30-59 (moderate disease).
Stage 4 – GFR 15-29 (severe disease).
Stage 5 – GFR less than 15 is time for dialysis or a transplant.
Remember, GFR tells you an estimate of your kidney function. Normal is 90 to 130 ml/minute.
If you have Stage 1 CKD, your kidney function may still be normal, but with protein in the urine it can progress. There are drugs that can help if you have protein in the urine. One of those drugs is an “ace inhibitor.” Diabetics, as well as those with high blood pressure, can develop protein in the urine.
If you have Stage 2 CKD, you may benefit from the same drug for protein in the urine. If you have high blood pressure, you may need three or more drugs to achieve a blood pressure of 120/70. Some of these drugs may include an angiotensin 2 receptor blocker (ARB). It may also include a “water pill” or diuretic. The goal is to prevent protein in your urine and control your blood pressure. You may also benefit from a special diet.
If you have Stage 3 CKD, the above also applies. Often people think a diet means they need to decrease their caloric intake. However, this is not so. You should reduce the protein in your diet to prevent too much urea from accumulating in your blood.
WHAT IS UREA?
Urea is a waste product that comes from eating protein. Healthy kidneys get rid of urea in the urine. Sick kidneys do not rid get of enough urea in the urine. Urea builds up in your blood. Blood urea nitrogen (BUN) should be between 5 and 25 mg/dl. Eventually, people with kidney disease may have a bitter taste in the mouth. Urea will accumulate in your saliva, which can cause a bad taste and bad breath.
If you have Stage 4 CKD, total kidney failure is near. Therefore, not only do the above suggestions apply, but also you need to become very serious about your attempts to help yourself.
If you have Stage 5 CKD, you need to speak with your doctor and decide what kind of dialysis you want. You need to get an access created in your arm to allow connection to the dialysis machine or you need to begin the workup for a kidney transplant.
HOW MUCH PROTEIN DO YOU NEED?
The World Health Organization tells us we need only 0.6 grams protein per kilo body weight per day for health. The recommended dietary allowance (RDA) for healthy people is 0.8 grams protein per kilo per day. No more than 0.6 to 0.7 grams protein per kilo body weight per day is needed if you are trying to delay the progression of CKD.
WHAT FOODS HAVE PROTEIN?
Almost all foods have some protein. The exception to this is carbohydrates like sugar, honey and jelly, or fats like oil and margarine, which have no protein. Some other foods also have very little protein, such as non-dairy products like Cremora®, Coffeemate® or non-dairy liquids. Some desserts like Italian ice or whipped non-dairy products like Cool Whip® do not have protein. Read the labels at the grocery store.
Here are some other examples:
1 egg = 7 grams protein
1 chicken thigh (2 ounces) = 14 grams protein
8 ounces skim milk = 8 grams protein
8 ounces regular milk = 8 grams protein
3 ounces broiled fish = 21 grams protein
1 slice bread = 2 grams protein
1 cup cooked rice = 4 grams protein
1/2 cup corn = 2 grams protein
IS THERE ANYTHING I CAN DO TO PREVENT THE PROGRESSION OF MY CKD?
• Keep good control of your blood pressure (120/70).
• If diabetic, keep your hemoglobin A1C less than six percent.
• Frequent check ups with your kidney doctor.
• Avoid medications that can affect your kidneys, such as non-steroidal anti-inflammatory drugs (NSAIDS).
• Follow a restricted protein diet. Be sure to get enough calories from carbohydrates and fats.
• Follow a restricted protein diet. Be sure to get enough calories from carbohydrates and fats.
On the next page, you will find two examples of a daily food menu for both the CKD/diabetic patient and the CKD/non-diabetic patient. These sample menus may assist you in following a nutritious diet.
SAMPLE CKD/NONDIABETIC MENU 50 GRAMS PROTEIN PER DAY
1/2 grapefruit or 4 ounces orange juice 0.5 grams
1 slice toast with extra margarine/jelly 2 grams
3/4 cup corn flakes with sugar 2 grams
1/2 cup liquid non-dairy creamer 0.5 grams
Coffee or tea with sugar/1 tablespoon non-dairy creamer
A small baked apple with 1/2 cup non-dairy Cool Whip® 1 gram
2 ounces cooked shrimp 14 grams
Chopped celery, onion, green pepper, chopped lettuce
1 slice tomato with extra mayonnaise 1 gram
2 slices sourdough toast with extra margarine 4 grams
1/8 cherry or apple pie 2.5 grams
Coffee or Iced tea with sugar, lemon
1 cup Italian ice 1 gram
2 ounces fried chicken thigh (sauté in extra margarine or olive oil) 14 grams
1/2 cup cooked yellow rice with olive oil 2 grams
1/2 cup broccoli with margarine 1 gram
1/2 cup coleslaw with extra mayonnaise 1 gram
2 peach halves in heavy syrup 0.5 grams
4 small sugar cookies 2 grams
1/2 small banana 0.5 grams
TOTAL 49 GRAMS
SAMPLE CKD/DIABETIC MENU DIABETIC 50 GRAMS PROTEIN ABOUT 2400 CALORIES
1/2 cup orange juice (4 ounces) 0.5 grams
English muffin or two slices toast 4 grams
1 tablespoon margarine
Coffee or tea with sugar substitute
1 tablespoon powdered non-dairy creamer
1/4 cantaloupe with 1/2 cup sorbet 1.0 gram
Two slices bread 4 grams
1 tablespoon mayonnaise
2 ounces cooked chicken thigh (no bone, no leg) 14 grams
Lettuce and tomato for the sandwich
1/2 cup lite fruit cocktail 0.5 grams
Diet Sprite® or iced tea, lemon, sugar substitute
1 small apple 0.5 grams
2 ounces cooked steak (without bone) 14 grams
1 medium baked potato 4 grams
1 tablespoon margarine
1/2 cup green beans or asparagus 1 gram
Mixed green salad with vinegar or lemon 1 gram
1 tablespoon olive oil
1 small roll or 1 slice bread 2 grams
1 tablespoon margarine
1/2 cup sliced mango 0.5 grams
Diet ginger ale
1/2 cup sorbet and 4 strawberries 1 gram
10 vanilla wafers 2 grams
TOTAL 50 GRAMS
Peggy Harum, RD, LD, is a renal dietitian from Miami, Fla. Ms. Harum has worked with AAKP for many years in developing dietary resources for kidney patients.
The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.
This article originally appeared in the September/October 2004 issue of Kidney Beginnings: The Magazine, Vol. 3, No. 3.