Articles

Kidney Diet on a Budget

Posted September 24, 2020 in Clinical CareFeatured Post by Natalie Sexton, MS, RDN, CSR, LD.

Many of your patients may assume that following a special diet means spending more money on food. However, this is not always the case. Sharing the tips listed below with your patients can help them to make budget-conscious decisions when following a kidney diet.

Plan ahead.

Planning meals ahead of time can be helpful in lowering food cost, reducing food waste, and helping one stay on track with a kidney diet. DaVita has a diet and nutrition webpage that is a great, free resource to help patients plan kidney-friendly meals. In addition to more than 1,000 kidney-friendly recipes, the webpage offers downloadable cookbooks, dining out guides and a food analyzer.

Shop the pantry or fridge first.

 Using foods already on hand, may help patients decrease their grocery bills. Suggest they look in their refrigerators for any foods that need to be eaten. They can then search on the DaVita diet and nutrition webpage to find recipes using these foods. They may already have all of the items needed to create a whole meal!

Leftovers can often be revamped into a whole new dish. For example, leftover chicken can be turned into a protein-packed chicken salad or soup. Leftover vegetables may be turned into a fiber-filled omelet. Ask patients to follow food safety guidelines when storing, reheating and consuming leftovers though.

Patients may want to stock up on pantry staples in bulk when they are on sale. White rice and pasta are good low-phosphorus carbohydrate options. Olive oil is a great way to add heart-healthy fats to a meal or make a flavorful salad dressing. Unsalted popcorn is a kidney-friendly, high-fiber snack that can be flavored many different ways. Canned tuna or chicken is great to use for a quick, protein-packed salad.

Canned vegetables have a long shelf life, but they can be a high in sodium. Remind patients to look for labels that say “low sodium” or “no added salt” when shopping. If a low-sodium option is not available, the canned vegetables can be rinsed under running water for one minute to remove some of the sodium.

Go meatless for a meal.

Meat is often the most expensive part of a meal. Replacing meat with a protein-packed vegetable can be a more cost effective alternative.

Some research may differ, but there is increasing research that shows that there are many potential health benefits of following a plant-based diet. Plant-based diets can potentially lower the risk of heart disease and type 2 diabetes. They have also been shown to slow the progression of chronic kidney disease, improve blood pressure, and reduce acid load. However, it is important to note that some meat substitutes may contain large amounts of sodium and phosphorus. Advise patients to read food labels, use a food analyzer such as the DaVita food analyzer, or talk with a dietitian to decide if a food fits their dietary needs. The DaVita diet and nutrition webpage also has several delicious, kidney-friendly, plant-based recipes.

Buy generic.

Brand-name items can be significantly more expensive than generic items. Inform patients that generic or store-brand items are often no different than brand-name items in terms of quality, nutrition and flavor, but they should always read the food labels when comparing items.

Shop in season.

In-season produce typically has better flavor, higher nutrient content and lower price tags than produce that is out of season. Grocery stores often put in-season fruits and vegetables on sale because they have a larger supply at that time. Suggest patients check their local grocery store flyer for weekly sales. (Patients who have been advised to limit their potassium intake should consult a dietitian on which fruits and vegetables are low in potassium.)

Buying locally grown produce at the farmers market may also be option for patients and is a great way to support their local farmers. By visiting the market right before it closes for the day patients may be able to get a better deal. Farmers may be willing to discount their unsold produce at the end of the day rather than take it all back home with them.

Prevent food waste.

Some leftover dishes like soups and casseroles can be frozen for later use. Vegetables can often be blanched (placed in boiling water for one minute then rinsed with cold water) and frozen. Fruits such as peaches or berries can be frozen and used later for smoothies. Adding frozen fruit instead of ice to smoothies can create a thick, creamy smoothie without extra fluid.

(ARTICLE WRITTEN FOR DAVITA MEDICAL INSIGHTS)

Missed Dialysis Treatments and Nutrition

 

Did you know that dialysis does not replace all of your kidney function? That’s right. Healthy kidneys work 24 hours a day, 7 days a week to clean your blood. Hemodialysis only works about 12 to 16 hours a week – just enough to keep you healthy. Home hemodialysis may be prescribed 5 to 6 days a week for 2 to 3 hours. Because of this, every minute spent on dialysis is important for keeping your blood clean and your body healthy. Missed dialysis treatments can mean trouble.

Your doctor has prescribed a “treatment time” designed specifically for you. This is the right amount of dialysis you need to keep your blood clean. Missed dialysis treatment, whether it’s a few minutes each treatment or an entire treatment altogether, can have serious consequences on your health.

Missing just one treatment may increase your risk of death. (1) In addition to this, missed dialysis treatments may cause shortness of breath, tiredness, nausea, decreased appetite, and confusion. All of these can affect your eating habits and nutrition level.

Watch this video that explains more about missed treatments.

Albumin

Albumin is a type of protein in your blood. A low albumin level can cause you to feel tired. It can also prevent wounds from healing and make you more likely to get an infection. If you are not eating enough protein or calories, your albumin level may be low. However, even if you eat enough protein and calories, your albumin level may be low if you are missing treatments. Missed dialysis treatments causes extra fluid to build up in your body. Having too much fluid in your body causes your albumin level to go down.

Hemoglobin and Iron

Low hemoglobin or iron levels may cause you to feel tired due to anemia. You may receive important IV medications at your treatment that help maintain your red blood cell count and iron levels. When you miss a treatment, you miss an important dose of these medications.

Potassium

Potassium helps keep your heart and nerves working well. Having potassium levels that are too high or too low may cause problems with your heart. Even if you follow a low-potassium diet, you still need dialysis to help remove any excess potassium from your blood.

Phosphorus

Having a good phosphorus level is important for keeping your bones and heart healthy. Even if you follow a low-phosphorus diet and take phosphate binders, you still need dialysis to help remove any excess phosphorus from your blood.

Calcium, PTH and Vitamin D

Like phosphorus, calcium, parathyroid hormone (PTH) and vitamin D each play an important role in keeping your bones healthy. You may receive important medications at your treatment to help maintain your calcium, PTH and vitamin D levels within a certain range. Missed dialysis treatments will cause you to miss getting these medications.

Fluid

Dialysis cleans your blood and removes excess fluid from your body. Missing treatments causes this fluid to build up, resulting in swelling, shortness of breath, difficulty sleeping, decreased appetite, and tiredness.

Life Happens!

Your dialysis care team understands that dialysis treatments can sometimes get in the way of other scheduled activities in your life. If you need to miss a treatment, let your dialysis care team know. Your team can help you reschedule your treatment to make sure you get enough dialysis to keep you healthy.

Resources:

  1. https://blogs.davita.com/medical-insights/2017/02/21/study-impact-missed-dialysis-treatments-clinical-outcomes/
  2. https://www.youtube.com/watch?v=OtqTLUcn6iA&feature=youtu.be

Additional Kidney Diet Resources

Visit DaVita.com and explore these diet and nutrition resources:

 DaVita Diet Helper online meal planner and tracker

 DaVita Kidney-Friendly recipes

 Today’s Kidney Diet cookbooks

 Diet and Nutrition articles

 Kidney Diet and Nutrition Hub

 Kidney Smart® Classes taught by kidney experts in your area

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

 

 

(ARTICLE WRITTEN FOR DAVITA PULSE BLOG.)

Traveling and the Dialysis Diet

 

Being on dialysis does not have to mean your travel days are over! DaVita has more than 2,500 dialysis centers nationwide making it easier to continue your treatments while traveling. After talking with your treatment team and insurance carrier about your travel plans, you will want to pack any medications you will need during your vacation (It is a good idea to pack extra medication in case of any travel delays). When planning your vacation, you also want to think about what, where and when you will be eating. Following your kidney-friendly diet plan can help you feel better and stay healthy while on vacation.

Flying

Solid food items can be transported in either your carry-on bag or checked bag. Liquid or gel food items (such as drinks or gelatin) larger than 3.4 ounces are not allowed in carry-on bags. (These items must be placed in checked bags.) Refer to the TSA website for rules on flying with food.

Some airlines offer complimentary snacks during your flight. However, these tend to be high in sodium (such as salted peanuts or pretzels). Bring your own low-sodium snacks instead. Some kidney-friendly snack ideas are:

  • Protein bars
  • Unsalted or low-sodium pretzels, crackers or tortilla chips
  • Graham crackers, unsalted rice cakes
  • Hard-boiled eggs
  • Rice Krispies® treats, Fig Newtons, shortbread cookies, vanilla wafers (watch portion size if you have diabetes)
  • Hard candy or gum (great for quenching thirst during a long flight!)

Camping or Road Trips

Packing a cooler with kidney-friendly meals and snacks can help you stick to your kidney-friendly meal plan. Here are some great on-the-go staples to pack with you:

  • Sandwiches made with low-sodium, fresh-cooked meats
  • Hard-boiled eggs or egg salad
  • Canned tuna or chicken (pick the no-salt-added brands or rinse salted products under running water for 3 minutes to reduce sodium content)
  • Fresh or canned low-potassium fruits (apples, plums, peaches, grapes, pineapples, strawberries, pears)
  • Unsalted crackers, pretzels or popcorn
  • Nutrition bars and drinks (ask your dietitian for kidney-friendly options)
  • Light-colored sodas such as 7-Up Sprite, and ginger ale (check all others for phosphate additives)

When preparing to eat at a fast food place or restaurant, research menus ahead of time and choose wisely. Many places post their menus online. Extra sodium, potassium, and phosphorus is often found in fast food. Use the Dining Out Guide from DaVita Diet Helper ™ for tips on what to order at various types of restaurants.

Cruise

Dialysis at Sea Cruises® is the largest provider of dialysis services aboard cruise ships in the world. Visit www.dialysisatsea.com for more information. Let the cruise line know ahead of time if you have any specific dietary needs such as food allergies or intolerances. Cruise ships often have a variety of food options, such as restaurants, buffets, cafes and room service. Follow the tips in the Dining Out Guide from DaVita Diet Helper ™ when ordering your food.

Find a Dialysis Center:  Call DaVita Guest Services at 1-800-244-0680 to talk to one of our placement specialists and find a dialysis center near your travel destination(s) if you are a DaVita patient or if you are not a DaVita patient and wish to have dialysis at a DaVita center while traveling.

For more on this topic read “Eating Tips for Travelers with Kidney Disease“.

Additional Kidney Diet Resources

Visit DaVita.com and explore these diet and nutrition resources:

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

References:

DaVita Kidney Care. Travel support for dialysis patients . Accessed February 4, 2019.

DaVita Kidney Care. Travel checklist for people on dialysis . Accessed February 4, 2019.

Transportation Security Administration. What can I bring: food . Accessed February 4, 2019.

DaVita Kidney Care. Travel . Accessed February 4, 2019.

Davita Kidney Care. 5 Lunches On-the-Go for a Kidney Diet . Accessed February 11, 2019.

 

 

(ARTICLE WRITTEN FOR THE DAVITA PULSE BLOG.)

Tips For Keeping a Healthy Potassium Level

 

Potassium is an important mineral to the body. We need enough potassium to keep our muscles and nerves working properly. However, too much potassium in the body can cause the heart to beat irregularly or stop beating at all. When you have kidney disease, your kidneys are not able to remove potassium from your blood through the urine. Your doctor will watch your potassium level closely. If your potassium level is too high or too low, you must find out why. Having a healthy potassium level is important.

Interpreting Potassium Levels

Tracking your potassium lab results can help with managing your levels. Here is a guideline to help you know what your results mean.

  • Low – less than 3.5 mg/dL
  • Normal – 3.5 to 5.5 mg/dL
  • High – 5.6 to 6.0 mg/dL
  • Very high – 6.0 mg/dL or higher

Potassium and Diet

When your kidneys are not able to remove potassium from your blood, you must limit the amount of potassium that you eat in your diet. By limiting or avoiding high-potassium foods, you can help get your potassium level into a healthy range. Some higher potassium foods include:

  • Bananas, cantaloupe, avocado, oranges, kiwi, papaya
  • *White potatoes, sweet potatoes, tomatoes, pumpkin, cooked spinach and artichokes.
  • Fruit or vegetable juices made from high-potassium produce (tomato or V-8 juice, orange juice, prune juice)
  • Dairy products such as milk, soy milk, pudding, ice cream, or yogurt (more than 1/2 cup per day)
  • Salt substitutes that contain potassium chloride.
  • Sweets containing chocolate or nuts

Consuming large amounts of low-potassium fruits and vegetables can also contribute to high potassium levels. You may want to discuss proper portion sizes and number of daily servings with your dietitian.

*Note: Potatoes can be double boiled or leeched to remove some of the potassium. Read “Lowering Potassium in Potatoes” to learn more.

Dialysis Treatments and Potassium

Potassium is removed from your blood during dialysis. Missing just one treatment can lead to unsafe potassium levels. It is very important to go to all scheduled dialysis treatments. In addition, stay for your full treatment time. Also, attend all access appointments to ensure that your dialysis access is working properly.

Home Dialysis

More frequent dialysis means more potassium removal. Patients who choose peritoneal dialysis and home hemodialysis often have a more liberal potassium diet. The reason is they are having dialysis 5 to 7 days a week. For this reason potassium levels do not build up as high compared to in-center hemodialysis treatments 3 times a week.

Medications and Herbal Supplements

Some medications such as potassium chloride, NSAIDs (nonsteroidal anti-inflammatory drugs) and potassium-sparing diuretics can lead to increased potassium levels. Certain herbal supplements and nutrient preparations with added potassium may contain high levels of potassium as well. Provide your healthcare team with a list of the current medications you are taking, (including any vitamins and supplements. They can look for medications that might lead to high potassium levels.

Other Causes of High Potassium

High blood sugar, gastrointestinal bleeding and significant constipation can all cause high potassium levels. If you are experiencing any of these, follow up with your primary care doctor as soon as possible. The use of chewing tobacco or snuff can also cause increased potassium levels.

Ways to Increase Potassium

Some patients struggle with potassium levels being too low. If this is the case, you may need to consume more potassium in your diet. Ask your dietitian for a list of high-potassium fruits and vegetables. Eat the recommended serving from this list every day until your potassium level is in goal. If your potassium level is still low after you’ve been including high-potassium foods, your doctor may prescribe a potassium supplement.

Following these tips can help you keep your potassium level in goal. What are some of your tips for potassium control?

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

(ARTICLE WRITTEN FOR THE DAVITA PULSE BLOG.)

Why are Calcimimetics Prescribed for Kidney Patients?

 

Calcimimetics are prescribed to treat a condition called secondary hyperparathyroidism (hyper-para-thyroid-ism). In this condition the parathyroid glands are overactive. Kidney failure often causes the parathyroid glands to make too much parathyroid hormone (PTH). Too much PTH can make your calcium and phosphorus blood levels increase, leading to hardening of organs and soft tissues, bone disease, and other serious complications.

Overview of PTH

Parathyroid glands are small glands located behind the thyroid gland in your neck. These glands make a hormone called parathyroid hormone (PTH). This hormone helps keep the calcium and phosphorus levels in your blood at a normal, balanced level.

PTH and Kidney Disease

As kidney function declines, the metabolism of phosphorus and vitamin D becomes disordered. Since diseased kidneys have difficulty excreting excess phosphorus from your body, phosphorus levels in your blood rise. Also, the diseased kidneys lose the ability to convert the vitamin D that you get from sunlight and food to active vitamin D. This is the kind of vitamin D you need for proper calcium absorption. Without this active vitamin D, less calcium is absorbed from your intestines into your blood. Blood levels of calcium decrease.

Calcium-sensing receptors (CaSR) are located on the cells of the parathyroid glands. The CaSR controls how much PTH is made by the parathyroid glands. If blood levels of calcium are low, the CaSR tells the parathyroid gland to make more PTH. PTH will pull calcium from your bones into your bloodstream to correct the low blood calcium level.

Over time, as the parathyroid glands are signaled to make more and more PTH, the glands become enlarged and the production of PTH becomes steadily higher. This leads to excessive PTH production, high blood calcium levels, and weak bones.

Treatment with Calcimimetics

Calcimimetics are a type of medication that lower PTH and calcium levels by making the CaSR more sensitive to the amount of calcium in the blood. Currently, there are two calcimimetics available on the market – Oral Cinacalcet (Sensipar ®) and IV Parsabiv ®.

While Sensipar and Parsabiv both target the CaSR, they bind to different sites on the CaSR. According to the pharmaceutical websites:

  • Sensipar is a small molecule compound that binds to the transmembrane domain of the CaSR.
  • Parsabiv is a synthetic peptide that binds directly to the extracellular domain, at a site separate from the calcium-binding site.

Both types of calcimimetics have shown to be effective at lowering PTH and calcium levels.

What are My Options to Discuss with My Doctor?

Since Sensipar has been on the market longer than Parsabiv, most patients are likely already taking Sensipar to control their secondary hyperparathyroidism. There are risks and benefits associated with both calcimemetics. It is best to discuss with your doctor which one is best for your needs.

Sensipar Key Points:

  • Taken orally (by mouth)
  • Taken every day (unless prescribed otherwise by your doctor)
  • Most common side effects are nausea, vomiting, and diarrhea
  • May cause low calcium

Parsabiv Key Points:

  • Given intravenously at the end of the dialysis treatment
  • Usually given three times per week at dialysis
  • Most common side effects are nausea, vomiting and diarrhea
  • May cause low calcium

Only one calcimimetic should be taken at a time. Your doctor will decide which calcimimetic is the best fit for you if you need this type of medication.

Your healthcare team will monitor calcium, phosphorus and PTH levels and make adjustments as needed. Your dietitian will discuss your intake of calcium and phosphorus and suggest diet changes if needed.

References

 http://www.parsabivhcp.com/about-parsabiv/

https://www.sensipar.com/

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

 

 

(Article written for the DAVITA PULSE BLOG.)

Managing Cholesterol after Kidney Transplant

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Kidney transplant is not a cure for kidney failure. It is kidney replacement therapy, also known as renal replacement therapy. There may be changes to blood cholesterol and fats after a kidney transplant.

Transplant Considerations

When a person receives a kidney transplant there are many things to consider, including nutrition care. A patient’s nutritional status is influenced by many different things such as appetite, electrolytes, gastrointestinal issues, medications, weight, and pre-existing medical conditions. After transplant it is important for the healthcare team to monitor the patient’s progress, reassess nutrition goals and address possible complications related to the transplant. Frequent follow-up visits with the transplant doctor and dietitian are essential. Check out the video clip below on what to expect during your transplant recovery.

Transplant and Dyslipidemia

One common complication after transplant is high cholesterol and fat (triglycerides) in the blood, also called dyslipidemia. It is reported to affect as many as 60% to 79% of transplant patients. Many of the medications commonly used to suppress the immune system and keep the body from rejecting the new kidney can make cholesterol and triglycerides go up. Dyslipidemia, in turn, can lead to cardiovascular disease (CVD).  CVD is linked to health problems like heart attack and stroke. Obesity, weight gain, age, male gender, history of diabetes, sedentary lifestyle, and certain diuretics and blood pressure medications can also contribute to dyslipidemia.

Tips to Help Manage Cholesterol and Triglycerides

Because of the increased cardiovascular risk in transplant patients, dyslipidemia should be taken very seriously. This is important because cardiovascular events such as stroke and heart attack are the leading cause of death in kidney transplant patients. So, how can you help prevent or manage cholesterol and triglycerides after transplant?

Diet Changes

  • If you are overweight, talk with your doctor or dietitian about a plan to reach a healthy body weight. In general, ideal BMI is from 25.0 – 28.0, but this varies from person to person. Ask your dietitian for your personal goal.
  • Decrease intake of saturated fat, trans-fat, and cholesterol. Saturated fats are found in most high-fat meats such as bacon, sausage, chicken skin, and fat on steaks and pork chops. Trans-fats are found in donuts, pastries, and foods made with shortening. Limit or avoid these foods in your diet. Choose lean meats and less-processed desserts instead.
  • Add fiber, nuts, and plant stanols to your diet. Whole wheat breads and vegetable oils like canola or olive oil are good sources of plant stanols.
  • Limit high sugar foods and alcohol if triglyceride levels are too high.

Other Changes

  • Take fish oil if prescribed by your doctor. Some studies showed heart-healthy benefits of taking fish oil supplements every day. Ask your doctor or dietitian what they recommend before adding any supplements to your diet.
  • Stop smoking. Any tobacco use greatly increases your risk of dyslipidemia.
  • Increase your physical activity if approved by your doctor. Exercise can help manage cholesterol levels. Aim for 30 minutes a day most days of the week, or 150 minutes a week. If you are just beginning an exercise regimen, then start smaller and work your way up. Ten minutes of brisk walking is a good starting point. If 30 minutes all at once is too difficult, you can do small, 10-minute sessions throughout the day to add up to 30 total minutes of exercise.

In summary, there are concerns about higher cholesterol and triglyceride levels after a kidney transplant. However, knowledge and tips, along with guidance from your doctor and dietitian, can help you manage dyslipidemia.

Reference

A Clinical Guide to Nutrition Care in Kidney Disease, second edition, by Laura Byham-Gray, Jean Stover, and Karen Wiesen. Page 94. Chapter: Nutrition Management of the Adult Renal Transplant Patient.

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

 

(ARTICLE WRITTEN FOR DAVITA PULSE BLOG.)

Hyperglycemia and Diabetes in Adult Kidney Transplant

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If you are considering a kidney transplant, or have already received one, there are some things you need to know. This blog post focuses on hyperglycemia and diabetes related to kidney transplant.

Nutrition care for kidney transplant patients is a complex process. A transplant recipient’s nutritional status is impacted by many different things – appetite, weight, digestive issues, altered electrolytes, the use of steroids and immunosuppressant drugs, and medical conditions that existed prior to, or continue to exist after transplant surgery. Continual follow up visits with a doctor and dietitian are needed to reassess nutrition goals, monitor the effectiveness of therapy, and address complications that may arise post-transplant. An individualized diet for kidney transplant will be provided by the transplant team dietitian.

Transplant Medications

After a kidney transplant, drugs are prescribed to stop the body from rejecting the new kidney. Corticosteroids such as prednisone and calcineurin inhibitors such as Cyclosporine A and tacrolimus are two of the medications commonly used to suppress the immune system. While this helps keep the body from rejecting the new kidney, there are possible side effects. Hyperglycemia, also called high blood sugar, is a side effect of these medications. It is a common occurrence in many transplant patients. Why does this happen? First of all, prednisone causes insulin resistance, a condition in which the body does not use insulin properly. Secondly, calcineurin inhibitors impair insulin secretion. Both of these conditions can result in high amounts of sugar being left in the blood. In addition, personal or family history of diabetes, age, ethnicity and obesity can all increase the risk of hyperglycemia.

Is Hyperglycemia Serious?

Hyperglycemia should be taken very seriously, as it can increase the chances of infection and loss of the transplanted kidney. High blood sugar can decrease the chances of survival after transplant. So, how can you help prevent or manage hyperglycemia after a transplant?

  • Monitor your glucose levels closely per your transplant team’s instructions.
  • Ask your dietitian for diet and physical activity recommendations. Once cleared by your doctor, exercise as recommended to help control glucose levels.
  • Ask your doctor if you will need medications to help manage your glucose.
  • Consider a referral to an endocrinologist (diabetes-specialist) if your diet, exercise and medications are not controlling your glucose levels.

Weight Gain and Transplant

Weight gain of 20 to 40 pounds is fairly common after transplant surgery. What causes it? Reduced calorie needs after stopping dialysis, the elimination of previous diet restrictions, the increased appetite from steroid use, and being of the female gender are all linked to weight gain after transplant surgery. In addition, rapid weight gain can also increase the risk of hyperglycemia.  Follow these tips to help manage your weight and glucose levels:

  • Reduce portion sizes of sugary or high-carbohydrate foods while still eating adequate amounts of calories and protein each day.
  • Keep a food diary to show to your dietitian at your follow up visits.
  • Set realistic goals in your weight journey.
  • If you find yourself using food as a “comfort” or “reward,” talk with your dietitian about different behavior modification techniques to help you have a healthy relationship with food.

For many transplant recipients, as steroid doses decrease, glucose levels return to normal. However, anywhere from 12% to 46% of patients will develop diabetes for the long-term after transplant. Therefore, it is very important that you follow the recommendations from your dietitian and doctor to help you stay healthy after transplant.

 

For more information go to “Understanding Kidney Transplant.”

Reference

A Clinical Guide to Nutrition Care in Kidney Disease, second edition, by Laura Byham-Gray, Jean Stover, and Karen Wiesen. Page 94. Chapter: Nutrition Management of the Adult Renal Transplant Patient

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

 

(ARTICLE WRITTEN FOR DAVITA PULSE BLOG.)

Keeping Bones Healthy with Kidney Disease

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Healthy bones are essential for good body structure and mobility. The human skeleton provides the framework for our body, supports our body weight, and protects our internal organs. Our bones also store two important minerals – calcium and phosphorus.

People with kidney disease often have imbalanced levels of calcium, phosphorus, parathyroid hormone (PTH) and activated vitamin D. This imbalance disrupts bone cells, causing a bone disease called renal osteodystrophy.

If untreated, renal osteodystrophy can cause weak, easily-broken bones, calcification of the soft tissues (such as the heart), and even death. Common symptoms are bone and joint pain, bone deformation, bone fractures and poor mobility. Since these symptoms often do not appear until a patient has been on dialysis for a few years, it is important to monitor blood levels of calcium, phosphorus, PTH and vitamin D to detect the disease.

Calcium and PTH

Calcium is essential for bone growth and strength. Dairy products like milk, yogurt and cheese are good sources of calcium. However, these items are usually too high in phosphorus to be included in a kidney diet except for in small amounts. When blood calcium levels are low, your parathyroid glands release a hormone called parathyroid hormone (PTH). This hormone pulls calcium out of your bones and into your bloodstream. Over time, as more calcium is pulled from your bones, your bones become very weak. If your blood calcium levels are too low, your doctor may prescribe calcium pills or calcium-based phosphorus binders.

High blood calcium levels are usually caused by overactive parathyroid glands or consuming too much calcium (either from your diet or calcium-based medications). Your doctor may prescribe certain medications to help suppress PTH or swap your existing medications for some that contain less calcium. Your dietitian can help you figure out which foods to decrease or remove from your diet.

For patients whose PTH levels remain high after trials of medications and diet changes, surgery to remove the parathyroid glands may be necessary.

Phosphorus

Most of the phosphorus in your body is stored in your bones and teeth. Phosphorus is found naturally in many different foods such as dairy products, beans, nuts and meats, but is also added to many processed foods. The body likes to keep phosphorus and calcium in balance. When blood phosphorus levels are high, the body pulls calcium levels from your bones into your bloodstream.

Keeping phosphorus levels within target range can help maintain bone health. Your doctor may prescribe phosphate binders to help keep you from absorbing all of the phosphorus from your food. Your dietitian can help you figure out which foods to decrease or remove from your diet.

Vitamin D

Healthy kidneys turn vitamin D into an active form called calcitriol. Calcitriol maintains PTH levels and helps the body absorb calcium from food. When the kidneys fail, they stop making calcitriol, making it impossible to absorb calcium from food. Therefore, the body has to take the calcium from your bones instead. When vitamin D levels are low, your doctor may prescribe a pill containing an active form of vitamin D. For patients on dialysis, this medication can be given through an IV during your treatment.

Treatment for Renal Bone Disease

So, how can you keep your bones healthy with kidney disease? Renal osteodystrophy can be managed with a kidney diet, proper medications, and (in the case of kidney failure) dialysis. Treatment involves:

  • Restoring the balance between calcium, phosphorus, PTH and vitamin D
  • Taking all medications as prescribed by your doctor
  • Following the diet advice your dietitian gives you
  • Not missing or shortening dialysis treatments

Physical activity is also a great way to help increase your bone strength. Ask your doctor before beginning an exercise regimen. Find a type of exercise most suited to your enjoyment and mobility level.

 

(ARTICLE WRITTEN FOR DAVITA PULSE BLOG.)

Liquid Food Supplements for an Elderly Person

(ARTICLE WRITTEN FOR LIVESTRONG)
Liquid Food Supplements for an Elderly Person

Older adults need higher amounts of certain nutrients than their younger counterparts. Changes in metabolism, chewing or swallowing difficulties and taste changes can all affect the ability of older folks to meet their nutrient needs. Liquid nutrition supplements are one of the easiest ways for older adults to meet their daily requirements.

Key Nutrients

Calcium, vitamin D, vitamin B-12, fiber, and potassium are the key nutrients older adults need. These nutrients play important roles in preventing osteoporosis, improving energy, maintaining nerve function, promoting healthy digestion and managing blood pressure. Many popular liquid supplement brands tailor their supplements to the needs of older populations, increasing the amount of calcium, fiber, potassium and other nutrients they contain.

Changes in metabolism and gastrointestinal issues can decrease the amount of nutrients older adults are able to absorb from food. Also, because chewing whole foods like fresh vegetables or raw nuts can sometimes be difficult for older adults with dentures or poor dentition, liquid nutrition supplements provide an easy, effective way to meet these daily nutrient requirements.

Types of Liquid Supplements

Liquid nutrition supplements come in a variety of brands and flavors. A convenient source of balanced nutrition, these supplements can easily be added to any eating plan. Many require little to no preparation and are easy to store and drink. Supplements can be drunk as is — best when chilled — or blended with milk, ice cream and fruits or vegetables.

Other Forms of Supplements

Some companies make a powder form of nutrition supplements. This form is convenient for people who like to create shakes using a variety of liquids and other foods. Powdered forms may also be a slightly less expensive option for people who are using these supplements often.

Preparation and Mixing

To increase the amount of calcium and vitamin D per serving, you can mix the supplement with milk or a milk substitute, such as soy milk. For people with lactose intolerance, many supplements are already suitable for lactose-free diets and can be mixed with lactose-free milk, if desired. Whole milk, evaporated milk, powdered milk and ice cream are good mixing options for those looking to increase calorie and fat intake.

Although many liquid nutrition supplements already contain significant amounts of fiber, adding a fiber supplement can help in meeting daily fiber goals. Supplements can also be blended with fruits or vegetables, such as strawberries or spinach, to make a fiber-rich, vitamin-packed shake.

Choosing a Supplement

Many brands offer lower-carb or low-sugar supplements. These types are good for people who have diabetes or are looking to decrease caloric intake while meeting protein needs. Other supplements are tailored to the needs of certain medical and health conditions, such as people with kidney disease or significant wounds. A doctor or registered dietitian can provide recommendations on which liquid nutrition supplement would best meet your nutritional needs.

Symptoms of Potassium Overdose

 (ARTICLE WRITTEN FOR LIVESTRONG)

Symptoms of Potassium Overdose

Potassium is an important mineral and electrolyte needed for many bodily functions. It helps regulate fluid balance throughout the body, maintain pH level and normalize blood pressure. Potassium also regulates your heartbeat by helping conduct nerve impulses and muscle contractions. Adequate intake of potassium for most adults is about 4,700 milligrams per day. Although uncommon, potassium levels can exceed normal limits (3.5 to 5.0 mEq/L) in the body, leading to hyperkalemia.

Causes

The most common cause of hyperkalemia is kidney failure. Since the kidneys excrete potassium from the body, any impairment in normal kidney function can cause potassium levels to rise. Other diseases and conditions such as Addison’s disease, rhabdomyolysis, insulin deficiency, metabolic acidosis or extensive tissue or red blood cell damage can lead to hyperkalemia. Excessive use of potassium supplements, potassium-sparing diuretics or salt substitutes can also cause hyperkalemia. Many common drugs such as certain birth control pills, ACE inhibitors or nonsteroidal anti-inflammatory drugs can affect potassium levels. Finding the cause of hyperkalemia is important in determining the appropriate treatment options.

Symptoms

Symptoms of hyperkalemia include decreased blood pressure, stomach cramps, diarrhea, vomiting, irritability and fatigue. An irregular heart beat can occur when the muscles and nerves begin to malfunction. Some people report a tingling sensation in the hands, feet and tongue. In severe cases, hyperkalemia may cause respiratory failure or flaccid paralysis in the arms and legs. If not treated soon, hyperkalemia can have long-term effects on blood pressure, heart rhythm, digestion and kidney function. Contact your doctor immediately if you believe you are experiencing hyperkalemia.

Treatment

The main goals of hyperkalemia treatment include stabilizing the heart rhythm and promoting potassium elimination from the blood. Calcium gluconate, sodium bicarbonate, diuretics, sorbitol or insulin will often be administered. These drugs work to either move potassium from the blood back into the cells or increase the amount of potassium excreted via urine or feces. In extreme cases, dialysis treatment has been used to resolve hyperkalemia. Serum potassium levels will be monitored closely throughout the course of treatment.

Prevention

Once your doctor has identified the cause of the hyperkalemia, he or she may prescribe certain therapies to prevent its reoccurrence. Low potassium diets are often recommended to manage hyperkalemia. Foods that are high in potassium should be eaten in small amounts or avoided altogether. These include tomatoes, bananas, kiwi, mango, oranges and orange juice, avocados, potatoes, raisins, prunes, honeydew, cantaloupe, apricots, pumpkins and spinach. A registered dietitian can create a low potassium meal plan specifically for you. Your doctor may also need to adjust or discontinue any medications that are affecting your potassium level.

Kidney-Friendly Lucky New Year’s Meal

Black-eyed peas

Black-eyed peas are thought to be a symbol of wealth since their round shape resembles coins. Warning: beans and peas are high-phosphorus foods! To help keep your phosphorus and potassium at a safe level and protect your bones and heart, limit portions to a 1/2 cup serving. Don’t forget to take your phosphorus binders.

Hoppin’ John

Hoppin’ John is a classic, black-eyed pea stew made with onions, celery, green bell pepper, chicken broth and a ham hock. Pork is another New Year’s Day staple since many cultures believe that a pig, with its rooting and pushing forward movements, symbolizes progress. To reduce the sodium content, use low (or no) sodium chicken broth and season with garlic, black pepper and cayenne pepper instead of salt.

Cooked Greensdva-collardgreens_0984_small

Leafy greens are a staple New Year’s item because their leaves look like money, thus symbolizing a prosperous or wealthy year. However, some greens may contain too much potassium for patients following a low potassium diet. Low-potassium leafy greens include Brussels sprouts, cabbage, collards, mustard greens and turnip greens. Limit servings to no more than two 1/2-cup servings per day to stay within your potassium goal.

This recipe for Cabbage Borscht includes cabbage and turnips. Show me the money!

Pot Likker Soup

Don’t throw away the broth from your cooked greens just yet! This leftover, nutrient-rich broth referred to as “pot likker” can be added to some onion, garlic, cooked greens, and ham hocks to make a delicious vegetable soup. But, don’t forget, broth or any sort of liquid counts towards your total fluid intake for the day. Be sure to limit your fluid to the prescribed amount if you are on a fluid restriction. Pot likker  contains potassium from the cooked greens. If you are on a low potassium diet limit the amount consumed.

Cornbread

Need something to sop up that pot likker soup? Cornbread is the perfect choice! Cornbread also represents money or wealth because of its gold color. However, boxed cornbread mix can contain extra phosphorus and sodium (salt). Check out this kidney-friendly recipe for Southern-style Cornbread on Davita.com. Do you want more recipes containing these lucky foods? Check out DaVita recipes. While adding these foods to your New Year’s Day menu can bring you a prosperous year, making them kidney-friendly can help make it a healthy year too!

(ARTICLE WRITTEN FOR DAVITA PULSE BLOG)

Thanksgiving Tips for Leftover Turkey

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It’s the day after Thanksgiving. You wake up from your post-Thanksgiving day food coma only to find that you are left with a full plate of leftover turkey. Let’s be honest. There are only so many boring roast turkey sandwiches you can eat before you won’t want to even look at turkey again until next November! I’ve gathered 10 turkey recipes from DaVita that can turn your leftover bird into new, flavorful dishes you’ll actually enjoy.

Tip:  For recipes that call for ground turkey, finely chop your leftover turkey and substitute it instead. For recipes that call for their own seasonings, pull off the skin.

Here are some other quick and easy options for using leftovers.

  • Spread cream cheese and cranberry sauce on a flour tortilla. Add sliced turkey. Top with a lettuce leaf and a sprinkle of black pepper (if desired).
  • Add leftover turkey and fresh veggies to chopped lettuce to create a chef salad.
  • Add leftover turkey and vegetables to cooked pasta. Toss with oil and vinegar salad dressing. Add your favorite low-sodium seasoning blend.
  • Add leftover turkey and vegetables to scrambled eggs. (Wrap in a flour tortilla for a breakfast burrito.)
  • Need ideas for the rest of your Thanksgiving leftovers? Check out DaVita recipes for more ideas.

Food Safety Tips:

  • The United States Department of Agriculture (USDA) recommends cooking all poultry to an internal temperature of 165° F as measured with a food thermometer.
  • Bacteria grow rapidly between 40-140° F. Try to keep cold foods below 40° F and hot foods above 140° F to prevent bacteria growth.
  • All perishable foods that have been left at room temperature for more than 2 hours should be thrown away. (To avoid having to throw away food, try to get any leftovers in the refrigerator within 2 hours of cooking it.)
  • To cool food rapidly, divide it into smaller dishes or cut it into smaller pieces. This will help it reach the refrigerator-safe temperature of below 40° F.
  • Once sealed in airtight packaging or storage containers, leftovers can be kept in the refrigerator for 3 to 4 days, or frozen for 3 to 4 months.
  • Reheat all leftovers to an internal temperature of 165° F.

What’s your favorite Thanksgiving tip?

 

(ARTICLE WRITTEN FOR DAVITA PULSE BLOG)

The Difference Between Ensure & Ensure Plus

(ARTICLE WRITTEN FOR LIVESTRONG)

The Difference Between Ensure & Ensure Plus

Ensure and Ensure Plus are often used in diets to gain or maintain a healthy weight. Both types of shakes provide adequate nutrition to support normal body growth, development and maintenance. The shakes are often recommended for people who are malnourished, at nutritional risk or experiencing involuntary weight loss.

Shake Vs. Shake

Ensure Plus contains more calories and protein per serving than Ensure. One 8-ounce serving of Ensure contains 250 calories, 9 grams of protein and 6 grams of fat. Ensure Plus contains 350 calories, 13 grams of protein and 11 grams of fat per 8-ounce serving. While both shakes are excellent sources of an omega-3 fatty acid — alpha-linolenic acid, or ALA — Ensure Plus contains 650 milligrams compared to only 320 milligrams in Ensure. ALA is a plant-based omega-3 essential fatty acid that has been shown to promote heart health by lowering cholesterol levels and improving blood pressure.

Nutrient Similarities

Both types of shakes are excellent sources of 24 essential vitamins and minerals as well as heart-healthy omega-3 fatty acids and are low in fiber. Ensure contains 1 gram of dietary fiber per 8-ounce serving. Ensure Plus contains no dietary fiber. Both shakes are suitable for people with celiac disease (gluten intolerance) and lactose intolerance. Also, both shakes are considered halal and kosher.

How to Substitute With Stevia

(ARTICLE PUBLISHED ON THE BUMP)
Stevia is a natural herb used as a calorie-free, carbohydrate-free sweetener. It can be substituted for sugar in cooking to reduce the amount of sugar and calories in the recipe. Stevia may lower blood pressure and blood sugar levels, making it beneficial for people with hypertension or diabetes. Because stevia is much sweeter than regular sugar, substituting it in recipes can be a trial-and-error process before getting it just right.

 

Determine how much sugar you need. If you are using a recipe, find out how much sugar the recipe calls for.
Convert the amount of sugar into a stevia equivalent. Stevia is commonly sold in powder or liquid form. For 1 cup of sugar, use 1 teaspoon of powder or 1 teaspoon of liquid. For 1 tablespoon of sugar, use 1/4 teaspoon of powder or six to nine drops of liquid. For 1 teaspoon of sugar, use one pinch to 1/16 teaspoon of powder or two to four drops of liquid.

Replace the sugar with correct amount of stevia. For example, if your recipe calls for 2 cups of sugar, use 2 teaspoons of powder or 2 teaspoons of liquid. Mix according to recipe instructions.

Use an ingredient to replace the bulk of the sugar in the recipe. For every cup of sugar that is replaced by stevia, add 1/3 cup of the bulk ingredient to the recipe. You will need to do this because you use stevia in a much smaller amount compared to sugar. Good options to add bulk include yogurt, unsweetened applesauce, egg whites, fruit juice, fruit puree or water. You only need bulk substitutions when you are using recipes. For items like coffee or tea, where you use sugar as a sweetener, you do not need to add any other ingredients for bulk.

Items you will need

  • Stevia (liquid or powder form)
  • Measuring cup, measuring spoons or liquid dropper

Tips

  • The substitution equivalencies are approximate. Adjust the amount to your individual taste preference. Too much stevia can make a food or recipe taste bitter. The quality and sweetness also differ between brands of stevia. Try a few brands to find one you like.
  • Because stevia does not have the same molecular structure and quality as sugar, some recipes will not work with stevia. For instance, caramel requires caramelized sugar to form. Other desserts, like cookies and fudge, are possible but may require multiple tries to perfect the process.

Warnings

  • Although stevia is generally recognized as safe, much research is needed before declaring it safe to use during pregnancy and breastfeeding.
  • Stevia is non-fermentable, so it is not a food source for yeast in recipes. Breads made with stevia will still rise but not as much as those made with sugar.