What Conclusions Can Be Drawn For Patients With Ckd From The Above Incomplete Data
The issue of optimal salt intake in the general population, and particularly in patients with CKD, is highly controversial. Given the evidence currently available, dogmatic ex cathedra statements are certainly not appropriate. As in the general population, there is currently no evidence to assume that reducing salt intake to 56 g/day causes harm or adverse effects in cardiovascular patients and patients with CKD. In the above-mentioned studies, no systematic adverse effects were noted with this intake. Having said this, it is wise to pay attention to some practical points. In all patients, sodium excretion should be monitored in 24-h urine collections, blood pressure control should be performed in the sitting and standing position . Higher salt intake may be appropriate during episodes of, or in patients with, sodium loss, e.g. diarrhoea, vomiting etc.
Controlled gold standard evidence has not been provided by prospective controlled trials documenting less cardiovascular or renal events as a result of reducing dietary salt intake per se. Nevertheless, convincing studies show that reduction of sodium intake lowers blood pressure in essential hypertension.
Conflict of interest statement. None declared.
Foods To Avoid In Renal Diet
Kidney failure patients should avoid foods that are high in phosphorus or sodium. Some examples include biscuits, muffins, pancakes, waffles, oatmeal, cookies, pretzels, deli-style meat, processed cheese, canned fish, artichokes, spinach, potatoes, fresh beets, dates, oranges, frozen dinners, seasoned salts, soy sauce, and other condiments and sauces.
Here is a list of items you should avoid on a renal diet divided by food group category.
- 1 small biscuit or muffin
- 2 x 2-inch square of cake
- 1 pancake or waffle
- ½ cup of oatmeal
- ½ cup of whole-wheat cereal or bran cereal
- 1 piece of cornbread
- ¾ ounce of salted pretzel sticks or rings
- 4 sandwich cookies
- Artichoke or ¼ of a whole avocado
- Brussels sprouts or okra
- Sweet potato
- Tomatoes, regular and low-sodium tomato juice, or ¼ cup of tomato sauce
- Winter squash
- 1 cup of canned or fresh apricots, or 5 dried apricots
- 1 small nectarine
- 1 small orange or ½ cup of orange juice
- ¼ cup of dates
- of a small honeydew melon
- 1 small banana
- 1 ounce of deli-style meat, such as roast beef, ham, or turkey
- 1 ounce of canned salmon or sardines
- ¼ cup of cottage cheese
- Processed cheese, such as American cheese and cheese spreads
- Smoked or cured meat, such as corned beef, bacon, ham, hot dogs, and sausage
Eating With Chronic Kidney Disease
Angela Larson is a registered dietitian who works with Brookshire Brothers promoting real fresh, real delicious healthy foods;and providing nutrition education to the community.
Read her advice on Chronic Kidney Disease below.;
Learning to eat well with chronic kidney disease can seem complicated, but it can actually be quite simple when streamlined to focus on the most important changes that can help keep the kidneys working well. The four areas to focus on when making diet modifications are in eating the right amount of protein, phosphorus, sodium, and potassium. Eating well with chronic kidney disease can be easily combined with any other dietary needs such as eating for diabetes or heart disease, because the foundation of the diet is the same: eat a variety of healthy foods that are simply prepared and wholesome. Track your nutrient intake for a few days to see how your intake of protein, phosphorus, sodium, and potassium measures up to the recommended amount for CKD listed below.;
Foods high in phosphorus include meat, dairy, nuts, seeds, beans, peas, chocolate, whole grains, oatmeal, dark cola, and bottled iced tea. Choose small portions of high phosphorus foods, and try not to eat more than two or three portions of high phosphorus foods in one day. Choose low phosphorus drinks and avoid dark colas and bottled tea.;
Cooking Tips for Lowering Sodium Intake:
Shopping Tips for Lowering Sodium Intake:
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The Best Salt Substitute For Kidney Patients
*Please note that this post contains clearly identified affiliate links.; If you click on these links and choose to make a purchase, I may receive a commission . As an Amazon Associate I earn from qualifying purchases.
So, your doctor told you to start following a low sodium diet. You are probably wondering how you can make your food taste good without the salt! The good news is that you absolutely can eat flavorful, delicious meals on a low sodium diet. You just need to learn some new kitchen tricks!
Here is a complete list of healthy salt substitutes for kidney patients. And, which salt substitutes to avoid.
Low Sodium Diet For Kidney Disease
A low sodium diet is a pillar of healthy eating for nearly every health condition that affects the kidneys. People with Chronic Kidney Disease, Polycystic Kidney Disease, FSGS, nephrotic syndrome and kidney stones should all avoid too much salt.
A high salt diet can cause high blood pressure, which is harmful to kidneys. In fact, high blood pressure is the second leading cause of Chronic Kidney Disease in the United States. In addition, a high salt diet can make uncomfortable swelling, or water retention, worse for people with kidney disease.
For most people, a healthy daily sodium goal is 1,500-2,300mg per day. Only 1 teaspoon of salt has around 2,300 mg of sodium. This is less than half of what most people in the United States eat every day!
It is very important to realize that most of the salt we eat is already in our food. The best place to start removing salt from your diet is to eat foods low in sodium in the first place! Then, make those foods tasty with a healthy salt substitute for kidney patients!
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Spices To Use Instead Of Salt
- Chili powdertastes great in chili or taco meat flavoring. Also try it in rubs. View a recipe using this spice.
- Smoked paprikaadds a smoky flavor to marinades, gives brown color to breadcrumb casserole toppings and is great for barbecue rubs, or seasoning blends for sautéing or searing proteins. View a recipe using this spice.
- Lemon zestadds a lively taste to breadcrumbs, breaded chicken tenders, fish sticks and kidney-friendly vegetables . Lemon zest is also great in dressings, marinades and when added to dry spices for rubs.;View a recipe using this spice.
- Dried oreganoenhances flavor of scampi sauces and combines well with lemon zest. Gives steamed vegetables and tossed salads a fresh, earthy taste and aroma. Add it to fajita seasonings with chili powder, cumin, cayenne and lemon zest. View a recipe using this spice.
- Italian seasoning*a blend of thyme, oregano and basil is great for finishing off sauces such as a stroganoff or gravies. Works well on baked, grilled or sautéed proteins with lemon zest and a little oil. Add it to lemon zest, lemon juice and olive oil to make delicious dressings.;View a recipe using this spice.;*Check to be sure you are using a salt-free product.
Alternative Mechanism Of Sodium Toxicity
Recent experimental findings suggest that skin could work as a reservoir of sodium, escaping from renal control . In particular, high salt intake might cause sodium accumulation in the skin, which is detected by cells of the Monocytes Phagocytes System located in the skin interstitium, which act as osmoreceptors by expression of the tonicity enhancer-binding protein . This transcription factor leads to Vascular Endothelial Growth Factor production that increases sodium clearance by the lymphatic network . Moreover, high sodium levels in the CKD condition would promote the expression of pro-inflammatory factors, such as Interleukin-6, VEGF, and Monocyte Chemoattractant Protein-1 , via Ton-EBP pathway, leading to local inflammation and vascular proliferation in peritoneal, heart, and vascular tissue .
summarizes the potential mechanisms underlying the increase of BP levels and dependent CV risk associated with high salt intake in CKD.
Potential pathogenic mechanisms of hypertension in CKD due to high salt intake. Abbreviations: CKD: Chronic Kidney Disease; AT-II: Angiotensin-II; CNS; Central Nervous System; CV: cardiovascular.
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How To Make Your Dishes Flavorful Without Salt
Our kidneys are responsible for filtering out sodium and expel it from the body through the urine. However, if you have chronic kidney disease , your kidneys have a reduced capacity to clean up excess waste and keep your sodium at a healthy level.
Cutting back on your salt or sodium intake will help keep these health issues at bay. Moving towards a low-sodium diet begins with eliminating salt and sodium-rich condiments and seasonings from your kitchen and table.
How Much Salt Do We Need
The Dietary Guidelines for Americans recommends that everyone limit sodium to 2,300mg per day. The average person in the United States consumes closer to 3,500mg each day.
One teaspoon of salt, whether it be rock salt, sea salt, or any other kind of salt, has about 2,300mg of sodium.
However, this doesnt mean we should add a whole teaspoon of salt to our food each day. It is very important to know how much salt is already in the foods we eat. About 80% of the salt we eat is already in food.
Common high salt foods:
- Salty snacks like chips, pretzels, salted nuts and crackers
- Processed cheeses like American or nacho cheese sauce
Always check the Nutrition Facts label to see how much sodium is in the foods you eat.
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Point: Moderate Sodium Intake Is Harmful For People With Heart Failure
Sodium intake is associated with fluid retention, hence the puffiness and bloating that may follow a very salty meal. And excessive sodium intake may worsen high blood pressure, or hypertension. High blood pressure increases the risk of developing heart failure and can worsen existing heart failure. Hypertension may also lead to other types of heart disease, stroke, or kidney failure. A low-sodium diet may help lower or prevent high blood pressure, and may reduce the risk of such diseases.
High-sodium diets are also usually high in total fat and calories, which may lead to obesity and its many associated complications. Some studies also suggest that there may be a link between sodium intake and osteoporosis and stomach cancer. Additionally, consuming salty foods over a long period of time can accustom your taste buds to the taste, and in turn make you more likely to reach for saltier foods.
Effects Of Altered Dietary Salt Intake In Patients With Chronic Kidney Disease
AMY CRAWFORD-FAUCHER, MD, FAAFP, Forbes Family Medicine Residency Program, Allegheny Health Network, Pittsburgh, Pennsylvania
R. MICHAEL HUIJON, MD, Western Psychiatric Institute and Clinic, St. Margaret Family Medicine Residency Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Am Fam Physician.;2017;Apr;1;95:423-424.
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Renal Diet Foods List
If you intend to follow a healthy renal diet plan, the first step to take is to stock your kitchen with the right foods. Youll also need to educate yourself on;renal diet restrictions and be careful to avoid foods that contribute too much;sodium, potassium and phosphorus to your diet.
In recent years, advice about the best diet for people with kidney disease has started shifting. A 2017 study published in the Clinical Journal of the American Society of Nephrology found that healthy dietary patterns, as opposed to a traditional renal diet, were associated with lower mortality in people with kidney disease. Healthy eating patterns referred to diets that included fruits and vegetables, fish, legumes, whole grains and high-fiber foods, while also limiting red meat, sodium and refined sugar intake.
This finding is noteworthy because it goes against the traditional renal diet guidelines that were recommended in the past.; Recent findings from the;DIET-HD;multi-national cohort study that included over 8,000 hemodialysis patients also showed that a high adherence to the Mediterranean or DASH-type diet was not associated with reduced cardiovascular mortality or all-cause mortality, and actually helped reduce;mortality;risk.
Based on the latest research, here are renal diet foods to eat:
And here are renal diet foods and ingredients to avoid:
Hints To Keep Your Sodium Intake Down
- Cook with herbs and spices instead of salt.
- Read food labels and choose those foods low in sodium.
- Avoid salt substitutes and specialty low-sodium foods made with salt substitutes because they are high in potassium.
- When eating out, ask for meat or fish without salt. Ask for gravy or sauce on the side; these may contain large amounts of salt and should be used in small amounts.
- Limit use of canned, processed and frozen foods.
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Why Does The Body Need Salt
Sodium is an essential trace mineral found in salt. The body needs this for a variety of functions.
It can support:
- preventing low blood pressure
Recent research has suggested that eating salt can reduce the risk of infection and kill harmful bacteria.
There are several claims about the health benefits associated with pink salt consumption. These include:
Are Salt Substitutes Safe For My Kidneys
For people who are put on a low-potassium diet as part of their treatment plan, it may not be advisable for you to use salt substitutes. This is because most of these products contain potassium chloride. High-potassium salt substitutes are also harmful for people who are taking hypertension medications.
If youre looking for kidney-friendly salt alternatives other than herbs and spices, NKF recommends the salt-free seasonings by Spiceology. With 13 different blends to choose from, the US-based spice company makes experimenting with flavors healthier for kidney disease patients without exceeding their daily salt, potassium, and phosphorus limits.
Spiceology worked closely with NKF, registered dietitian nutritionists, and chefs in developing these salt-free blends. This to ensure that the final products meet the specific nutrient requirements for CKD patients while still giving their palates a savory treat.;
These 13 salt-free seasonings were concocted and tested with every kidney disease patients flavor preferences in mind:
Each seasoning is intended for use for specific dishes.
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Impact Of Salt Intake On The Response To Renoprotective Interventionin Particular Renin
In the debate over the possible merits of low sodium intake, it might be useful to distinguish between the effects of diet as such in subjects without medication, and the effects of low dietary sodium as an amplifier of the benefit of well-established treatments, e.g. reninangiotensinaldosterone system blockade and others. As RAAS blockade is evidence-based first-line treatment in CKD as well as in heart failure, and a main treatment in essential hypertension, this issue deserves more consideration in the salt debate.
Effect of dietary salt reduction, hydrochlorothiazide and their combination on proteinuria in proteinuric patients treated with losartan. Figure reproduced with permission.
Annual event rate end-stage-renal-disease according salt intake in non-diabetic patients and diabetic nephropathy patients . *Salt intake was estimated from 24-h sodium excretion in both trials.
Finally, the benefits of dietary sodium reduction appear to go beyond renal and cardiovascular disease. In the elderly population, which constitutes a major cohort of patients with chronic kidney disease, low sodium intake has also beneficial effects on the preservation of cognitive performanceillustrating that one has to look at the patient in his or her entirety and not simply at one organ or one disease .
Risks And Side Effects
Remember that a number of factors influence the best type of kidney diet that someone can follow, including: the stage of their renal disease, type of treatmentthey are on, and presence of other medical conditions.
Even though a healthy diet that is similar to the DASH diet or Mediterranean diet has been slow the progression of kidney disease and other diseases like heart disease too, some patients will still need to follow a special diet that is more restrictive. To be safe, always speak with your doctor before changing your diet, especially if you have;chronic kidney disease.;The DASH diet and Mediterranean diet are not intended for people on dialysis, who should work with a dietician to make sure they are managing their nutrient intake carefully.
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What Is A Renal Diet
According to;NephCure Kidney International, A renal diet is one that is low in sodium, phosphorous, and protein. A renal diet also emphasizes the importance of consuming high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium. Every persons body is different, and therefore, it is crucial that each patient works with a renal dietitian to come up with a diet that is tailored to the patients needs.
What Kinds Of Spices And Herbs Should I Use Instead Of Salt To Add Flavor
Try the following spices with the foods listed.
Allspice:Use with beef, fish, beets, cabbage, carrots, peas, fruit.
Basil:Use with beef, pork, most vegetables.
Bay Leaf:Use with beef, pork, most vegetables.
Caraway:Use with beef, pork, green beans, cauliflower, cabbage, beets, asparagus, and in dips and marinades.
Cardamom:Use with fruit and in baked goods.
Curry:Use with beef, chicken, pork, fish, green beans, carrots and in marinades.
Dill:Use with beef, chicken, green beans, cabbage, carrots, peas and in dips.
Ginger:Use with beef, chicken, pork, green beans, cauliflower and eggplant.
Use with beef, chicken, pork, green beans, cauliflower and eggplant.
Rosemary:Use with chicken, pork, cauliflower, peas and in marinades.
Thyme:Use with beef, chicken, pork, fish, green beans, beets and carrots.
Sage:Use with chicken, pork, eggplant and in dressing.
Tarragon:Use with fish, chicken, asparagus, beets, cabbage, cauliflower and in marinades.
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The Right Balance Between Too Little And Too Much Salt
Public awareness about a potentially adverse role of high sodium chloride consumption was first raised by a study in Finland . In that prospective study on 1173 men and 1263 women, 24-h urinary sodium excretion was measured at baseline. A 17-year follow-up documented that a high sodium intake predicted mortality, particularly in males and overweight individuals .
Unfortunately, there is a paucity of high-quality prospective randomized controlled intervention trials investigating whether a lower than currently usual level of dietary salt intake improves long-term outcome. Only two prospective intervention trials have been conducted. Long-term follow-up data of these trials provided evidence that reducing salt intake confers cardiovascular protection. In the TOPH I and TOPH II trials 3126 men and women received comprehensive education and counselling on reducing salt intake. The participants were randomized to intervention, i.e. dietary sodium reduction or usual care, for a duration of 18 months or 3648 months . In TOPH I, a net reduction in the daily sodium excretion of 44 mmol/24 h was achieved and in TOPH II a reduction of 33 mmol/24 h . Although the effect on blood pressure during the intervention was unimpressive, after a 1015-year follow-up, the risk of cardiovascular events was 25% lower in the intervention group .