Eating to beat chronic kidney disease



• Vegetarian very low–protein diet supplemented with ketoanalogues, dietary cocoa
flavanols may slow disease progression
• Fried diet, meat cooked at high temperatures, toxin in seafood may cause organ damage
• Gum disease, heartburn medications may increase risk of death

As Nigeria joins the rest of the world to mark this year’s World Kidney Day, researchers have identified foods that can cause as well as those that can prevent kidney damage.

According to a study published in the Journal of the American Society of Nephrology (JASN), adhering to a certain low–protein diet supplemented with ketoanalogues may help postpone the need for dialysis in patients with chronic kidney disease (CKD).

Ketoanalogues are nitrogen-free analogues of essential amino acids.

Dr. Liliana Garneata from the Dr. Carol Davila Teaching Hospital of Nephrology, in Bucharest, Romania, and her colleagues designed a randomized trial to evaluate the effectiveness and safety of a vegetarian very low–protein diet supplemented with ketoanalogues for slowing progression of CKD. For the trial, 207 patients with CKD were randomized to a ketoanalogue-supplemented diet (0.3 g/kg vegetable proteins plus ketoanalogues per day) or continue a mixed low-protein diet (0.6 g/kg per day) for 15 months.

The team found that five patients with severely reduced kidney function (stage 4 or higher CKD) would need to adhere to the ketoanalogue-supplemented diet to avoid a greater than 50 per cent reduction in kidney function or the need for dialysis in one patient.

The beneficial effects of the ketoanalogue-supplemented vegetarian very–low protein diet seemed to stem from its ability to correct metabolic complications of advanced CKD, rather than its effects on kidney function.

“The results draw attention to the role of dietary interventions, particularly of a ketoanalogue-supplemented vegetarian protein-restricted diet, as effective, safe, and feasible in selected pre-dialysis patients with CKD,” said Garneata. “This type of nutritional intervention could be used in compliant patients with advanced disease and with good nutritional status to postpone dialysis initiation.”

Also, another new study published in American Journal of Kidney Diseases has found that the types of food that many Southerners seem to prefer- fried foods, sweet drinks and processed meals- may be deadly for people with kidney disease.

According to the study, by the same token, a diet high in fruits and vegetables appears to reduce the risk of death by nearly a quarter in kidney patients.

A “Southern-style” diet was associated with a 50 percent greater risk of death over a six-year period for people with kidney disease, researchers found.

The researchers believe the death risk increases because kidney patients have an impaired ability to filter out the harmful fats, sugars and minerals contained in a typical Southern diet.

Lead author of the study and kidney expert at the University of Alabama School of Medicine, United States (U.S.), Dr. Orlando Gutierrez, said: “People who have kidney disease have a harder time getting rid of a lot of the substances in these types of food that are bad for you.”

It should be noted, however, that the study was only able to show an association between diet and the risk of death in people with kidney disease. It was not designed to prove that dietary factors directly caused a higher or lower risk of death.

Gutierrez said this is the first study to identify a regionally specific diet pattern that seems to be damaging to people suffering kidney disease.

“It is well known that the Southern region has poor health outcomes in a number of different areas including stroke, heart disease and sepsis, and that the style of diet plays a role,” he said.

Gutierrez and his team approached their research with the aim of looking at dietary patterns, rather than specific foods or nutrients.

“We looked to see whether certain patterns of eating correlated with increased risk of death among kidney patients,” he said. “We wanted to put the spotlight on what people are actually eating, rather than salt intake or fat intake.”

The researchers identified nearly 4,000 people with chronic kidney disease who had not started dialysis, and analyzed the way those folks regularly ate.

The researchers found that those who primarily ate processed and fried foods, organ meats and sweetened beverages — all items popular in Southern diets — had slightly more than a 50 percent increase in their risk of death during the approximately six-year follow-up period.

Gutierrez said the Southern diet is rich in nutrients that aren’t recommended for kidney patients. For example, processed foods tend to contain lots of salt and phosphorus, which kidney patients have a hard time filtering from their bloodstream and can lead to high blood pressure and heart disease.

The same goes for the sugar loaded into sweet tea and soft drinks, which increases risk of diabetes, and the heavy doses of fats contained in fried foods.

But the study also showed that while a healthy diet comprised primarily of whole foods, fruits and vegetables can improve survival, it did not protect patients against progression to kidney failure and dialysis.

“This doesn’t mean that eating a healthy diet doesn’t help. But it suggests that a healthy lifestyle overall- not smoking, exercising and eating right- the combination of these things is more important for kidney health,” Gutierrez said.

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