Pre-Dialysis

In preparing the following information presented to you by the Association for the Advancement and Preservation of the Public Kidney Patients in Israel are many partners: Professional Counseling – Dr. Farhuqui Victor – Key Director of Nephrology and Hypertension, Carmel Medical Center. Tal Kaminsky Rosenberg – Clinical Dietitian. Nepromor – Nephrology Institute Network, Atid Nephrology Forum Management Team – Dietitians Association in Israel. Writing & Editing – Katz-Vodi Selait marketing communications.

What is the role of kidneys?

The kidneys are responsible for blood filtration. They filter out waste materials and remove excess salts and fluids, participate in regulating blood pressure, balancing blood acidity and producing hormones that are essential for the body's functioning and the preservation of our bones. Most people have two functioning kidneys, although one can only live with one kidney. The size of each kidney is the size of a punch. The kidneys are located at the bottom of the back, below the rib arch.

What is chronic kidney disease?

Chronic kidney failure develops due to a variety of medical problems (diabetes, hypertension, cardiovascular disease, renal aging, congenital disease and more) that cause ongoing and irreversible renal function. The disease starts from a stage of partial failure and may deteriorate to an advanced state of terminal failure. In this situation, where the kidney function level is 15% or less, the damage to the kidneys is irreversible and is life threatening. To prolong life, the patient must receive treatment that replaces the normal functioning of the kidneys through dialysis or kidney transplantation.

What are the warning signs of kidney disease?

Most people with chronic kidney disease do not have symptoms until a relatively advanced stage of the disease. Warning signs of kidney disease are: blood and / or protein in urine, high blood pressure, abnormal creatinine level in blood test

How are kidney functions measured?

Blood Creatine Test – This test called – eGFR -estimated Glonerular Filtration Rate is used to assess renal function by calculating the renal filtration rate. The renal filtration rate calculation formula contains the creatinine values, age, sex and weight data. Creatinine is a decomposition product of creatine which is an important component of body muscles. Creatinine levels vary from person to person and also depend on muscle mass. Creatinine undergoes renal filtration and is excreted in the urine and is therefore a marker of renal function. When there is a decrease in kidney function, less urinary creatinine is excreted and blood creatinine values increase. The rate of renal filtration decreases as renal function deteriorates.

The goals of the pre-dialytic diet are to reduce the accumulation of protein metabolism products (urea, creatinine, uric acid, phosphorus and potassium), maintain normal nutritional status, and slow down disease progression as much as possible. A proper diet may discourage the need for dialysis, but may not be a substitute for this treatment when needed.

How can I minimize the damage to the disease?

Chronic kidney failure can be slowed down and sometimes terminated by terminal kidney failure by adhering to the following principles:

Medical monitoring and treatment of drugs that protect the kidney function
Lifestyle change – adhering to a unique diet to maintain kidney function, quitting smoking, exercising
Vigorous balance of blood pressure, sugar level and blood lipids
Avoid taking drugs from certain groups that can cause kidney damage, such as anti-inflammatory or anti-inflammatory drugs. Due to the many limitations of drug therapy, it is important to consult your doctor about each drug individually.

What are the benefits of monitoring and treating the pre-dialysis clinic?

The pre-dialysis clinic team includes doctors, nurses, dietitians and social workers who specialize in nephrology, and whose role is to perform nephrological monitoring of your medical condition and to tailor treatment to help slow the rate of disease progression. Tracking includes:

Periodic examinations by a doctor and follow-up by a nurse
Perform laboratory tests and provide medication to address problems such as anemia, iron deficiency, excess fluid, etc.
Dietetic counseling and menu adjustments according to blood test results.
Meetings with a social worker for help in solving social problems and receiving emotional support.

It is important to know that your collaboration with the team that cares for you, while implementing its recommendations, can help you prevent or at least postpone your arrival to dialysis.

Proper nutrition plays a major role in the treatment of chronic kidney failure. The diet is adjusted according to the stage of the disease – pre-dialysis, peritoneal dialysis or hemodialysis. Dietary determination is also affected by other background diseases (such as hypertension, diabetes and blood lipids), nutritional status, and drug therapy. For this reason, there is no uniform diet for all those with kidney disease. Advice and follow-up from a specialist kidney disease specialist (nephrologist) to adjust the diet at any stage.

Pre-dialysis nutrition

When compiling a proper diet, pay attention to the following elements in the menu:

Protein and calories – Protein is an essential component of the body, but in chronic kidney failure, its excess consumption can cause its decomposition products to worsen and worsen the disease. The recommendation is to limit protein consumption to 0.6-0.8 g / kg body weight / day. The animal is of a higher quality, so it should be at least half the protein on the menu. The risk in this diet is malnutrition, so it is important to maintain adequate caloric intake, under close dietary control. The fats and sugars on the menu.
Sodium (salt) – Excess sodium intake in kidney failure can cause an increase in blood pressure and formation of edema. In contrast, the low sodium diet lowers the undesirable urinary protein secretion. Sodium is found in cooking salt, but its main source is in processed foods such as powdered soup, industrial sauces, sausages, canned goods, savory cheeses, salted fish, snacks and salted crackers. Bread and baked goods also contain considerable amounts of salt. The recommended daily intake is 2300 mg sodium per day (about 6 grams of salt). Nutritional marking should be used to choose sodium-reduced foods. Do not use salt substitutes without consulting a doctor or dietician.
Potassium – Potassium is a mineral found in many foods and should usually be limited to kidney failure due to a decrease in urinary excretion. There are also medicines that raise its level in the blood. Low or high blood potassium levels, among other things, impair muscle function, most notably myocardium. Potassium is mainly found in vegetables (such as tomatoes, avocados, potatoes, sweet potatoes, beets, artichokes, pumpkins), fruits (such as banana, melon, apricot, tropical fruits, guava, pomegranate, citrus fruits, natural fruit juices, dried fruits) and dairy products Nigerians (such as milk, white, yogurt). The recommended daily potassium intake will be determined by the level of potassium in blood tests.
Phosphorus – Phosphorus is also a mineral found in many foods, and should be restricted to diet with kidney failure due to decreased body capacity to excrete it. Excess phosphorus in the body causes, among other things, impaired cardiovascular function and bone disease. Phosphorous foods include internal organs, fish such as salmon, sardines and carp, sausages, crackers, legumes, hard yellow cheeses, Nigerian dairy products, egg yolk, whole grains, cola drinks and cocoa. It is sometimes necessary to use phosphorus-binding drugs with food to reduce its absorption into the body.

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