Potassium Restriction in CKD

When you have kidney disease, your kidneys cannot remove extra potassium in the right way, and too much potassium can stay in your blood. When you have too much potassium in your blood, it is called hyperkalemia, or high potassium. Having too much potassium in your blood can be dangerous

Why are CKD patients advised to restrict potassium in diet?

Potassium is an important mineral in the body that is needed for the proper functioning of muscles and nerves and to keep the heart beat regular.

Normally, the level of potassium in body is balanced by eating potassium containing foods and removal of excess potassium in the urine. Removal of excess potassium in the urine may be inadequate in a patient with chronic kidney disease and can lead to the accumulation of a high level of potassium in the blood (a condition known as hyperkalemia).

The risk of hyperkalemia is less in patients undergoing peritoneal dialysis compared to those on hemodialysis.

The risk differs in both groups because the process of dialysis is continuous in peritoneal dialysis while it is intermittent in hemodialysis.

High potassium levels can cause severe muscle weakness or an irregular heart rhythm that can be dangerous.

When potassium is very high, the heart can stop beating unexpectedly and cause sudden death. High potassium levels can be life threatening without noticeable manifestations or symptoms (and therefore it is known as a silent killer).To avoid serious consequences of high potassium, CKD patients are advised to restrict potassium in diet.

What is normal potassium level in blood? When is it considered high?

The normal serum potassium (level of potassium in blood) is 3.5 mEq/L to 5.0 mEq/L.

When the serum potassium is 5.0 to 6.0 mEq/L, dietary potassium needs to be limited.

When the serum potassium is greater than 6.0 mEq/L, active medical intervention is needed to reduce it.

A serum potassium greater than 7.0 mEq/L is life threatening and needs urgent treatment such as emergency dialysis.

Classification of food according to potassium content:

To maintain proper control of potassium in blood, food intake must be modified as per the doctor’s advice. On the basis of potassium contents, foods are classified into three different groups (high, medium, and low potassium containing foods).

High potassium = More than 200 mg/ 100 gms of food

Medium potassium = 100 to 200 mg/ 100 gms of food

Low potassium = Less than 100 mg/ 100 gms of food

Foods with high potassium content

Fruits: Fresh apricot, ripe banana, chico, fresh coconut, custard apple, gooseberry, guava, kiwi fruit, ripe mango, oranges, papaya, peach, pomegranate and plum

Vegetables: Broccoli, cluster beans, coriander, drumstick, mushroom, raw papaya, potato, pumpkin, spinach, sweet potato, tomatoes and yam

Dry fruits: Almond, cashew nut, dates, dry figs, raisins and walnut.

Cereals: wheat flour

Legumes: Red and black beans and mung (monggo) beans

Non-vegetarian food: Fish like anchovy and mackerel; shell fish like prawns, lobster and crabs; and beef

Drinks: Coconut water, condensed milk, buffalo milk, cow milk, chocolate drinks, fresh fruit juices, soup, beer, wine and many aerated drinks

Miscellaneous: Chocolate, chocolate cake, chocolate ice cream, Lona salt (salt substitute), potato chips and tomato sauce

Foods with Medium Potassium Content

Fruits : ripe cherries, grapes, lychees, pear, sweet lime and watermelon

Vegetables: Beet root, raw banana, bitter gourd, cabbage, carrot, celery, cauliflower, French beans, okra (ladies finger), raw mango, onion, radish, green peas, sweet corn and safflower leaves

Cereals: Barley, general purpose flour, noodles made from wheat flour, rice flakes (pressed rice) and wheat vermicelli

Legumes: red and black beans and mung (monggo) beans

Non-vegetarian food: Liver

Foods with Low Potassium Content

Fruits : Apple, blackberries, lemon, pineapple and strawberries

Vegetables : Bottle gourd, broad beans, capsicum, cucumber, garlic, lettuce, green peas, raw mango and pointed gourd

Cereals : Rice, rava and wheat semolina

Legumes : Green peas

Non-vegetarian food : Beef, lamb, pork, chicken and egg

Drinks : Coca-cola, coffee, lemonade, lime juice in water, and soda

Miscellaneous : Cloves, dried ginger, honey, mint leaves, mustard, nutmeg, black pepper and vinegar

Fluid intake in Chronic kidney disease

Fluid Intake

Why must patients with CKD take precautions regarding fluid intake?

The kidneys play a major role in maintaining the proper amount of water in the body by removing excess fluid as urine. In patients with CKD, as the kidney function worsens, the volume of urine usually decreases.

Reduced urine output leads to fluid retention in the body causing :

puffiness of the face, swelling of the legs and hands and high blood pressure. Accumulation of fluid in the lungs (a condition called pulmonary congestion or edema) causes shortness of breath and difficulty in breathing.

If this is not controlled, it can be life threatening.

What are the clues that suggest excess water in the body?

Excess water in the body is called fluid overload. Leg swelling (edema), ascites (accumulation of fluid in the abdominal cavity), shortness of breath, and weight gain in a short period are the clues that suggest fluid overload.

What precautions must CKD patients take to control fluid intake?

To avoid fluid overload or deficit, the volume of fluid should be recorded and followed as per the recommendation of the doctor. The volume o fluid permitted may vary for each CKD patient and is calculated on the basis of urine output and fluid status of each patient.

How much fluid is a chronic kidney disease patient advised to take?

In patients without edema and with adequate urine output unrestricted water and fluid intake is permitted.

It is a common misconception that patients with kidney disease should take large amounts of fluid to protect the kidney. The amount of fluid allowed is dependent on the clinical status and kidney function of the patient .

Patients with edema and reduced urine output are instructed to restrict fluid intake. To reduce swelling, fluid intake in 24hours should be less than the volume of urine produced per day.In order to avoid fluid overload or deficit in patients without edema the allowable volume of fluid per day = urine volume of previous day plus 500 ml.

The additional 500 ml of fluid approximately make up for the fluids lost through perspiration and breathing.

Why must CKD patients maintain a record of their daily weights?

Patients should keep a record of their daily weight to monitor fluid volume in the body and to detect fluid gain or loss. The body weigh remains constant when the instructions regarding fluid intake are followed strictly.

Sudden weight gain indicates fluid overload due to increase in fluid intake. Weight gain warns the patients about the need for more meticulous fluid restriction. Weight loss usually occurs as a combined effect of restriction of fluid and a response to diuretics.

Useful Tips to Reduce Fluid Intake

It is difficult to restrict fluid intake, but these tips will help you:

Weigh yourself at the same time every day and adjust fluid intake accordingly.

The doctor advises you on how much fluid consumption is permitted in a day. Calculate accordingly and take the measured volume of fluid everyday. Remember that fluid intake includes not only water but also tea, coffee, milk, juice, ice cream, cold drinks, soup, and other foods with a high water content such as watermelon, grapes, lettuce, tomatoes, celery, gravy, gelatin, and frozen treats like popsicles.

Reduce salty, spicy and fried food in your diet as they increase thirst, leading to a greater consumption of fluids.

Drink only when you are thirsty. Do not drink as a habit or because everyone is drinking.When you are thirsty, take only a small amount of water or try ice.

Take a small ice cube and suck it. Ice stays longer in the mouth than liquid, so it is more satisfying than the same amount of water. Do not forget to account for ice as consumed fluid. For easy calculation, freeze the allotted amount of water into an ice tray.

To take care of dryness of the mouth, one can gargle with water without drinking it. Dryness of mouth can be reduced by chewing gums, sucking hard candy, lemon wedge or mints and the use of mouthwash to moisten the mouth.

Always use a small sized cup and glass for your beverages to limit fluid intake.

Take medicines after meals when you are taking water to avoid extra water consumption for medicine.

A patient must keep himself busy with work. A patient who has little to occupy himself feels the desire to drink water more often.

High blood sugar in diabetic patients can increase thirst. A stringent control of blood sugar is essential to reduce thirst.Since hot weather increases one’s thirst, any measure taken to live in cooler comfort is desirable and recommended.

How does one measure and consume the prescribed amount of fluid per day?

Fill a container with water, equal to the exact amount of fluid prescribed by the doctor for daily intake.

The patient must bear in mind that no more than that amount of fluid intake is permitted for the day.Each time the patient consumes a certain amount of fluid, the same amount of water should be removed from the water container and discarded.

When the container has no more water, the patient will have consumed his quota of fluid for the day and should not drink anymore.It is advisable to distribute total fluid intake evenly throughout the day to avoid the need for additional fluid.

Repeated daily, this method, if followed, effectively delivers the prescribed amount of fluid per day and prevents excessive fluid intake.

Kidney …The Important Organ

Our kidneys play many important roles keeping our bodies in balance. They remove waste and toxins, excess water from the bloodstream, which is carried out of the body in urine. They helped to make hormones to produce red blood cells, and they turn vitamin D into its active form, so it’s usable in the body.

Where is kidney located in our body?

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of your spine. Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water to make urine.

What are the functions of the kidney?
The primary function of the kidney is to make urine and purify the blood. Each kidney removes waste materials, and other chemicals which are not required by the body. Most important functions of the kidney are described below.

Removal of waste products
Purification of blood by removal of waste products is the most important function of the kidney.
The food that we consume contains protein. Protein is necessary for the growth and repair of the body. But as protein is utilized by the body it produces waste products. Accumulation and retention of these waste products is similar to retaining poison inside the body. Each kidney filters blood, and toxic waste products which are eventually excreted in the urine.
Creatinine and urea are two important waste products that can easily be measured in the blood. Their “values” in blood tests reflects the function of the kidney. When both the kidneys fail, value of creatinine and urea will be high in blood test.

Removal of excess fluid
The second most important function of the kidney is the regulation of fluid balance by excreting excess amount of water as urine while retaining the necessary amount of water in the body, that is essential for living .When the kidneys, fail they lose the ability of removing this excess amount of water. Excess water in the body leads to swelling.
Balance minerals and chemicals
The kidneys play another important role of regulating minerals and chemicals like sodium, potassium, hydrogen, calcium, phosphorus, magnesium and bicarbonate and maintains normal composition of body fluid.
Changes in the sodium level can affect person’s mental state, while changes in the potassium level can have serious adverse effects on the rhythm of the heart as well as functioning of the muscles. Maintenance of normal level of the calcium and phosphorus is essential for healthy bones and teeth.
Control of blood pressure
The kidneys produce different hormones (renin, angiotensin, aldosterone, prostaglandin etc) which help regulate water and salt in the body, which plays vital roles in the maintenance of good blood pressure control. Disturbances in hormone production and regulation of salt and water in a patient with kidney failure can lead to high blood pressure.
Red blood cells production
Erythropoietin is another hormone produced in the kidneys, it plays an important role in the production of red blood cells (RBC). During kidney failure, production of erythropoietin is decreased, which in turn leads to decreased production of RBC resulting in low hemoglobin (anemia). This is the reason why in patients with kidney failure, the hemoglobin count does not improve despite supplementation with iron and vitamin preparations.
To maintain healthy bones
The kidneys convert vitamin D into its active form which is essential for the absorption of calcium from food, growth of the bones and teeth, and keep the bones strong and healthy. During kidney failure, decreased active vitamin D leads to decreased, growth of bones and they also become weak.

Growth retardation may be sign of kidney failure in children.

How is blood purified and urine formed?
In the process of blood purification, the kidneys retain all necessary substances and selectively remove excess fluid, electrolytes and waste products.

Let us understand this complex and amazing process of urine formation.

Did you know that every minute, 1200 ml of blood enters the kidneys for purification, which is 20% of the total blood pumped by the heart? So in one day, 1700 liters of blood is purified!
This process of purification occurs in small filtering units known as nephrons.
Each kidney contains about one million nephrons, and each nephron is made up of glomerulus and tubules.
Glomeruli are filters with very tiny pores with the characteristic of selective filtration. Water and small-sized substances are easily filtered through them. But larger-sized red blood cells, white blood cells, platelets, protein etc. cannot pass through these pores. Therefore such cells are normally not seen in the urine of healthy people.
The kidney’s chief function is to remove waste and harmful products and excess water in the form of urine.
The first step of urine formation occurs in the glomeruli, where 125 ml per minute of urine is filtered. It is quite astonishing that in 24 hours, 180 liters of urine is formed. It contains not only waste products, electrolytes and toxic substances, but also glucose and other useful substances.
Each kidney performs the process of reabsorption with great precision. Out of 180 liters of fluid that enters the tubules, 99% of fluid is selectively reabsorbed and only the remaining 1% of fluid is excreted in the form of urine.
By this intelligent and precise process, all essential substances and 178 liters of fluid are reabsorbed in the tubules, whereas 1-2 liters of fluids, waste products, and other harmful substances are excreted.
Urine formed by the kidneys flow to the ureters, and passes through the urinary bladder and is finally excreted out through the urethra.
Can there be variation in the volume of urine in a person with healthy kidney?

The amount of water intake and atmospheric temperature are major factors which determine the volume of urine that a normal person makes.
When water intake is low, urine tend to be concentrated and its volume is decreased (about 500 ml) but when a large volume of water is consumed, more urine is formed.
During the summer months, because of perspiration caused by high ambient temperature, the volume of urine decreases.

During winter months it is the other way round – low temperature, no perspiration, and more urine.
In a person with a normal intake of water, if the volume of urine is less than 500 ml or more than 3000 ml, it could indicate that the kidneys need closer attention and further investigation

About Ayurveda Sankalp

Welcome to Ayurdeva Sankalp Clinic India. We were established in the year 2018 with a mission of spreading awareness in Ayurveda and managing chronic obstinate lifestyle disorder. Ayurveda sankalp Clinic was established in the year 2020 with a view to provide people a holistic approach towards preventing and curing diseases through Ayurveda.