GOALS AND PRINCIPLES OF NUTRITIONAL MANAGEMENT ~ OF RENAL PATIENTS 4 The three major functions of the kidneys are: 1) to excrete the waste products of protein breakdown; 2) to regulate the blood levels of electrolytes and maintain fluid balance in the body; and 3) to produce renin and erythropoietin which affects blood pressure and stimulates the production of red blood cells, respectively. When the kidneys are diseased, they become less able ta rid the body of waste products of protein metabolism, excess electrolytes andfluid. These waste products accumulate in the tissues and blood, anduremia - the final common pathway of chronic progressive kidney disease - develops. To avoid such accumulation of more waste products from the food and liquids in the diet, proper dietary control must be exercised. , Dietary modifications for patients with impaired or absent renal function aim to: * maintain or improve nutritional status minimize uremic toxicity retard progression of renal failure promote patient's well-being SoMa Protein The major end products of protein metabolism are non-protein nitrogen such as urea, uric acid as well as sulfate, creatinine, organic acids, carbon dioxide and water which are normally eliminated through the kidneys. When the kidneys are not functioning normally, these waste products are not excreted properly and nitrogen accu- mulates in the blood and tissues, causing anorexia, nausea and vomiting, drowsiness and.a general feeling of ill health. Thus, in renal patients, the protein Intake must be restricted.. toms as well as the degree of impairment of,renal function as shove The level of protein intake is determined by.the patient if by a creatinine clearance. The Suggested intakes o/ protein per kilogram of body weight at the corresponding leveis of creatinine Clearance are shown below The higher the creatinine ciearance, the greater the level of protein allowed, Creatinine clearance Dally Protein Intake mi/min g/kg 30 to 20 0.60 - 19to 5 3 0.45 5 0.36 For children, protein intake should not ve less than 1.0 le 1.39 - kg per day to assure adequate protein supply ior arawtir . 'i there i loss of protein in the,urine, the diet should provid oat to replace this. 3 When the diet is restricted in protein, itis important that at least 2/3 is of high quality and distributed evenly throughout the day's meai to ensure an adequate supply of essential amino acids, Egg whites are the best sources of high quality protein. Meat, fish, milk and whole ‘eggs are other good sources .. The amount of rice er vegetables need to be regulated as the protains in! lower biological value. Minerals Excesses and deficiencies, of certain electroly quence of kidney malfunction are common features of These can lead to disruption of other body process: Sodium Hypernatromia may lead to high blood pressure and edema (with consequent wergiit gain), whereas hyponatrenia caugus low bloce pressure, depletion of extracellular fluid volume, rapid weight loss and a further deterloration in excretory capacity. therefore important to control or regulate the sodium intake of nis wilt ranal dicanca 5The level of sodium intake shouldbe specificto the patient's need. When there is edema and hypertension, a sodium intake of 60 to 90 mEq (1380-2070 mg) per day-is indicated. In extremely edematous patients, a stricter controlis necessary which means an intake of less than 60 mEq (1380'mg) per day. - Sodium Is naturally present in nearly all foods and beverages. However, the amount of natural sodium’differs in various foods, and the greatest source of sodium in most diets is table salt. Potassium When the kidneys are not functioning properly, potassium accu- mulates in the body. Too much potassium will cause headache and vomiting, bradycardia and cardiac arrest. The daily intake of potassium should not exceed 70 mEq (2370 mg) per day. Some foods and beverages contain more potassium than others. Careful food selection is therefore important to control potassium levels in renal patients. Fruits, although ideal for their low sodium and protein content and high acceptability, may pose a problem in planning low potassium diets. Most fruits are’ good sources of potassium. Vegetables vary in their potassium content. Likewise, beverages such as instant coffee may provide significant amounts of potassium. Phosphorus and Calcium Phosphate retention occurs with a decline In renal function. As a result, serum calcium goes down. A lowered serum calcium concen- tration stimulates an Increase in the secretion ofparathyroid hormone which results in the withdrawal of calcium from the bones. Thus, bone abnormalities may develop. Unfortunately, dietary phosphorus and calcium are difficult to control. Increasing the calcium Intake and at the same time reducing the phosphorus Intake may be difficult since those nutrients usually occur together in foods. E.g., Meat and milk products are high in bothThe level of phosphorus restriction may range from 45 to 65 mEq (700 to 1000 mg) daily. This, however, may not be low enough to control serum phosphorus. Thus, the use of phosphate binders such as aluminum hydroxide to render phosphate unabsorbabie in the ‘intestine is frequently needed to achieve adequate control of hyperphiosphatemia. Increased calcium neéds are often best met by calcium supplements. oN ‘ Flulds Impairment of kidney function includes reduced ability to conserve or to eliminate excess fluid. Thus, the fluid intake of individuals with renal dysfunction needs to be regulated. The fluid intake of patients with kidney failure must match their ability to eliminate fluid. Renal patients must be advised to consume ‘500 to 600 mi fluid more than their 24-hour urine output; this will provide for the insensible daily loss of water via the lungs, skin anc -the water in the feces. An excessive fluid intake will result to edema, manifested by swelling of the hands and feet and consequent body weight gain, as well as to hypertension and shortness of breath. In addition to drinking water and beverages, fluid sources are the water content of foods and the water formed from the oxidation of foods. The total fluid cqntent of the diet is the sum of these three sources. Calories Apatient with renal disease must have an adequate calorie intake at all times to prevent the breakdown of body protein, to ensure that dietary protein is not used as an energy source, and to maintain a constant body weight. Utilization of dietary protein is diractly influenced by total caloric Intake. Inadequate calorie Intake encourages tissue protein break- down and may aggravate the existing uremla. aTo maintain the desirable body weight, adults usually need at least 35 kcal/kg desirable body weight per day. Calorie intake of children should be no less than 80% of their recommended allowance for age (60-80 kcal/kg) to prevent growth retardation. Since protein intake of patients with renal diseasé is restricted, an adequate supply of calories should come from the carbohydrates and fats in the diet. In such cases, the patient shouid be made; to understand the overuse of candies and sugar as well as fats and oils in the diet.MECHANICS OF PRESCRIPTION WRITING FOR PROTEIN, SODIUM, “POTASSIUM, PHOSPHORUS, CALCIUM AND FLUID CONTROLLED DIET The following guidelines based on the objectives in the dietary management of renal patients, are given as a starting point, with Modifications to be made as needed. 1. Consider the laboratory results, nutritional status and clinical findings of the peuen Example: A hypothetical patient with the following data Desirable body weight - 62 kg Present weight 58 kg (wet weight)? ~ Creatinine clearance “Qo mimin Potassium (serum) : 6 /mEq/liter Phosphorus (serum) - 5.5 mg/dl Calciym (serum) - 7.0 mg/dl 2. Calculate the protein level. (See guidelines on protein allow- 3. Calculate the total energy requirement (TER). Since the patient Is underweight, allow at least 40 kcal/kg desirable body weight, t, Thus, TER = 4@kcalx 62 kg (2500 kcal4. Calculate the non-protein calories by, subtracting protein : ; calories from TER. wo q Protein Calories = 40 kcal x4 kcal/g = 160 kcal Non-Protein Calories : = 2500 kcal — 160 kcal = 2340 kcal 5. Divide non-protein calories into: Carbohydrate : 55-80% Fat : 20-45% and compute for grams carbohydrate (CHO) ,and fat by dividing the calories from CHO and fat by their respective physiologic fuel value. Calories from CHO = 70% (2340) = 1638 kcal 1638 ‘4 kcal/g gramsCHO = 410g Calories trom fat - = » 30% (2340) = 702 kcal 702 - grams fat6. Specify the level of sodium, potassium, calcium, phosphorus and fluid based on the clinical symptoms and biochemical findings. + Example: Rx diet = 2500 CaypPaoF 75 2000\mg Na‘(87 mEq)" 25 \1600|mg K (41 mEq)! 2 \\ 500\mg phosphorus (39 mEq)! {1200 mg calcium (60 mEq)! 500 ml fluid T To convent milligrams (mg) to miliequivatonts (mEq): milligrams —— x valence = milliequivalents atomic weight Sodium (Na): mg Na a0 ES Potassium (kK): mg K 11 39 Phosphorus (P) : mg P 12 Calcium (Ca): mg CaUSING THE FOOD EXCHANGE LISTS FOR PROTEIN, SODIUM, POTASSIUM, PHOSPHORUS, CALCIUM AND FLUID CONTROLLED DIET Atter planning the prescription, this is then translated into food items. The following steps may be used as guide: | | | | | | I i | | | | ! | | | | | A. Diet Rx = 2500 CyroPasFrs i 2000 mg (87 mEq) Na | 1600 mg (41 mEq) K | 600 mg (39 mEq) P I 1200 mg (60 mEq) Ca | 1500 mil fluid | I | | | | | I | | \ \ ! | I | 1 | | | I I | 1." Divide the prescribed protein into 2/3 to 3/4 as high biological value (HBV) protein and 1/3 to 1/4 as low biological value (LBV) prate Example: HBV protein = 23(40) = 259 LBV protein = 1/3(40) = 159 ‘Distribute HBV protein into foods. Consider patient's prefer- ences in distributing HBV into milk and meat exchange. After allocating milk allowance, divide the remaining HBV protein by 8 to determine number of meat exchanges (one meat exchange =(8 g protein). | s { 3. Specify the type of meat exchanges preferred (refer to pages 41 to 47 forlisting). Since K and P are the electrolytes which | may have to be limited, their computation Is apriority over the : other electrolytes.Example: Food Group Milk A, pom. Meat _ Laan Meat (Group V-A) Fish (Group V-A) Egg (Group V-C) Total No. of Exchanges 12 3 4 46 Protein 3) 4 24 + 28 aero Nea) Ne (mg) 80 30 30 110 250 K (mg) (mg) 200 200 200 95 655 (60 Ca 190 50 260 om P (mg) 135 70 30 70 HR Wo Fluld CHO (@) (9) 03 6 073 & a Fat (9) vegetables. Specify the type (refer to pages 32-35 for listing). Divide the remaining LBV protéin by 2 to determine the number of rice exchanges. Distribute rice exchanges into different types preferred (see pages 39-41 for listing). Example: Food K Group Vegetable 81 Rica A 8 _ Total Total d'¢(4) FS No. of Exchanges 2 < 4 Protein (a) 06 12 12.6 408 Na (mg) 16 a 460 aaa 734 K (ma) 220 240 120 580 1275 ca (mg) 60 60 40 160 4 Fluid CHO @ 6 3 - 138 ao 2 320 1a 13 @) Fat (a) 5. Compute the amount of carbohydrates coming trom milk, vegetables.and rice, Subtract the computed value from the 7 prescribed carbohydrates, Distribute the remaining car- Lahuenta nennariniinn Inia fande eantainina carhahudratas, | \ | | | ! | I i I | | | | | I ! | | | 4. Distribute LBV protein into foods. Determine’ exchanges of t | I | | | i I | | | | ! | ! | I ! | | | | ! | | i IlConsider the potassium prescription in choosing the type and amount of frults. Subtract from the prescribed carbohydrate content of fruits and divide remainder by 5 to determine exchanges:of sugar. a C- Example:. y Food No.of Protein Na K Ca P Fluid CHO’ Fat «or Exchanges (g) (mg). (mg) (ma) (mg) (a) (@)_ (a) yor Fruits 3 Om cubhdetng dae iphergtincs ae ee A 2 os. 6 2 20 20 98 jm) — _8 1 02 2 6 5 5 4 (v) - Sugar 48 NOS he ie Se Tol = 19 8 0 8 197 2B 6. Compute the amount of fat coming from milk and meat. Subtract from the prescribed fat. Divide the remainder by 5to determine fat exchanges. Specify the type of fat (see page 48 for listing). Example: \) Food Prowin Na K CaP Fluld CHO Fat Group (a) (mg) (mg) (mg) (mg) (9) (a) (9) Fat oA 8 — 30 10 80 80 80 — 4 # 8 ve os 9 220 «40 100 90 — 25 % Free Foods 4 = = = - = = = 2» 30 Total - 05 929 380 120 180 170 — 625 Total 3,4, - 421 1071 1619 457. 653 641.9 407 755 7. Total the protein, electrolytes, carbohydrates and fat content of the provisional diet.8. Compute the additional oral fluid by subtracting inherent flui from prescribed fluid. i Fluid prescription 1500 ml ‘ Inherent fluid - 641.3 ml Additional oral = 888.7 ml fluid 9. The additional sodium required to meet the prescribed leve is computed by subtracting, the inherent sodium content c the diet from the prescribed level. This may be given as asa’ supplement in the form of.solution or packet.’ Sodium prescription — 2000 mg Inherent sodium -° 1071mg Additional sodium — 929 mg Tablespoon salt solution = 1Gia T 10. The additional calcium to meet the prescribed level is bes given in the form of calcium supplements. Calcium prescription — 1200 Inherent calcium “= 457 Additional calcium = - 743 = 1 tablet 44, Compute for final totals. T Garr sotudon a prepared by dissolving § weaspoons.saltin 1 cup of wate, Gowan) of the solution will provide 1 aecimani(geomg cn ‘salt packet is used, this may beSAMPLE MEAL PLAN AND _ |.MENU FOR ONE DAY The diet.prescription for a patient with renal disease must be translated into a diet pattern acceptable to the patient. In some situations, the sodium, calcium and fluid content of the diet is inadequate; in which case, salt solutions and calcium lactate maybe added and water intake may be increased to meet the total require- ments for the day. Here is a sample meal plan and menu for one day. Total exchanges of food for the day : , Vegetable By Vegetable B Fruit Milk Sample Menu Breakfast: Ripe Mango Fried Egg cooking oll Pandesal Margarine Coconut Jam milk, powdered sugar Lunch: Pechay Gulsado pork lomo cooking oil Rice Candiad Rimas ooud 20eo0Nn 2 Exchanges Sugar = 46 Rice = 6 Meat = 3 Fat = 1212 Amount 1medsi-11x6em 1 piece 1 tsp 4pes-7x4em 2tsps — 4 tsps 2 level T 3 tsps 1/4 cup 1/2 of 3. cm cube 1 tsp 3/4 cup Spes-8x4cemrt Sample Menu Supper: Fried Bangus ~ cooking oil Coleslaw cabbage mayonnaise crushed pineapple . Rice Butterballs sugar butter flour water A.M. Snack Saba Nilupak margarine sugar grated coconut Hard candies P.M.Snack Bihon Guisado chicken breast cooking oll Hard candies Tea w/ sugar Additional: Salt supplement Calcium supplement . Fluid Exchanges Amount 1slice- 7 x3x2em 1 tsp 1/2 cup 1tSp 3T 3/4 cup 5 tsps 4 tsps 1tsp 4 tsps 1 small 1tsp 3 tsps 1T 2 pes 1 cup 1/8 breast 1tsp 2 pes 3 tsps 1 3/4 T solution 1 tablet, 650 mg 31/2 cups| DIETARY EVALUATION SHEET | Eneroy|cHO [PRO [rat | Na] x [ca |p [rua Foodttem | Exchange | Amount Geaty (a) |) 1 _|(em0d firma) |trmo) fons) | (9) Broakfest Ripe mango 1 | dmadt-t1x60m| 400 | 100) o4| 10.0) 10.0] 48.0 Feed Eog 1 | 1 piece: eso] - | 8 450 ‘cocking of 1 | ats aso | -.| - | 50] ¥ {| Pandesal 2 4pea-Tx4em | 2000 | 46.0! 4.0) ~ 200 i) Margarine 2. | 2tspe soo | - | - | 109) 20 || coon tam a | Ate soo. | 200) = i {|., es, we |at 850 | 60| 40] 03 || sugar 3 | Sipe soo | 150| - | - - || tanehe ||" Pechey guisado 1 | ae 40 | 075| o6| ork amo, 12 | vaaoemete | 205 | 0) 40 | enki ot 1 | tts aso | ~ | - Rice 1412 Bae 150.0 | 345] 3.0} ; | Candied Fimas 24 | Spes-axdem | 4800 [120.0] — Fried Bangus_ 1 Val-7x3x2em | 41.0 | - | 80} 1.0) 30.0)200.0) 15.0] 70.0) 31.0 ‘cocking of 1 | 189 aso | - | - | 50] Coleslow-catboge | 1 | te 0 | 15] 08| - | 80|1100| s00] 100] s00 mayonnaise 1 | tsp aso | - | - | 50) 400] 20] 10] 10] 10 cushedpinepple | 4 | aT 400 | 100) - | - | 20) 600} so] sol 420 Rice wn | ue 1500 | 345| 30] - | 30| 900] 225) s2s|ii25DIETARY EVALUATION SHEET Eneray|cHO [PRO |rat | Na] x [oa |p [rid Rood ae: Exchange | __ Amount (heat) [(9) |(9) [(a)_|{m9) |(ema) |irmg) |tmop | (a) Buttorbats ; ar 5 Stsps. 100.0 | 25.0] - buter + | Alege {soo | — | = | 200}s600} 80] 40] 40] 40 four ve | tp 172 | 3a| os| - | 02] so) 08| 40] o6 ator aps 200 ‘Aw Snack: Sta Niepak 1} tsmau-tox4en } 400 | 10.0] 04] - | 3.0}1200] 10.0) 100] 40.0 margarine + | tp aso | >| — | sol 4oo| 20) 10] to} 10 sugar a | ape foo | 350 : grateseacona = | a | aT zs |'- | os| 25| 90| 220] 40] 100] 90 ad Candios 2 | zee 400 | 100) PM. Snack: ‘hon gussde 1 | rep sooo | 2a8| 20) 20| 60.0| 16.0} 26.0) 75.0 ‘chickon boast ve | vitvaast 205 | 00| 40| 05| 150|1000| 75] a50| 15.5 | cooking oi + | 18 #80 | 09] 00) so| Hard Canes 2 | 2p 400 | 100) Tea ‘sugar a | au 600 | 150 Suptorat | 2404.7 |410.0| 42.0| 755] 1071.) 1618 [457.8 |657.0]662.9 Sat suppiomeie | 1-44 T soition 9283] eee [ee se | Fie | aie a7. | Tora! ' : 2484.7 |410.0| 420] 75:5}2000 | 1618 1107.4 657 |1500, | |COMPOSITION OF RENAL EXCHANGE LISTS Food Na K Ca P Us Food Gop Proteinig)| (ma) | (mo) (9) i) 1 Vegetable A 0.6 20 60.0 15.0 15.0 1 Vegetable Sub group A. os 20 | 1200 40.0 150 1 Vogotable 8 os 0 | 1000 iso 100 | Vogetable Subgroup 81 os go | 1100 30.0 100 Frit Fresh o4 30 | 1200 100 100 Il FruitB - Processed 02 20 60.0 5.0 5.0 MMi a0 | 100 | 4000 | 3600 | 2500 IV Rice A - Rice & Substitutes 20 20 60.0 15.0 35.0 1V Rice B- Breads 40 | 200 | 69 | . 200 35.0 IN Ree C -Rootcops 18 70 | 5000 500 450 ‘V Meat A 8.0 30.0 200.0 15.0 70.0 V- Maat Sub-group B.1 ao | s00 | 2000 35.0 90.0 V- Moat Sub-group B2 ao | 760 .| 2000 25.0 900 V_ Meat Subgroup B.3 so | 600 | 2000 600 | 1150 Vo Meat ao | tt00 95.0 soo | 1150 V Moat 0 so | 700 | 2000 | 100 | 1350 Wt FAA oo | 400 20 10 10 Mi Fate 19 180 460 6.0 20.0 Vi Sugar A 70 200 450 p00 Vil Froe Foods (Fat & Sugar) o ~ - = -, _\ \ DIETARY GUIDELINES FOR RENAL DISORDERS CHRONIC RENAL INSUFFICIENCY ° The diet for chronic renal insufficiency is also called the predialysis diet. The dietis restricted in two major nutrients: protein and phospho- tus. Restrictions of sodium, potassium, fluid, and calories are based onindividual needs. Because of restrictions in certain foods, the diet is deficient in calcium, iron, vitamin B12, and zinc. A low protein diet may also’be deficient in thiamin, riboflavin, and niacin. The need for vitamin and mineral supplementation should be assessed on an individual basis. Pr The dietary modifications aim-to: 4) reduce the workload of the diseased kidney(s) by reducing the urea, uric acid, creatinine and electrolytes (especially phosphates) that must be excreted; 2) prevent: acceleration of nephrotic damage resulting from excessive protein intake; 3) prevent calcification secondary to renal dystrophy; 4) prevent renal osteodystrophy; and at the same time, 5) promote a feeling of well being and postpone the need for dialysis. Diet Prescription ‘ ‘The diet order should state the level of calories, protein and electrolytes desired.Diet Modifications Dietary Factor Protein (g/kg JBW) Energy (Kcal/kg IBW) Phosphorus (mg/kg IBW) Sodium (mg/day) Potassium Fluid Calcium (mg/day) Fiber i | | [Fhe Upper rl of this range Ia preferred for patients with diabetes or nephrote syndrome, allow 0.8-1.0 /kgIBW. Recommendation 0.6 -0.8* formal weight: 35 keakg IBW obese: 20-80 underweight or catabolic: 50 8-12 1000 - 3000°* Typically not resrtricted Typically restricted Typically not restricted 20 - 25 gid malnutiton. For eepa Food Selection Gulde Food Group Allow Avold oF Restrict Vegetable Allfresh in Legumes, pickled ¥ Fruit Milk Rice Meat or substitute Fat salt fermented yegalat burong mustasa, sauerhras : ”jgimohi; canned and f928" 4 , vegelables if soar is restricled allowed amounts waraschino cherries All except on yi fmuits, dried fruits avoided list, in allowed amounls iowa Evaporated, whole in allowed amounis commercial foods a 2 milk, condensed mili. 7. milk, milk mixes, sher’2t chocolate, cocoa Rice, breads, bihon, Commercially prepared macaroni, spaghetti, desseris, mixes and pastries. corn, all of these potato chips. pretzels, snack and their products chips, cereais, of crachers in allowed amounts containing baking pawder baking soda, sat, or other sodiuin somnpounds; bran pereals, boxed, irozen or grai neared reese snag ail nits All excepttuts; In ever. seeds, beans in sauths and beans allowed amounts Cooking fats, butter, margarino. salad olls and dressingsFood Group Allow Avold or Restrict ; ‘Sugar and All Except those with sweets chocolates and nuts Dessert, Maade with allowed Those with milk, 99S and cereals in allowed amounts foods only; low- \ protein desserts as such asice cream,” custard,” plain arrowroot of pudding: cakes, cookies, comstarch and bibingka, elc.; 00004, puddings, nata de chocolate, nuls coco, matamis na bao, lohwa (putled tice only), kondol, rimas, ago OF kaong with syrup CHRONIC RENAL FAILURE The diet for chronic renal failure (CRF) is designed to: 1) meet nutritional requirements; 2) minimize uremic complications; lood chemistries, blood pressure and 3) maintain acceptable bl fluid status in patients with impaired renal function; and at the same time, 4) promote well-being. Generally, the diet has controlled amounts of protein, potas- sium sodium, phosphorus, and tlulds. ‘Additional modifications of fat, cholesterol, triglycerides, and fiber may be necessary depending on individual requirements. The diet Is used for patients with CRF requiring hemodialysis or peritoneal dialysis treatments. Diet Prescription The diet order should state the calorie, level required. protein and electrolyteDletary Modifications Dietary Factor Hemodialysis Peritoneal Dialysis Protein (g/kg IBW) 1.1- 1.4; at least 12-15 hae 60% high biological 1,2 1.3 for value maintenance os 1.5 for repletion 1.2 for reduction or #f with diabeles Energy (kcal/kg IBW) 30 - 35 for welght 25 = 35 for mainte- maintenance; nance; 25 - 30 for 95 - 50 for repletion; reduction; 20 - 25 for reduction, 40 - 50 for weight 35 if with diabetes y \ | I 1 I | | | | | | | | ! | | | y gain (in CRPD and CCPD | include dialysate I calories)" Phosphorus <17 mEq or approxi-< or approximately | mately 800-1200 1200 mg/d. (Keep | mg/d. (Keep serum _seruin level at maxi- | i level at maximum of | mum ol 6 mg/100 mi) H | ! \ | 1 | | ! | | | l | | ! | \ | | | \ 4-6 mg/100 mi) | Sodium 2000-3000 mg/d —_—ndividualized, based con blood pressure and | weight. | Potassium 40 mg/kg IAW or Generally unrestricted | . approximately 50- with CAPD & CCPD. 80 mEq/d (1250- for IPD: 2000 - 2000 mg/d) 3000 mg/d Fluid 500-750mUd plus INCAPD & CCFO, appro- ally urine output __ximately 2000 ~3000,mU of approximately day based on dally 750-1500 mid weight luctuations and blood pressure; IPD, same as for hemodialysis To determine calories trom dialysate solutons: ‘a. 1.5% solution contains approximately 15 9 glucose pe ltr. '5% solution contains approximataly 25 g glucose per 2b feeDietary Factor Hemodialysis Callum (mg/d) Approximately Peritoneal Dialysis ‘Same aé for hemo- 1000 - 1800 mg/d; dialysis supplement as * needed depending * on serum level r Fat Limit cholesterol lo ~ Same as for hemo- less than 300 mg/d; dialysis emphasize - unsaturated fats. Fiber 20-25g/d Same as for hemo- 1 dialysis Multiply total volume of each dialysate exchange in liters by its glucose concentration perliter (grams ofglucose) to obtain grams of glucose in the dialysate exchange. Add the grams of glucose from each dialysate exchange to determine the total grams of glucose. . Multiply total grams of glucose by the approximate absorption rate of 80%. Multiply total grams of glucose absorbed by the calories pergram of glucose (3.7 kcal/g) to determine the total calories absorbed from the dialysate solution. Example: 2 Lof 2.5% solution: 2 L x 25g glucose = 50 g total glucose 50 g glucose x 0.80 = 40g glucose absorbed 40 9 x 3.7 kcalig = 148 kcal from dialysate solution. Food Selection Gulde (Refer to Guide for Chronic Renal Insufficiency, Pp. 24)ACUTE RENAL FAILURE acute renal failure (ARF Woeth F 1) reduce the accumulation of the uremig toxins; 2) contfol electrolyte abnormalities; . 3). correct fluid retention; and atthe same time, 4) time maintain nutritional status. Dietary factors thatneedtobe controlled include protein, sodium, potassium, phosphorus and fluids. Calorie requirement depends on individual needs and the frequency of dialysis treatment. ) aims'to The diet for The dietis for patients with ARF with orwithout dialysis treatment. Dietary Prescription The diet order should state the calorie, protein and electrolyte levels desired. Dietary Modifications Dietary Factor Recommendation body weight (but not less is GFR retums to normal; g of present weights Protein 0.50.6 g/k9 present than 40 g/d; increase 3: with dialysis, allow 1.0- 1.5. 9/K Energy 435 - 50 kcal/kg present body weight; energy must take into consideration the stress accompanying ARF. Phosphorus Individualize according lo laboratory values, ‘Sodium ‘Anuric - oliguric phase: 500 - 1000 mg/d Diuretic phase: replace losses depending on uanary sodium levels, edema, and frequency of dialysis. Anuric - oliguri¢ phase: 4000 maid Potassium Diuretic phase: replace losses aS indicated by \d urinary golassium urinary volume, serum an ree sal diaivels ani drua therapyDietary Factor Recommendation Fluid . Assess on a daily basis ? Anuric-oliguric phase: replace output (urine, vomitus, and diarrhea) plus 500 m) from the previous day. ‘ Diulatic phase: large ‘cutis ot fluid may be needed. Calcium Individualize based on laboratory valués Fat No modification indicated during ARF Food Selection Gulde (Refer to Guide for Chronic Renal Insufficiency, p. 24) POST KIDNEY TRANSPLANTATION The diet for renal transplantation is designed to ‘provide adequate calories and protein to counteract the catabolic effect of surgery during the early postransplantperiod and to manage, nutritional side effect of immunosuppressive drugs. The diet is used for patients with chronic renal failure who have undergone renal transplantation. Dietary Modifications — First Month After Transplant and During Dietary Factor © Treatment for After First Month Acute Rejection Protein 1.3 -1.5 gkg/d 1.0 ghkg/d Calories 30 - 35 kcavkg/d Sufficient to achieve/ (more if underweight) maintain optimal weight for height o>Dietary Factor Carbohydrates Fats Potassium Sodium Calcium Phosphorus Fluids First Month After Transplant and During; Treatment for Acute Rejection After First Month Remainder of total * game calories; encourage complex carbohydrates No more than 35% of Same calories; cholesterol <400 mg/d; polyunsalu- rated-saturated ratio >1 Variable: restrict or Same supplement as necessary based on serum level 2-4 g/d may be neces- Not more than sary in acute rejection 3g 1200 mg/d Same 1200 mg/d, some patients Same may require supplements Ad libitum unless fluid retention and hyperten- sion worsen. Food Selection Guide The diet guide for normal diets may be followed if there are no complications. To meet the increased need for calcium and phospho- tus, give 3-4 glasses of = milk per day, or give a calcium and proephorue supplement (calcium phosphate) if milk is poorly toler- ated.NEPHROTIC SYNDROME rome The protein- and sodium-controlled diet for nephrotic syndi (NS) is designed to: 1, minimize edema and proteinuria; 4 2. control hypertension; 3. retard the progression of renal disease; 4, prevent muscle catabolism and protein malnutrition; and 5. supply adequate energy. The diet is for persons with NS who are not being dialyzed. Dietary Prescription The diet order should: state the energy. protein and sodium levels desired. , Dietary Modifications Dietary Factor Recommendation Protein adults: 0.610 1.0 g/kg IBW plus replacement of urinary protein losses children:’ RIDA for age plus replacement . of urinary protein losses Sodium 1o3gd Fluid generally unrestricted Fals «30% of total calories per day Cholesterol <300 mg/d dietary cholesterol Eneroy sulfcient o achieve and maintain edema-free |BW Vitamins and supplements may be necessary it protein | Minerals Intake Is 60 9 OF lessid ‘ Food Selection Guide ‘ (pater ta Guida for Chronic Renal Insutficiency, p. 24)RENAL EXCHANGE LISTS LIST! VEGETABLES Group A ‘One exchange provides: Protein - 0.69 Phosphorus - 15.0 mg Sodium - 20mg CaP Ratio - 1 Potassium - 60 mg Moisture - 309 Calcium - 15mg Food + Measure Welght (9) Malunggay, bunga 1/4 cup, cooked 20 Paayap 1/4 cup, cooked 20 Patola 1/2 cup, cooked 45 Pepino 4/4 cup, raw 10 Sayote, bunga 1/2 cup, cooked 45 Sayote, dahon 1/4 cup, cooked 20 Sibuyas, bombay 1/2 cup, cooked 45 Singkamas, bunga 1/2 cup, cooked 45 Sitsaro 1/4 cup, cooked 20 Togue 1/4 cup, cooked 20 Upo 4/2 cup, cooked 45 high potassium content, an The following vegatables have .2mg per exchange). ya of 97 Mg per axchange (or 75.2to 128 4 averag! They ara to be avoided If thera Is need to lessen potassium Intake. Food Measure Weight (9) Kamatis 1/2 cup, cooked 48 Balaw 1/2 cup, cooked 45 | Labong 1/2 cup, cooked 45 Sill, berde 4/2 cup, cooked 45 45 alana 179 c41n ,conkad |a ee Sub-group A.1 | \ One exchange provides: Protein - 0.69 Sodium - 20mg Ca:P Ratio = 2.7:1 Potassium - 120 mg Moisture - 309 Calcium - 40mg . Food Measure Abitsuelas, berde 4/2 cup, cooked Ampalaya, bunga 1/2 cup, cooked Kalabasa, bulaklak 1/4 cup, cooked Kalabasa, dahon 1/4 cup, cooked Kamoteng kahoy, dahon —_1/4 cup, cooked Malunggay, dahon 1/4 cup, cooked Saluyot 1/4 cup, cooked Sigarilyas 1/2 cup, cooked Phosphorus - 15.0 mg Welght (9) 45 45 20 20 20 20 20 45 The following vegetables have high potassium content, an aver- age of 155.8 mg per exchange (or 102 +261 mg per exchange). They are to be avoided if there is need to lessen potassium intake. ’ Food Gabi, dahon ‘Saging, puso Ampalaya, dahon: Kalabasa, bunga Kamote, dahon Langka, hilaw Okra Sitaw, berde Himbabao, bulaklak 1/4 cup, cooked 1/2 cup, cooked 1/4 cup, cooked 1/2 cup, cooked 1/4 cup, cooked 1/2 cup, cooked 1/2 cup, cooked 1/2 cup, cooked 1/4 cup, cooked Welght (9)Group B One exchange provides: i * Protein - 0.69 Phosphorus - 10 mg Sodium - 80mg Ca:P Ratio - 1.5:1 Potassium - 100 mg Moisture” - - 309 Calcium -_ 15mg : Food Measure Welght (9) Katuray, bulaklak 1/2 cup, cooked 45 Labanos 1/2 cup, cooked 45 Letsugas 1/4 cup, raw 10 The following vegetableshave high potassium content. They are to be avoided if there is need to lessen potassium intake. Food Measure Welght (9) j Koliplower (136 mg) 1/2 cup, cooked 45 | Pako (111mg) 1/4 cup, cooked 20 i Sub-group B.1 \ One exchange provides: Protein - 069 Phosphorus - 10.0 mg Sodium - (8.0mg Ca:P Ratio - 3:1 Potassium - 110 mg Moisture - 309 Calcium - 30mg Food Measure Welght (9) Mustasa 1/4 cup, cooked 20 Petsay 1/4 cup, cooked 20 | / Repolyo 1/2 cup, cooked 45 \5 The following vegetable has a high sodium coritent, 35.0 mg per \ jodium Intake. \ e \ exchange. Itis to be avoided if there is need to lessen s\ | ; Food Measure Welght | (9) | Se . I I | | I | | I Rarot 1/2 cup, cooked 45° The following vegetables have ‘high potassium content, an average of 129 mg. (71.2-183.2 mg) per exchange. They are to be avoided if there is need to lessen potassium intake. | Welght: Food Measure (g) | | Talinum 4/2 cup, cooked 45 f Kangkong 1/2 cup, cooked 45 | Sili, dahon 1/4 cup, cooked 20 | Alugbati, dahon 1/4 cup, cooked 20 | Ispinaka 1/4 cup, cooked 20 | Sibuyas, dahon 1/2 cup, cooked 45 | I I LIST Il FRUIT EXCHANGES i | Group A- Fresh | | One exchange provides: I Protein - 49 Phosphorus - 10 mg | Sodium - 3.0mg Ca:P Ratio - 1:1 ! Potassium - 120 mg Moisture - 489 | Calcium - 10mg | Food Measure Welght | (9) Buko, malauhog 1/4 cup 50 | Buko, water, mature 1/4 cup 45 | Kalamans! 1/4 cup 60 | ‘ 7 RAID em) 70. 'fous Measurt 1/2 medium - cm diam Kaymito, berde Dalanghita, ladu 1 medium - 6 cm diam Istroberi 1/2 cup A Langa, hinog 2 segments - 8 ¢m Letsiyas 4 pieces fi Mangga, hilaw, kalabaw = 1 medium slice - 11 x 6 cm Mangga, hilaw, piko 1 medium slice - 11x 6cm Mangga, paho 2small Mansanas, pula 1, small - 6 cm diam Papaya, hinog 4/2 slice -10x6x2em it 1 slice -10x6x2cm Pinya Sampalok, hinog 2 medium - 7 segments Tiyesa 1/4 medium - 10 cm long Tsiko ° 1 small - 4cm diam Ubas 12 pieces (9) 60 65 70 40 50 65 65 15 65 40 75 15 25 40 50 The following fruits have high potassium content, an average of 146 mg (107-229.6) per exchange. They are.to be avoided if there is need to lessen dietary potassium. Milon, pakwan and kamatsili are also high in sodium, with an average of 9mg perexchange. They are to be avoidedif there is need to lessen dietary sodium. Food - Measure Santol 1medium - 7 cm diam Milon, kastila 1/2 slice - 23 x 6 cm Lanzones 7 medium -4x2 cm Mabolp 1/2 small - 6 cm diam 2 medium - 4cm diam Bayabas, pull Saging, bungulan 1/2 of 1 medium - 15 x 4.cm Guwayabano V2 of 8x6x2em Anonas 1/2 small - 5 cm diam Saging, saba 1 small - 10x4om Saging, latundan 1 small- 10x 40m Bayabas, pula 2 medium - 4 cm diam Saging, lakatan 1 small: 10 x 30m Makopa 6 small - 4 cm diam Milon, tagalog 1/2 slice - 23 x 6 cm Welght (9) 70 85 70 50 50 40 60 20 40 40 50 40 130 85 WolghtFood Siniguelas Mansanas, berde Balimbing Duhat Pakwan Atis Kamatsile Mangga, hinog, kalabaw Mangga, hinog, piko _ Group B - Processed Frult: One exchange provides: Protein - 0.29 Sodium - 2mg Potassium - 60 mg Calcium - 5mg Food Apple juice, sweetened Apple sauce Fruit cocktail Fruit cocktail, tropical Mango juice, sweetened Orange juice Peaches Pineapple, crushed, sweetened Pineapple juice, unsweetened Pineapple orange, sweetened Pineapple pomeb, sweetened Pineapple, sliced, sweetened Prune julce Moasure } 5 small -3.cmdiam 1 small- 6 cm diam 3/4 large-9x5crv | 24 small pleces 1slice-11x6cm 7 4/2 small -5x4em 4 T pods 4 madium slice - 11x 6cm 1 medium slice - 11x 6¢m 4 Phosphorus - 5 mg Ca:P Ratio - 1:1 Moisture ~ - 429 Measure 2 tablespoons 3 tablespoons 1/4 cup 3 tablespoons 3 tablespoons 3.1/2 tablespoons 4.medium 3 tablespoons 1/4 cup 3 tablespoons 5 tablaspoons 1 slice - 7cmdiam W4eup . ‘Weight (g)/ \ \ : LIST Ill MILK EXCHANGES ‘ \ : \ One exchange provides : 4 I Protein - 89 Phosphorus - 250 mg | LE Sodium - 160mg © CaPRatio - | 141 f 3 Potassium- 400mg * Moisture - 1419 | k Calcium - 360 mg | e | ‘ Food Measure Welght | : (9) | 4 Evaporated mik 112 glass, undiluted 120 H Evaporated, filled 1/2 glass, undiluted 140 | Evaporated milk, | hood recombined 4/2 glass, undiluted 155 | Fresh carabao's mik 1 glass 240 | Fresh cow's milk tglass 240 | Mik, powdered, whole’ 4 level tablespoons 30 -b4 hevtte The following type of milk has high potassium content, 518mg per exchange. Itistobe avoided if thereis needtolessen potassium | intake. Food Measure Weight | (9) Milk, powdered, non-fat 4 level tablespoons 30 I ! | | | | | | | | I | \ | Il | | | \ | | 1 !5 aie ET LIST IV RICE EXCHANGES j Group A Fy One exchange provides: z Protein - 29 Phosphorus - 35 mg Sodium 2mg Ca:P Ratio - 1:2. Potassium - 60 mg Moisture - 759 Calcium - 15mg Food Measure Welght (9) Bihon 4 cup 100 Lugaw tcup * 180. Rice, cooked 4/2 cup, packed 80 * Spaghetti 1 cup 100 phosphorus content, an average The following foods have high ). They are tobe avoided if there of 70 mgper exchange (65-74.8 mg) is need to lessen phosphorus intake. 172 mg per serving, and should Mais is also high‘in potassium, be avoided when both dietary potassium and phosphorus need tobe lessened. Food Measure Weight (9) Macaroni cup 100 Mais, nilaga tcob-12x4em 65Group B : é One exchange provides: Protein - 4g Phosphorus - 35 mg Sodium - 230mg Ca:P Ratio - 1:1.8 Potassium- 60mg “Moisture - 10g Calcium - 20mg Food Measure Welght (9) Pan americano 2 pieces -9x8x1cm 40 Pan de leche 1 piece -3x8x8cm 40 Pan de sal 2 pieces -7x 4cm 40 Rolls 1 piece -9x3x3cm 40 The following type of bread has high sodium content, 256 mg per | serving. It is to be avoided if there is need to lessen sodium intake. ” Food Measure Pan de limon 1 piece -§x5x4cm Group C One exchange provides: Protein - 1.59 Phosphorus Sodium - 7mg Ca:P Ratio - Potassium - 500 mg Moisture Calcium - 50mg Food Measure Kamote, dilaw 1 piece -8 1/2x5cem Kamoteng kahoy: 1 piece - 6 x 5 cm Welght (9) 40 - 45mg a - 909 Welght (9) 80 85‘The following ,rosterops ‘are high in’; potassium, an averdge of 563 mg (436.9-763.3) per exchange. They are to be avoided when 4 there Is need to lessen potassium intake. f \ 5 i Patatas is ‘also high in phosphorus and flujd, 73 mg and 138 grams, respectively per exchange. It is to be avolded when there is need to lessen both potassium and phosphorus. Ubils also high In sodium, 16 mg per exchange. Itis to be avoided when there Is need to lessen dietary sodium in addition to potassium. i Food Measure Welght | (9) } . { | Gabi 1 piece -9x5 1/2cm 85 i | Patatas 1 1/2 pieces - 8x 6 cm 165 t Tugi" 4 2 pieces - 11x3cm 135 i Ubi 1 1/4 cups, cubed 130 { { f LIST. V MEAT AND FISH EXCHANGES i I Group A i i One exchange provides: i ’ Protein -- 89 Phosphorus - 70 mg Sodium - 30mg Ca:P Ratio - 1:4.7 Potassium - 200 mg Moisture - 319 Calcium - 15mg . Food Measure Welght (9) Internal Organs Beef, atay (liver) 1slice-4 /2x3x1¢m Carabao, atay (liver) 1slice-41/2x3x1cem Chicken, atay (liver) 11/2 pleces Pork, atay (liver) tslico-4 V/2x3x1¢m Pork, lapay (spleen) 3/4 cup ae | SeSaR| ‘ Food Measure Weight z i (9) & Lean Meats 1 piece - 3. cm cube 35 Beef, kabilugan (flank), a : punta y pecho (brisket), - 2 y tagiliran, gitna (porter house steak), 1 ; tagiliran hulinan (sirloin steak) ,* £ tagiliran unahan (centerloin) Carabao, paypay (shoulder) Pork, lomo (tenderloin) pigi (ham) tagiliran laman (centerloin) The following meats have lowér phosphorus content. They may be'used more often if phosphorus is restricted. Food Measure Weight (9) Chicken, balun-balunan (gizzard) 2pieces 30 Chicken, hita (leg) 1/2 small piece 20 Pork, kasim (picnic) 1 piece - 3. cm cube 35 liempo sa tiyan 1 piece - 3 cm cube 35 (platelet) © The following meats also provide 30 mg sodium per exchange, but other minerals are variable. Chicken, laman (lean), pork, buntot (tail) and kitang have lower potassium and phosphorus. Use more often If potassium and phosphorus are restricted, Avoid llempo -sa hulihan (lean fat), labahita, tanigi, dalagang bukid, matangbaka if potassium is restricted. § Mani, binusa has lower sodium and potassium content but has slightly more phosphorus.| ara Food Measure Weight (9) Beef, bias (shank), | piece - 3. cm cube 35 laman {meat), ar . paypay (chuck), - piema corta at larga ; ez (round), solomilyo (tenderloin) tadyang (plate) Carabao, hita (round) 1 piece - 3. cm cube . 35 Chicken, laman (meat) 1 piece -3.cmcube 20 Chicken, pitso "(breast meat) 1/4 breast 20 Pork, buntot (tail) fiempo sa hulihan (leantat) likod (backtat), paypay Jaman (shoulder steak) 1 piece -3.cm cube 3 4 Fishes: Large size Banak, bangus, dalag labahita, maya-maya, | salmon, tambakol, | tanigi Medium size Ajumahan, apahap, biyang putl, karpa, kitang, dalagang bukid, hito, matangbaka, pampano, samaral, talakitok, tulingan 4sice- 7x3x2cm 35 1 plece - 16x 4m 30 Man, binusa 1W¢ 25Group B The'sodium content varies per sub-group. / Sub-group B.1 One exchange provides: : Protein - 89 Sodium - 30mg Potassium - 200 mg Calcium - 35mg Food Fishes: Medium size Bisugo, galunggong, salay-salay Small size Asuhos, tamban, tilapya Sub-group B.2 Phosphorus - 90 mg CaP Ratio - 1:26 Moisture - 35g Measure Weight (9) 1 piece - 16x4cm 30 2small - 12 3/4 x 4 1/2 cm or 1/4 c very small 35 This sub-group contains more sodium than those in Sub-group BI. One exchange provides: Protein - 89 Phosphorus - 90 mg Sodium - 76mg Ca:P Ratio - 1:3.6 Potassium ; 200 mg Moisture + 409 Calcium - 25mgFish: 3 Large size kanduli, ~ lapu-lapu 1plece- 7x3x2cm* - Medium size Alakaak, dapa, . hasa-hasa 1 piece - 16x 4.cm 30 Small size : Sapsap 2 small-12 3/4 x 4 1/2 cm 35 Other sea-foods: Pusit 2 1/4 medium pieces 45 ‘Sugpo {medium - 22x39 1/2cm 25 Sub-group B.3 One exchange provides: Protein - 89 Phosphorus - 115mg Sodium - 60mg Ca:P Ratio - 1:1.9 Potassium - 200 mg Moisture - 409 Calcium - 60mg The foods in this sub-group contain more calcium than those in Sub-group B1, Use more often when It is necessary, to increase calcium intake. However, tawills and itlog, pugo have higher phos- phorus content. ‘Avoid them if phosphorus is rastricted. Food Measure Weight (9) Lean Meat: Pork tadyang 1 piece - 3 cm cube 35 (spareribs) Fish: Small size Ayungin, lapad 2small- 12 2x3 35 tawilis, tunsoy x 1 cmor 3/4 cup very smallFood’ Measure Welgnt (a) Other sea-foods: é Hipon, puti 1/2 cup 70 Hipon, suahe 9 pieces or 2/3 Cup 45 Egg: ¥ Itlog, pugo 9 eggs 70 4 Group C One exchange provides: Phosphorus - 115mg Protein - 89 - Sodium - 110mg CaP Ratio - 12.3 Potassium - 95mg Moisture. - 459 Calcium - 50mg , Food Measure Welght (9) Egos: Pato 1.piece 65 Chicken 1 piece 65 This egg has lower sodiun content 85 mg per exchange. Food Measure Weight (9) 1 piece 65 PenoyGroup D \ One exchange provides: : é Protein - 89 Phosphorus - 135mg Sodium - 70mg Ca:P Ratio - qa Potassium - 200 mg Moisture “- 359 Calcium - 120mg Ttie foods in this sub-group have high potassium and/or phos- phorus content. Avoid them if potassium and phosphorus are restricted. Alimango and alimasag are also high in sodium and should be avoided on low sodium diets. Food Measure Welght (9) ‘Seatoods - “Dilis. wae 35 Alimango 1/2.¢ flaked or 2 medium 45 Alimasag 1/2¢ flaked or 3 medium 40 Tulya 4/3.¢ shelled or 7 cwith shell 90 Beans and Nuts * Kasuy 16 40 Mani, nilaga vec 60 Munggo, berde 2c 55 Munggo, dilaw 126 55 Munggo, pula 126 55 Patani, buto, tuyo W2¢ 75 a : a! ndLIST VI FAT EXCHANGES E Group A One exchange provides: “ ne Protein - O Phosphorus - 1 mg . Sodium y: 40mg —, CaP Ratio - 1:1 Potassium- 2mg Moisture - 19 Calcium - 11mg Food Measure Welght j . (a) \ Butter 1 teaspoon 5 i. Margarine: 1 teaspoon 5 5 Mayonnaise 1 teaspoon 5 t : : Group B_ i ; One- exchange provides: Protein - 1.09 Phosphorus - 20 mg Sodium - 18mg Ca:P Radio - 1:2.5 ; Potassium - 44 mg Moisture - 18g j Calcium - 8mg i Food Measure Welght | @) | Avocado, green 1/2 medium - 12 x 7m 75 j Coconut, milk 1 tablespoon 1B i Coconut, grated 2 tablespoons 20 i Peanut Butter 2 teaspoons D Whipping cream 1 tablespoon 15 : Avocado has a high potassium content while peanut butter contains higher phosphorus and sodium. They are to be avoided when potassium, phosphorus and sodium are restricted, na .LIST Vil SUGAR EXCHANGES: é Group A One Exchange provides: oe i Protein - 0 Phosphorus - 20 mg Sodium - 7mg. Ca:P Ratio - 1:1.3 Potassium - 20 mg Moisture - 29 Calcium = - 15mg Food Measure Weight (g) Peanut brittle 1/2 bar-8cm 10 Soft drinks 145 (Coca-Cola, Pepsi Cola) 3 tablespoons The following food contains protein, but may be considered a sugar exchange if2 teaspoons orless is used. Ithas high’ sodium and potassium content, 11.2 mg and 31.4 mg respectively. Avoid this if d potassium are restricted. sodium an Food Measure Welght . (9) Condensed milk 2 teaspoons 10 free food. whetherwhite orin the form ofsyrupisa Note:Table suga’,! LIST Vill FREE FOODS { | 2 P f 1 The foods In this list contain zero to negligible protein and | electrolytes and are useful In meeling the energy requirement of | . patients with renal disease. ef i Fat i i Food Measure Welght | (a) | | Shortening I (lard, asayte, corn ol, - | coconut oil) 1 teaspoon . 5 i Sugar ’ | . Food Measure Welght | (9) | | Banana Chips 1 piece - 6x 1/2. cm 5 | | Bukayo 1 plece -3 1/2x1cm 5 I | Caramel 1 piece -2x2cm 5 | | Hard candy 1 piece 5 | Honey 1 teaspoon 5 | Ice drop 1/4 piece 25 | } Jam, jellies, | ‘ preserves 2 teaspoons 10 I - Kundol, matamis 1/4 piece -7x 5m 5 ! Marshmallows 1 piece 5 ! Matamis na bao 1 teaspoon 5 | Nata de coco 2 tablespoons or 1/8 cup 10 ! Pakaskas 1/2 tablespoon 5 | Pulboron 1/4 piece «8x 5cm 5 | | Rimas, matamis 1/8 piece -8 x 4cm 5 t Sampalok, candy 1 piece 5 | ‘Sugars (white) 1 teaspoon 5 I Tira-tira 1 piece 5 | Tottee candy tplece -2 12x 1 /2x 1m 5 | Ubedol 1/4 bar- 5x 2.cm 5 i 5 I 1 piece -5x 1 1/4.cmFOOD SELECTION AND PREPARATION SUGGESTIONS FOR INDIVIDUALS WITH RENAL DISEASE On the use of vegetables and also to Increase caloric Intake: 1. If sodium is restricted, avoid pickles, pickle relish, cloves, sauer- kraut. 2. If potassium is restricted, cook vegetables ina large amount of water and drain well béfore using’ 3. Watch out for foods like canned and frozen vegetables which may have added salt or monosodium glutamate. 4. Add butter or margarine in allowed amounts to cooked, drained vegetables. 5. Stir-fry vegetables or serve boiled vegetables with vinegar-oil- ‘sugar dressing to increase calories. On the use of frults and also to Increase caloric Intake: 1. Fruits and juices may be fresh, frozen or canned. Use regular canned fruits packed in heavy syrup to increase calorie unless prohibited. Most regular canned fruits and juices are low in sodium except maraschino cherries and candied fruits. 2. If fluid intake has to be lessened, drain all fruits well before eating. 3. The molsture content of frults mustbe counted in the dally fluid allowance, Read labels on processed frult and fruit juices. Watch out forOn the use of rice exchanges and also to Increase caloric Intake: 1. Read labels of commercially prepared desserts, mixes and pastries. Avoid those high in salt, or compute sodium contentinte the diet. 3 2. If there is need to lessen dietary potassium, avoid food/ood Products containing chocolate, caramel, coconut, dried fruits, molasses and nuts. 3. Avoid potato chips, pretzels, snack chips, cereals or crackers containing baking powder, baking soda, salt and other sodium compounds. 4. Beware of self-rising flours, breads with salted tops, and party snacks. a 5. Serve allowed breads with jam, jelly or marmalade. On the use of meats and also to Increase caloric Intake: Do notuse salted, smoked, cured, dried meat, fish and poultry. All processed and preserved foods are to be avoided unless labeled “Low Sodium". 1. 2. Serving sizes of meats refer to cooked weight without bones, skin or fat. The fat and skin which were removed from weighing may be eaten as additional source of calories. Season with pepper, paprika, curry, green pepper, onion, garlic onpastry. Herbs and spices may be used in normal amounts. |. Meat, fish, poultry may be baked, broiled, roasted, stewed or fried. When frying, roll meat in cornstarch to increase calorie Intake. Seafoods are good sources of calcium, Use more oftenifsodium, potassium and phosphorus are not restricted because seafoods are also good sources of these minerals.1 REFERENCES Burton, B. Current concepts of nutrition and diet in diseases in the kidney. 1974. J. Am. Diet A. 65: No. 5 423-491, Burton, B. and Hirschman, G.H. Current concepts of nutritional therapy in chronic renal failure: An update. 1983. J. Am. Diet A. 82. No. 4 359-363, Chanter, C. et. al. Nutritional therapy in children with chronic renal failure. 1980. Am. J. Clinical Nutrition. 33: 1682-1689. Gillet, D., Stover, J. Spinozzi, N. 1987. A Clinical Guide to Nutrition Care in End-Stage Renal Disease. The Am. Diet A. Handbook of Clinical Dietetics. 1992. 2nd ed. Arcata Graphics Book Group, W. Hanover, Massachusetts. The Am. Diet A. 190-200. i ..Kopple, J.D. Nutritional therapy in kidney failure. 1981. Nut. Rev. 39. No. 5 193-206. Kurtzman, M. Chronic renal failure: Metabolic and clinical consequences. August 1982. Hosp. Pract. 107-122. Mayo Diet Manual. 1981. Sth. W.B. Saunders Co. Philadelphia, 80-85. Migone, L. et. al. The place of dietetic treatment in chronic renal failure (cons). 1982. Contr. Nephrol. 34; 8-22. Overton, M. and Lukert, 8. 1977. Clinical Nutrition (A Physi- ological Approach). Yearbook Medical Pub., Chicago. 129- 149. Spinozzi, N.S., and Grupe, W.E.: Nutritional implications of renal disease |V. Nutritional aspect of chronic renal insuffi- clency In childhood, 1977. J. Am, Diet Assoc, 70: 493-497. Swendseld, M. Nutritional implications of renal disease. 1977. J. Am. Diet A. 70: 488-492, \ \ \ \ 1 ! | | ! | I I | ! I i I I I I | | | I i | | | I | | ! ! | | I ! | | ! | | | | | ! ! | '