What can a patient with kidney failure eat. Diet for kidney failure: menu, nutritional principles

Renal failure is a pathological condition of the body in which the functioning of the kidneys is disrupted.

This leads to improper exchange of nitrogen, water and electrolytes.

The disease is acute and chronic, and it occurs for a number of reasons, which only a doctor can identify.

In the treatment of this disease, medications are used, but nutrition plays an important role.

Kidney Diet - General Principles

The normal functioning of the kidneys allows the body to function "like a clock". The kidneys maintain the balance of water, the content of trace elements necessary for health, and remove toxic substances. In case of disruption of the work of such an important organ, it is necessary to eat in such a way as to remove the load from the kidneys as much as possible, while not forgetting to saturate the body with vitamins and other useful substances.

A diet for kidney failure is the use of healthy fats, carbohydrates, and fiber. The patient's diet should contain vegetables, fruits, berries. It is better if these products are familiar. Vegetables are consumed boiled, stewed, baked or lightly fried. From fruits and berries, you can cook compotes and jelly, as well as cook delicious jelly.

The diet for kidney failure implies the maximum restriction of protein products, both of animal and plant origin. Protein food has the strongest burden on diseased kidneys.

Experts advise not to use salt when cooking. The sodium in salt is the culprit in water retention, causing edema and hypertension. In violation of the kidneys, this condition is not desirable.

The kidneys (during their normal work) cope well with excess phosphorus. This element is mostly found in protein products. However, diseased kidneys do their job poorly, allowing phosphorus to negatively affect the skeletal system, causing problems with the joints.

Due to impaired kidney function, the amount of potassium in the blood can rise sharply. Pathology causes general muscle weakness, heart rhythm disturbance and even cardiac arrest.

Diet for kidney failure and renal colic includes the restriction of foods containing potassium. This element is also found in protein foods. Reducing the intake of potassium means automatically reducing the load on the kidneys and improving the general condition. Bananas, dried fruits, nuts, avocados, wheat, legumes should be excluded from the menu.

So, the main important concepts of diet therapy for renal failure:

1. Maximum restriction of protein intake. Up to 20-70 g per day is allowed (it all depends on the state of health). The "dose" is prescribed by a specialist.

2. Providing energy from fats and carbohydrates.

3. The inclusion in the diet of such a quantity of vegetables and fruits - a real "storehouse" of the most useful vitamins and microelements, so that you can cover the deficiency of these most necessary substances for the body.

4. Culinary processing of products in order to improve their nutritional appeal. After all, salt-free food is not a secret that it is fresh and not very tasty.

5. Restriction of salt and regulation of water intake in the body.

6. Introduction to the habit of traditionally spending a day of "unloading".

Kidney Diet - List of Prohibited and Allowed Foods

The kidney failure diet is characterized by a high-calorie diet, which distinguishes it from other nutrition systems. Why? If an organism that suffers from impaired kidney function does not receive many calories, then it will begin to expend its internal resources, namely proteins. Decaying, they increase the content of urea in the blood. At the same time, the sick person gradually weakens and loses weight. This negative process is able to stop a high-calorie diet.

Prohibited foods for chronic renal failure:

Concentrated coffee, cocoa, tea, hot chocolate, and alcohol

salty foods

Refractory fats

Sorrel, spinach

Legumes

Sausages

canned food

Mustard, horseradish

Bananas, dried fruits, apricots

Garlic, radish

Products - substitutes for prohibited:

Sago grits, rice

Salt-free protein-free bread

vegetable soups

Lean meat (veal, chicken, turkey, rabbit)

Lean fish

Familiar vegetables (potatoes, beets, carrots, pumpkins, tomatoes, greens)

Eggs (preferably no more than 1 per day)

Limited Dairy Products

Weak infusion of tea, rosehip decoction - a source of vitamin C, non-concentrated juices

Fruits in the form of jelly, mousse, jam, jam

Candies

Spices, thanks to which the taste of any, even the most dietary, dish is improved. These are pepper, bay leaf, cinnamon, vanillin.

Attention! A diet for renal failure and renal colic should be prescribed by a doctor, based on the individual characteristics of the disease.

Sample menu for renal colic

Renal colic, as such, is not a pathology in itself. Rather, it is a symptom of a negative process occurring in the body, indicating obstruction of the ureter.

An attack of colic can be short-term, and can last up to several days. In order to avoid pain, it is necessary to adhere to a certain diet, which provides for the removal of stress from the kidneys.

Sample menu for the week:

1 day

Breakfast: Omelet from 1 egg, a small piece of bread with a thin layer of butter, weak tea (your choice: green or black).

Dinner: Bouillon without meat with the addition of whole grains - pearl barley, potato chops, milk.

Afternoon snack: Cottage cheese with berries, a glass of kefir.

Dinner: Chicken (boiled), vegetable salad, compote or juice.

2 day

Breakfast: Buckwheat (no milk), hard boiled egg, tea.

Dinner: Rice soup, potato casserole, chicken piece, berry jelly.

Afternoon snack: Pumpkin baked in the oven, rosehip broth.

Dinner: Carrot salad, boiled squid, apple juice.

3 day

Breakfast: Milk vermicelli soup, 1 egg, yogurt or kefir.

Dinner: Soup with pumpkin, pilaf with chicken, weak tea.

Afternoon snack: Cottage cheese casserole, apple juice.

Dinner: Mashed potatoes, stewed veal, kefir.

Day 4

Breakfast: Millet porridge on the water, yeast-free bread with jam, tea.

Dinner: Soup with buckwheat, chicken, rice, pomegranate juice.

Afternoon snack: Watermelon

Dinner: Boiled vegetables, a piece of fish, tea.

Day 5

Breakfast: Delicate milk wheat porridge (you can also use water), salt-free pancakes, coffee (weak).

Dinner: Potato soup, vegetable stew, tea.

Afternoon snack: Cheesecakes, jelly.

Dinner: Chicken pilaf, vinaigrette, cranberry juice.

Day 6

Breakfast: Pancakes, hard boiled egg, weak coffee.

Dinner: Soup with vermicelli, cauliflower with beef (baked), tea.

Afternoon snack: Baked apple, fermented milk product.

Dinner: Vegetable stew, lettuce (cucumbers, tomatoes), pear juice.

Day 7

Breakfast: Corn porridge on the water, bread and butter, milk.

Dinner: Vermicelli soup, stewed turkey, vegetables, tea.

Afternoon snack: Fruit jelly.

Dinner: Boiled fish, baked potatoes, salad (beetroot), compote.

The above menu clearly demonstrates how diverse the patient's menu should be. Compliance with the basic principles of nutrition will help to avoid unwanted relapses and bring recovery closer.

How to cook some diet meals?

1. Borscht without meat.

Components: root crop - beets (1 pc.), Medium potatoes (2 pcs.), Onions (1 pc.), Carrots (1 pc.), White cabbage (300 g), water (1.5 l).

Beets are washed, peeled, chopped and dipped in boiling water. Cook until done. Onions, carrots are sautéed in vegetable oil, a tomato is added.

Potatoes are added to the boiling beet broth (cut into slices), and after 10 minutes, chopped cabbage. After the cabbage is cooked, sauteing is added, the borscht is brought to a boil and cooked for another 5 minutes. The recommended amount of salt is added to the finished dish.

2. Vegetable stew.

Potatoes (200 g) are washed, peeled, cut into cubes and stewed until tender. Separately stew carrots (70 g), cabbage (50 g), beets (20 g), onions (20 g). Everything is mixed and stewed in sour cream for another 5 minutes.

3. potato soup.

Wash, peel and cut into cubes potatoes (300 g). With carrots (25 g) they do the same and sauté it in butter. Separately from carrots, onions are sautéed (1 pc.).

Potatoes are thrown into boiling water and boiled for 15 minutes, then onions and carrots are added. Let the soup simmer a little. Before starting a meal, finely chopped greens are put in the soup.

4. potato cutlets.

Peel, wash and boil potatoes (160 g). Then boil it and grind it hot. A quarter of an egg is added to the chilled puree. Everything is mixed and formed into cutlets, which are rolled in flour, laid out on a baking sheet and baked in the oven until a delicious golden crust is formed. Before you start eating, the dish is poured with sour cream.

5. boiled fish.

The kidney diet menu necessarily includes boiled fish, which is cooked like this. 700 g of pike perch, bream or cod wash, clean and dip in boiling water. Cooking time - 15 minutes.

The fish is cooked whole or cut into portions. When serving - put a piece of butter.

6. Baked apples.

Wash the apples, remove the core. Pour sugar into the hole. Pour water on a baking sheet (about 1 cup) and place the apples side by side. Sprinkle more sugar on top. Bake in the oven for 10-15 minutes.

7. Casserole (vermicelli and cottage cheese).

In half a liter of water, boil the vermicelli until partially cooked. Drain in a colander and let it cool slightly. 1 raw egg is added to the product, mixed and the mass is laid out in any greased form, which, of course, is in the kitchen of every housewife. Prepared cottage cheese is spread on top of the vermicelli (with the addition of sugar), and the rest of the vermicelli is placed on the cottage cheese. Bake in the oven, pouring the dish with oil.

Kidney diet - what to look out for

Diet therapy for kidney failure has some important points that must be taken into account:

1. The use of eggs is not prohibited. However, do not forget that this is a protein product. Therefore, if you ate an egg, then it is better to reduce the portion of fish or meat per day.

2. Dairy products: milk, cottage cheese, kefir, yogurt, etc. are allowed. You can't eat cheese.

3. Meat must be chosen lean. It can be boiled, baked, steamed. To say "no" should be bacon, smoked meats, caviar, canned food.

5. Almost any cereals are allowed. Everyone can choose according to their preferences.

6. Diet for kidney failure excludes the use of chocolate.

8. With special care should be taken to the use of salt both in pure form and as part of pickles, marinades, canned food. Even in the initial stage of the disease, the recommended dose is 2-3 g per day.

9. The amount of liquid consumed, including liquid food, should not exceed the amount of urine excreted by more than 500 ml.

So that the diet during the period of illness does not seem fresh and tasteless, to improve the taste, it is allowed to add greens, some spices, sour vegetable juices, lemon juice to dishes.

By adhering to the basic rules of the diet and following all the recommendations of the doctor, you can expect that in a short period of time you will forget about your illness.

Patients with chronic renal failure are forced to constantly take medication and be under medical supervision. An important place in the complex treatment is occupied by a diet for chronic renal failure. Table No. 7, as well as No. 7 A and No. 7 B, are prescribed for impaired renal function.

It makes itself felt by a violation of all kidney functions. The reasons can be very diverse: poisoning of the body, trauma, nephritis, acute infectious diseases. This condition is caused by diabetes mellitus, urolithiasis and oncological diseases.

When proteins are broken down and body cells are destroyed, urea is formed. With kidney failure, urea becomes more concentrated and poisons the body.

Most of all, the body suffers during a decrease in diuresis. The duration of the period is 20 days. During this time, the water-salt balance is disturbed, toxins accumulate in the blood, tissues swell, and acidosis develops.

Symptoms of nausea are pronounced, a person vomits, so nutrition should be special. Despite the lack of appetite, the body must receive protein. Without amino acids, metabolism is disturbed and all systems suffer.

The chronic stage of renal failure is characterized by the fact that kidney function is not fully restored, the state of health can only be maintained.

CRF is additionally accompanied by anemia, as the disease progresses, the level of creatinine falls.

Drinking regimen for chronic renal failure

You can use non-carbonated water. Refuse should be from mineral sodium water. You should also exclude the intake of strong tea and coffee, a complete rejection of alcoholic beverages is required.

The allowable amount of liquid drunk per day is not standardized. The patient is allowed to drink more than half a liter of fluid today than was excreted yesterday.

If the limbs begin to swell and the pressure rises, then limit the amount of salt and fluid consumed.

Nutrition in acute renal failure

In the acute phase, the patient's condition is corrected using diet No. 7 A.

Nutrition principles:

1. Eat more carbohydrates, which provide the main energy. These are vegetables, rice, fruits, sugar, honey. The body also receives energy from vegetable fats, namely butter or vegetable oil.
2. Reduce the intake of potassium and magnesium.
3. With anuria, reduce the restriction of sodium intake.
4. Eliminate salt from the diet.
5. Enter first half a liter of liquid, then the volume is regulated by the doctor, depending on the manifestation of diuresis. It is recommended to drink water without gas, nectars, weak teas, kefir.
6. The daily protein intake should not exceed 20 g.

When the disease has passed its peak period and the body began to recover, a transition is made to table No. 7 B. The amount of salt in the diet increases, and the protein content reaches 40 g.

After the tests are normalized, the doctor transfers the patient to table No. 7. It must be observed for at least one year. If renal failure is mild, then table number 7 is observed from the first day of treatment, but with the exception of products containing potassium.

Proper nutrition in chronic renal failure

The kidneys should be under minimal stress. Pay attention to the principles of the diet for chronic renal failure, which are applied in the diet.

Depending on the severity of the disease, protein is limited. The more severe the patient's condition, the less protein can be consumed. Protein should be easily absorbed by the body, so the main source of amino acids are eggs and milk. It is not forbidden to use vegetable proteins.

Before use, meat and fish are boiled and stewed or baked to remove excess extractive substances from the products. To prevent protein restriction from harming health, analogues of histidine and essential amino acids are introduced.

Calcium necessary for the body is obtained from vegetables, dairy products, eggs. Easily digested and removes phosphorus from the intestine calcium carbonate. The dose and course of administration is determined by the doctor depending on the clinical picture.

A sparing regimen for CKD implies a decrease in the intake of phosphorus and potassium. Therefore, you need to give up sea fish, cottage cheese, cheese, whole grain bread, cereals, bananas, bran, nuts, fruit juices.

In minimal quantities, potassium should also enter the body. Otherwise, hyperkalemia may develop. It is found in large quantities in dried fruits, fresh fruits, and vegetables.

In fresh form, it is forbidden to use greens, onions, garlic. This is due to the presence of essential oils in them.

Due to the large number of restrictions, the body may not have enough energy, so it is necessary to introduce polyunsaturated fatty acids into the diet. Together with carbohydrates, they allow the protein to be better absorbed.

If the diet does not allow you to get a daily calorie intake, in the first half of the day, the consumption of protein, sour cream, and honey increases. Preference is given to complex carbohydrates, it is worth abandoning refractory fats.

With diabetes, butter, margarine, sugar, honey, rice, semolina and pearl barley, juices, fruits are excluded from the diet.

The menu for the week is developed depending on the daily norm of kilocalories. With chronic renal failure, it is 2700 kcal. With insufficient intake of calories in the body, it begins to use its own resources, in particular. tissue proteins. The breakdown of proteins leads to an increase in the level of nitrogen in the blood, which aggravates the situation of the patient. Therefore, useful substances should be ingested regularly throughout the day, the number of meals should be at least 4-5.

Fasting days

In chronic renal failure, the diet is supplemented by the introduction of fasting days. There can be from one to three per week. These days, only one low-calorie food is consumed.

On a vegetable day - 1.5 kg of vegetables. They are boiled or salads are made with vegetable oil. On this day, you can eat only cucumbers, pumpkins, potatoes, each serving is about 300-400 g. Vegetable dishes are not salted.

A fasting day can be spent using only juices, vegetable and fruit, always unsweetened. Instead of each meal, 200 ml of weakly concentrated juice is drunk.

Unloading can be carried out with the help of apples, strawberries, grapes, watermelon. Each meal includes 300 g of fruit.

Nutrition depending on the degree of CRF

• CRF 1 degree. Amino acids are not assigned. The daily intake of protein is about 50 g, bread is replaced with protein-free.
• CRF 2 degrees. Amino acid supplements are prescribed to remove phosphate from the intestines. The amount of protein and phosphorus decreases. You can eat beef, fish, rice, potatoes. The use of egg yolk, meat, cheeses, milk is limited.
• CRF 3 degrees. The amount of protein per day ranges from 20 to 40 grams, depending on the patient's well-being and tests. The emphasis is on animal proteins.

The less urine is excreted, the less salt can be consumed. To normalize the level of iron and calcium in the blood, synthetic drugs are prescribed, as well as complexes of vitamins and microelements.

If you pre-boil or stew fresh vegetables and fruits, their potassium content will decrease. To improve the taste, spices, sweet and sour sauces can be added to dishes.

• 4 degree CRF. The menu is saturated with carbohydrates and fats. Hemodialysis is added to the course of treatment. The procedure provokes the excretion of amino acids and other necessary elements from the body, so more protein is introduced into the diet.

Since the digestive organs suffer, the patient loses his appetite, taste sensations change, food should be light.

Special dietary nutrition is prescribed for diabetes mellitus. This condition is called diabetic nephropathy. The amount of carbohydrates in nephropathy should be kept to a minimum.

Sugar, sweet fruits, flour products are considered diabetic food, so they should be discarded. It is important not to allow a sharp increase in blood sugar levels.

The diet restores the disturbed water and salt balance, contributes to the normalization of the kidneys. In addition, edema, which is characteristic of renal failure, disappears.

While the kidneys are functioning normally, a person does not understand what an important role they play. These paired organs of the urinary system remove nitrogenous metabolic products, control water balance, and are involved in the metabolism of carbohydrates and fats. As soon as the kidneys fail, there is a violation of the protein-energy and electrolyte balance. And here there is a need not only for treatment, but also for a change in nutrition. A diet for kidney failure helps to reduce the load and maintain the correct ratio of trace elements, the balance of which was previously controlled by the kidneys.

diet for kidney failure

Therapy and prevention of kidney disease imply a mandatory adjustment of nutrition.

The diet restores disturbed water and salt balance, improves kidney function. In addition, edema, which is characteristic of renal failure, disappears.

Only a specially selected diet will restore and maintain metabolism. For kidney diseases, experts have developed a sparing diet - according to Pevzner. There are also several variations of this diet, which are applied at different stages of the disease.

During remission, when the disease recedes, it is recommended to adhere to table No. 7, it is suitable for the rehabilitation period after such pathological processes as the acute course of nephritis, pyelonephritis, glomerulonephritis.

During an exacerbation or with severe chronic renal failure, diet No. 7a is prescribed. It helps to minimize the load on the affected organ, and to cope with slagging with nitrogen and protein compounds, improves metabolism. Compliance with such a diet allows you to get rid of puffiness, lower blood pressure.

If a person has a history of concomitant diseases, an individual menu is selected.

Features of the diet in renal failure

The main sparing diet is to reduce protein intake. Depending on the degree of the disease, the daily diet can contain up to 60 grams of protein food. The energy value of meals is increased by carbohydrates and fats - this is the second principle of the diet for kidney failure.

The body needs the necessary amount of vitamins and minerals, so the basis of nutrition should be fresh fruits and vegetables. But it is also important to take into account the protein composition of dishes and the level of salt in them.

With extensive edema, fluid intake and sodium, which retains water, should be reduced as much as possible.

The principles of a sparing diet include:

• culinary processing of products - stewing, baking, boiling;
• balanced menu;
• compliance with the regimen - meals with the same interval of time;
• fractional food.

Nutrition for kidney failure and kidney disease requires restrictions on potassium intake, and you also need to enrich the menu with fiber and healthy fats.

Exceptions from the menu

A low-protein diet for kidney failure involves the rejection of many of the usual, but harmful to the urinary system dishes. Since nutrition, especially during an exacerbation, will be sparing, and the body needs to get rid of metabolites and excess fluid as soon as possible, the following prohibited foods for kidney failure are excluded from the diet:

• soups based on mushrooms, meat, legumes;
• bread with salt content;
• canned food;
• sausages and smoked meats;
• semi-finished products;
• legumes;
• mustard, horseradish sauces;
• cheeses;
• coffee and black tea;
• chocolate;
• cocoa;
• greens containing oxalic acid;
• hot spices, seasonings.

In addition, the minimum amount of protein in the diet should be of plant origin. Salt-containing foods should be completely avoided. The calorie content of the menu should be at the level of 2 thousand kcal.

Care must be taken in the process of cooking. In chronic renal failure, products are processed by the following methods:

• boil;
• bake;
• cook for a couple.

You can fry foods only slightly and already during the period of remission of the disease, in case of an acute course, this type of heat treatment is strictly prohibited, such recipes are completely excluded from the diet with a high degree of CRF.

During the period of exacerbation and rehabilitation, it is important to provide the body with all the necessary vitamins and minerals. There is a list of allowed and recommended products that help restore water and electrolyte balance and metabolism.

To help the kidneys cope with the load, the diet menu includes the following:

• bread and other pastries without protein from cornstarch and bran without salt;
• salt-free vegetable soups;
• poultry meat, lean veal, rabbit or turkey;
• low-fat types of fish - perch, pike perch, pike, roach;
• boiled or baked vegetables;
• pasta;
• dairy products in limited quantities;
• sweets;
• fruit in any form.

Of the sauces, milk, tomato or vegetable marinade is allowed. To maintain water balance, the diet includes a decoction of wild rose or lingonberries, non-concentrated fruit juices, weak tea, fruit compotes, fruit drinks from berries.

You can indulge yourself with various sweets, mousses, jams, jelly sweets, if there are no concomitant diseases that exclude the use of sugar. When observed, the diet should not contain large amounts of glucose.

In the summer, you should eat watermelon. It has a diuretic effect and the liquid does not linger in the body.

Diet menu for kidney failure

Drawing up a power scheme requires an individual approach. It is important that the menu is quite nutritious and more balanced. Particular attention should be paid to the protein content in ready-made meals and the energy value of the products.

A sample menu for kidney failure should look like this:

• breakfast - semolina pudding, fat-free cottage cheese, green tea;
• second breakfast - apples with honey, berry smoothie;
• lunch - potato soup, steamed veal with baked vegetables, cranberry broth;
• afternoon snack - pumpkin soufflé, cherry compote;
• dinner - rice porridge, boiled pike, summer salad of tomatoes and cucumbers, apple jelly.

At night, you can drink fat-free kefir to improve digestion. With kidney failure, the menu for the week is quite diverse, and you can come up with a lot of options without harming yourself.

Diet Recipes

Many tasty and nutritious dishes can be prepared from permitted foods for chronic renal failure. These can be various recipes for salads from vegetables or fruits, side dishes, main courses and soups.

fish salad

For its preparation it is necessary:

• 200 grams of boiled perch;
• 150 grams of potatoes;
• one boiled egg;
• 2 tomatoes;
• greens;
• olive oil, balsamic vinegar for dressing.

First you need to boil the potatoes. So that it does not lose its nutritional value, it is better not to peel it. Finely chop the boned fish, cut the egg and potatoes into cubes, do the same with tomatoes and herbs. Mix the ingredients in a salad bowl, season with oil and vinegar.

For 3 servings you will need:

• 100 grams of beets;
• 150 grams of potatoes;
• 70 grams of carrots;
• 50 grams of onion;
• 2 tomatoes;
• 200 grams of white cabbage;
• 1 teaspoon of sugar;
• 2 grams of salt;
• greens.

Peel the vegetables, boil the beets until half cooked and chop. Peel potatoes and cut into small cubes. Chop onions, carrots and tomatoes, lightly stew in vegetable oil. Put potatoes and beets in boiling water, after 10 minutes add cabbage, finely chopped beforehand.

After the vegetable broth boils, you can put the dressing. Add sugar 5 minutes before it's done. Serve lean borscht with herbs and sour cream. You can salt the soup only if the disease is in remission.

Chicken in milk sauce

It is served with a side dish of rice, wheat porridge or buckwheat. For cooking you need:

• 150 grams of boiled chicken;
• 300 grams of milk;
• 2 tablespoons of flour;
• 20 grams of butter;
• 1 teaspoon of sugar.

Boiled white chicken meat cut into slices. Dilute milk with water and boil. Add sugar as desired. In a frying pan, dry the flour until golden brown and slowly add the milk. When the mixture thickens, add butter. The meat can be served by pouring the sauce or boil it in advance for 10 minutes.

When preparing meals as part of a diet for kidney failure, finished foods can be salted, but only within the allowable range.

The diet in CKD is complex, in conditions of decreased kidney function, the balance and usefulness of the diet is of particular importance, the slightest excess in nutrition leads to aggravation of metabolic disorders caused by nephropathy, at the same time, a deficiency of essential amino acids, insufficient calorie intake lead to protein-energy deficiency syndrome.

Regular monitoring of nutritional status, keeping food diaries, and consultations with a nutritionist are important.

Meals should be regular, if possible, frequent - 3 main meals plus 2 light "snacks". The diet should contain a large number of vegetables and fruits. By-products, canned food, food concentrates, fast food and semi-finished products should be excluded.

Limiting salt intake (no more than 5

g / day, and if possible, even more stringent) is of fundamental importance for the adequate correction of arterial hypertension, increases the antiproteinuric efficacy of ACE inhibitors and angiotensin receptor blockers. Food should be cooked without adding salt and should not be salted on the table. In case of intolerance to a strict salt-free diet, it is allowed to slightly salt the prepared dishes in a plate (no more than 1 g per day - that is, on the tip of a knife). If there are no contraindications from the gastrointestinal tract, you can use spices, spices so that the food does not seem insipid. The exception is tubular lesions with increased sodium excretion.

Recommendations for limiting protein intake are based on the data that this reduces the content of uremic substances - products of protein metabolism, and that some amino acids that enter the blood during the digestion of protein foods increase glomerular perfusion and aggravate glomerular hypertension, increase proteinuria. Clinical studies also show the benefits of a low-protein diet. Decreased uremic symptoms and metabolic
violations, the state of health improves, the progression of renal failure slows down. A low-protein diet (MBD) also has additional beneficial effects: it increases sensitivity to antihypertensive therapy, insulin, increases the antiproteinuric effect of ACE inhibitors, and contributes to the correction of hyperphosphatemia.

The degree of protein restriction should be adequate to the stage of CKD (0.7-0.8 g/kg of body weight per day with a moderate decrease in GFR, 0.6 and, in some cases, lower - up to 0.3 g/kg/day with a pronounced decrease functions). In most cases, a moderate low-protein diet (0.6-0.8 g / kg / day) is recommended, but at the same time, at least 60% of the protein should be of high biological value, that is, contain a sufficient amount of essential amino acids; an adequate caloric content of the diet is required - 30-35 kcal / kg / day.

However, due to the possible inadequate dietary intake by patients or the deterioration and perversion of appetite (aversion to meat food), which is often observed in severe CKD, the risk of developing protein-energy deficiency syndrome is increased, which is characterized by a violation of the synthesis of vital proteins, hypercatabolism of muscle and other proteins of the body, an increase in the level of nitrogenous slags and potassium, an increase in the mortality of patients. Therefore, with a low-protein diet, a ready-made drug of all essential amino acids and their ketoanalogues (Ketosteril) is prescribed, which provides reliable prevention of protein-energy deficiency syndrome. Keto analogs do not contain an amino group, which reduces the nitrogen load.

A more strict low-protein diet (but not less than 0.3 g/kg/day) is acceptable only if there are technical and organizational capabilities for extended and regular monitoring of nutritional status, and is combined with the mandatory intake of essential keto analogues of essential amino acids.

In addition to limiting salt and protein, which are fundamental in CKD, the diet of CKD patients is subject to the following principles:

■ adequate water regime

■ adequate calorie intake

■ correction of hyperlipidemia and hyperglycemia

■ correction of disorders of purine metabolism

■ correction of disorders of phosphorus-calcium metabolism

■ prevention of hyperkalemia

The water regime is determined by the specific clinical situation. Most patients with CKD are shown an extended water regime, that is, at least 2 liters of fluid per day in cool weather, up to 3 liters of fluid per day in hot weather, especially with urolithiasis, purine metabolism disorders, and a tendency to urinary infection. With nephrotic syndrome, decreased diuresis, on the contrary, fluid intake should be sharply limited.

The recommended calorie intake for patients with CKD is 30-35 kcal/kg body weight. A calorie deficit is dangerous, the daily diet must contain a sufficient amount of carbohydrates. Patients with overweight, obesity, hyperlipidemia, decreased carbohydrate tolerance should limit their daily caloric intake to 1200-1400 kcal. Sugar, white bread, pastry, sweets and other sweets, mayonnaise, butter and palm oil, other fatty dairy products (soft cheeses, sour cream, cream), ice cream, fatty meat and poultry, soups with fatty broth and others should be excluded. high calorie foods.

We should not forget about the importance of dosed physical activity, mainly aerobic (swimming, brisk walking, exercising on a stationary bike and an elliptical trainer), which are necessary to optimize weight, blood pressure, and reduce the risk of cardiovascular complications. At the same time, jogging, running on a treadmill, horseback riding and other exercises associated with significant shaking of the body are undesirable for people prone to kidney prolapse. Physical education should be regular and evenly distributed throughout the week. If possible, at least 30 minutes a day or an hour 3 times a week.

Patients with disorders of purine metabolism (hyperuricemia and hyperuricosuria) should be excluded: rich broths, offal - liver, kidneys, heart, tongues, etc., pates, sausages, veal, pork, chicken, smoked meats, canned meat and fish , fast food, legumes (green peas, beans, beans, lentils), cocoa, chocolate, nuts, strong tea and coffee, grapes, raisins, grape wines.

In case of oxalic acid metabolism disorders (oxaluria, oxalate kidney stones, oxalosis), in addition to the restrictions shown with an increase in uric acid, greens, sorrel, spinach, rhubarb, peppers should also be limited.

In case of hyperphosphatemia, the same products are excluded as in violation of purine metabolism, and in addition, fish should be limited (no more than 1 time per week), as well as cereals (except rice) and other foods rich in phosphorus - see Note. The daily intake of phosphorus should not exceed 800 mg/day. As a substitute for cereals, artificial sago (a product derived from starch) can be used. Sago is added to first courses, used to make cereals, puddings, meatballs, pie fillings.

In order to correct hyperkalemia, it is recommended to limit the same products as in violation of purine metabolism, as well as dried apricots, figs, bananas, apricots, peaches, nectarine, etc. - see Appendix. Limit potatoes (to 2-3 times a week) and cook them in a special way: peel, cut, soak in water for at least 3 hours, drain and boil the soaked potatoes in fresh water.

An important component of nephroprotective therapy is the patient's refusal to smoke, which is a significant cause of the development of endothelial dysfunction, impaired renal hemodynamics, and progression of nephrosclerosis.

■ Hypothermia and dampness, prolonged exposure to the sun

■ Overload and psychological stress, lack of sleep

■ Alcohol abuse, drug use

■ Professional and domestic frequent contact with paints, varnishes, organic solvents, heavy metals. For occasional contact, protective equipment should be used.

■ Independent, without the consent of a doctor, taking medications, nutritional supplements