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Sunday, December 12, 2010

Protein and Stages One Through Four of Kidney Disease

by Jim Duffy

Over 26 million Americans have chronic kidney disease with many millions more at serious risk of developing it. Early detection is vital to keep the disease from progressing from kidney disease to complete kidney failure. The major cause of death for people who have CKD is heart disease usually related to chronic and uncontrolled hypertension. Chronic kidney disease and high blood pressure are linked with one another: hypertension causes CKD and CKD causes hypertension. Excessive amounts of protein in the urine, medically known as proteinuria suggests the presence of CKD (Source: The National Kidney and Urologic Disease Information Clearinghouse)

Risk factors for kidney disease include diabetes, hypertension, family history and being African American, Hispanic, Pacific Islander or Native American. Doctors start suspecting kidney disease with the following warning signs: increased urination, fatigue, decreased appetite, nausea and/or vomiting, swelling of the hands and feet, itchy skin, numbness, drowsiness, trouble concentrating, darker skin color and muscle cramps. Diagnosis is completed by several tests which may include urine albumin and serum creatinine. Blood pressure tests might suggest kidney damage especially in those who are young or have no other risk factors for hypertension.

CKD tends to develop slowly though, and may have no initial symptoms at all. A person can have both chronic kidney disease and acute kidney disease at the same time. Acute kidney disease is a rapidly progressive loss of renal function with a decrease in urine, body fluid disturbances and electrolyte imbalances will develop and may be caused by a number of other conditions. Acute kidney disease can be more serious than chronic kidney disease because it starts so suddenly, often without any kind of warning before hand. All possible symptoms of kidney disease should be checked by a doctor so that appropriate treatment can be started before the disease can get started.

Chronic kidney disease can be affected by the diet, especially protein intake. When protein is digested and used by the body, it creates waste products. In a healthy kidney, these waste materials are filtered and removed by millions of cells called nephrons. An unhealthy kidney will be unable to filter protein waste which is then backed up into the blood stream. For this reason, the doctors recommend protein intake be decreased especially in the first four stages of the disease. However, stage five will mean a change in the entire diet which is completely opposite of the diet for the first four stages of the disease.

The five stages of chronic kidney disease is based on glomerular filtration rate (GFR), or the amount of blood that the kidneys can filter. Normal, healthy kidneys filter 18 gallons of blood per hour, filtering over half of all of the fluid taken into the body and eliminating about two quarts of urine every day (Source: MacLean, 1993).

- In Stage I of the disease, GFR is 90 or above which is normal, but there will be an abnormal amount of protein in the urine.

- Stage II has a GFR of 60-89.

- Stage III, GFR equals 30-59

- Stage IV, GFR equals 15-29.

- Stage IV is the last stage before dialysis becomes necessary.

During this stage of the disease, excessive amounts of protein will cause nausea and/or vomiting, weakness, a loss of appetite, possible changes in taste and itchiness. At this point, it is important to get good control of the blood pressure and control the amount of protein in the diet. (Diabetics must also maintain blood sugar control).

In the first three stages of chronic kidney disease, the protein intake should be around 12-15% (a commonly accepted amount for most diets). For instance, a typical vegan diet consists of about 10-12% protein (Source: Mangels, PhD, RD).

Once a patient reaches Stage IV of chronic kidney disease the protein intake should drop to ten percent which can, not only be hard to reach but can lead to deficiencies as well and should only be done with the direct advice of the doctor and under a nutritionist's guidance (Source:

Protein comes from two sources in the diet: animals and plant based. Animal protein is the most common source of the nutrient in most diets, however it may increase the level of protein waste products in the blood stream, a serious problem for already struggling kidneys. Some of the most common sources of protein may also increase levels of phosphorous in the system to an unsafe level. These include milk, yogurt and cheese. Several plant proteins also increase this mineral and includes dried beans, peas, nuts and seeds.

Vegetarian protein may slow the progression of chronic kidney disease, within reason. The primary goals of a plant based diet:

- To get appropriate protein needs while minimizing waste products building up in the bloodstream.

- To maintain sodium, potassium and phosphorous balance.

- To make sure there is good nutrition so that optimal health level can be reached and maintained.

(Source: Brookshyer, RD, CSR)

Protein is needed in the body, even in light of chronic kidney disease. Next to water, it is the most plentiful substance in the body and even though it is restricted, it is still necessary. Protein is used to create and maintain lean muscle mass, it is also necessary to regulate digestion, sleep, and ovulation as well as playing an important role in the central nervous system.

Protein also plays a role in keeping fluid levels in balance which is very important especially if there is nausea and vomiting. If the kidneys are not functioning well, there might be a fluid restriction imposed as well as a limit on protein.

Why Protein Supplements Might Be Beneficial

Drinking a protein shake or a liquid protein supplement shot might be easier on the body than trying to eat a meal would be, especially if the patient is feeling ill. Supplements also have more easily digestible protein than other options which may in turn lead to fewer protein wastes in the blood stream. A good protein supplement:

- Should have the right amount of protein to be within the established diet

- Should have high quality protein and other nutrients

- Should be free from other ingredients that might be considered harmful in the diet

- Should be palatable, in appealing flavors

One option, Profect from Protica is a liquid protein supplement shot which is 25 grams of protein, 100 calories and zero fats and carbohydrates. It provides 100% of the daily supply of Vitamin C and 10% of the B Vitamins. Profect or other protein supplements should be discussed with the doctor before they are added to the diet. Diabetics, especially have some concerns that they must keep in mind when choosing a protein supplement in addition to the protein restrictions that they must follow. There are some brands of protein supplements that are specifically designed for the diabetic.

About the Author:

Protica Research (Protica, Inc.) specializes in the development of Capsulized Foods. Protica manufactures Profect, IsoMetric, Pediagro, Fruitasia and over 100 other brands, including Medicare-approved, whey protein supplements for immunodeficiency patients. You can learn more at Protica Research - Copyright

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