During the early stages of most kidney diseases, the patient will be advised to limit protein intake to some degree. Because protein is so vital to the entire body, this limitation should only be made under doctor’s orders and with the guidance of a dietician or nutritionist. The protein that is left in the diet at this point will be high-quality with certain additional restrictions as well. However, once the patient reaches end stage kidney disease, the restriction on protein will not only end but the patient will also need to increase intake (Source: The National Kidney and Urologic Disease Information Clearinghouse).
The level that is suggested at this stage is double that of the average diet and may be hard to achieve with a normal diet for a number of reasons. Protein supplements will be beneficial because they are high in protein and can be high in calories, helping to reach the right amount as suggested by the doctor, and they may be easier to tolerate than trying to eat large meals.
In Stage I through IV, the protein level is restricted, with the strictest restriction at Stage IV, the final stage before dialysis becomes necessary. In this stage, dietary protein may be as low as 10%, but again, only with a doctor’s guidance. Excess protein at this point will lead to nausea and vomiting, a loss of appetite, weakness and itching that is sometimes intense. To put this into perspective: the average diet is 14-18% protein and the average vegan diet is 10-12% protein (Source: Mangels).
Not only is the amount of protein limited, but the type of protein may be limited as well. Vegetarian protein sources might be suggested in Stage IV so that protein can still be included in the diet but will also slow the progression of chronic kidney disease. A vegetarian diet gets protein from plant sources, which can be digested with less protein waste buildup. It also works to maintain the levels of sodium, potassium and phosphorous (Source: Brookshyer, RD, CSR).
Limiting the amount of phosphorous in the diet is important because it can deplete calcium in the body and may cause or worsen osteoporosis. Protein itself can cause this problem by causing too much calcium to be eliminated from the body through urination, even when the kidneys are healthy and functioning properly. In kidney disease, however, electrolyte imbalances can be common and certain minerals will compete with one another. These foods that need to be limited include bran cereals, dried beans, brown rice, lentils, salmon, organ meats, sardines, chocolate and cola. Dairy foods are also included on this list of limitations, especially skim milk (Source: Maree).
Once the end stage of chronic kidney disease has been reached, food needs will change dramatically, including a huge increase in both protein and calories to keep the weight steady despite a greatly decreased appetite. The calories have to be high enough to prevent muscle wasting and will be based on “dry” weight. Dry weight is calculated by estimating actual weight minus the fluid retained. The amount of recommended protein is based on this number.
Average Need vs. End Stage Needs
The average person’s protein intake is decided by gender, health, and activity levels. For a very sedentary person, that need may be as low as around .4 grams per kilogram of body weight. For a very active person, that need can increase to .8 to 1 gram of protein. Even a bodybuilder will not need an extreme amount of protein and may only need around 1.2 to 1.5 grams of protein. The American Heart Association recommends that the diet not be over 35% protein, however, that need might change with end stage renal failure (Source: Osterweil).
The average protein needs throughout life are as follows:
Age Grams of protein per kg of body weight
Newborn to six months 2.2 kg
Six to twelve months 2.0 kg
One to three years 1.8
Four to six years 1.5
Seven to ten years 1.2
Eleven to fourteen years 1.0
Fifteen to eighteen years .9
Nineteen years and beyond .8
(Source: US Guidelines on Protein and Diet)
For those who are in Stage V renal failure, there will be a minimum protein requirement of 1.5 to 2 grams per kilogram of weight(dry), with the additional suggestion of getting about 25% of their protein at every meal and to include supplements and snacks to get to the right level of protein. The patient will be told to get their protein from meats, frequent egg dishes since egg is the perfect protein and high protein supplements.
Because end stage renal failure can cause nausea and vomiting as well as decreased appetite, it is important to get high quality protein as well as high calorie counts in the easiest way possible. Supplements can be beneficial because they are easier to consume, they are high in soluble and digestible protein and they can be more appetizing than trying to eat foods. It is easier to pop open a supplement and drink it down than it would be to sit and try to make it through a whole meal. Because kidney disease may also cause taste changes, foods that were once favorites may not be as appealing any longer.
Supplements can be either powder, already mixed shakes, supplement shots, and protein bars.
Protein Powders – There are four protein powder sources: rice, whey, soy, and egg. The powders can be either from a single protein source or a combination of two or more. Anyone with known or suspected food allergies should stick with single ingredient protein supplements for safety. Vegans can use both rice and soy protein powder supplements.
Protein Shakes – Shakes that are already mixed and ready to go are fairly common and can save time and be more convenient to use. They should have enough calories in each serving as well as be a high quality protein. Diabetics should stick to the protein shakes that are recommended to them by the doctor; there are several brands that are created specifically for them.
Protein Supplement Shots – An even easier way to get the right amount of protein is with the liquid protein supplement shot. Profect, from Protica, is only 2.9 fluid ounces in size but has a full 25 grams of protein per serving. There are a number of flavors to choose from and it can be taken anywhere for easy consumption. Flavors include Grapefruit Mango, Fresh Citrus Berry, Cool Melon Splash and Blue Raspberry.
Protein Bars – The protein bars typically have a number of different dessert-like flavors that might be appealing, however, make sure that they do not have a lot of additional sugars in them which can be hard on the immune system. They should still have plenty of protein in them. One popular brand has 180 calories, 12 grams of protein and limited sugar, making it a good snack choice.