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SLOW YOUR KIDNEY DISEASE

BY PER ÅKE ZILLÉN

English69Contents

1. From me to you

2. Brief facts about slowing, dialysis and transplantation

3. Amazing organs performing multiple functions

4. You can reduce the risks

5. The kidneys’ decline

6. What the tests show

7. Collaboration for self care – your responsibility

8. Medications – for YOUR best interests

9. Planning and training

10. High pressure and low pressure

11. Diabetes and chronic kidney disease

12. Calcium and phosphate in balance

13. Anaemia

14. Fight acidosis

15. Salt and water

16- Potassium, the right amount

17. Good and bad fats

18. Itching

19. Diet is an important part of the treatment

20. Protein – less is better

21. Exercise is the best thing for you

22. No smoking is by far the best policy

23. The importance of weight

24. Alcohol – take it easy

25. Good teeth – healthy gums

26. Libido and sexual function

27. All these emotions

28. Glossary of terms

29. Acknowledgements

1. From me to you

The news that I had chronic kidney disease came as quite a shock. I was used to being healthy. I’d never been really sick before, and I saw myself as fundamentally a healthy person.

I had been feeling more and more tired for a few years, I had lost my appetite and lost weight, and my tummy was playing up, but symptoms like that could have any number of different causes. When I finally got round to seeing a doctor, chronic kidney disease wasn’t the first thing he thought of either. As for me, I had absolutely no idea what was wrong with me.

The next thing I found out was that chronic kidney disease couldn’t be cured; there’s no magic pill that can make our kidneys work properly again. And even worse, once my kidneys were done, so was I – unless I went on dialysis.

Having to gradually realise and then reluctantly come to terms with the fact that I was chronically ill was hardest emotionally, far harder on the soul than feeling ill physically. My life was turned upside down and would never be the same again.

Two questions came to mind:

  • Can chronic kidney disease in any way be stopped or slowed down, so I can go on living with the function that remains?
  • What can I do myself?

This book is about the answers to those questions. It’s a compilation of facts and experiences which doctors, nurses, dietitians and other kidney patients have shared with me. Their knowledge and experiences have been of great benefit to me personally in slowing my kidney disease.

My hope is that this book will help you too, if and when you decide wholeheartedly to slow your kidney disease.

Your own resolve and how you care for yourself can make all the difference.

Per Åke

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2. Facts in brief

The vast majority of people live their whole lives with kidneys that work properly. For one person in 10, their kidney function gradually decreases over time, whether due to age or illness. However, in the whole of Sweden there are only a few hundred every year who lose all their kidney function. Total renal failure is therefore unusual, but for the people it happens to it’s extremely serious.

It is difficult to completely prevent and avoid chronic kidney disease. However, it is possible to reduce the risks of chronic kidney disease. Discovering an increased risk of illness early on is also possible using simple tests. The earlier the risk is discovered, the more time and the more room for manoeuvre there is to slow development of the disease.

Far more than half the kidney function has to be lost before any signs of illness are felt. So to discover chronic kidney disease early you have to get tested, even though you may feel perfectly healthy. The same goes for high blood pressure, diabetes and cardiovascular disease, for instance. All these diseases can go on for a long time, years or in fact even decades, before you are aware of them in any way.

The worst thing about chronic kidney disease is that the risk of various diseases of the heart and blood vessels is so much higher than in people with healthy kidneys. In fact there are more chronic kidney disease patients who suffer cardiovascular disease than ultimately need dialysis.

Chronic kidney disease can be treated in three main ways:

  • By slowing the kidney disease
  • With a kidney transplant
  • Through dialysis

This book focuses on slowing chronic kidney disease. Brief information about dialysis and transplant can be found below. If and when those solutions become options for you, you will need far more detailed information. But as the saying goes, you can cross that bridge when you come to it.

 

Slowing

As yet there is no good or effective cure for chronic kidney disease. The kidney function cannot be reversed, so you cannot be restored to full health. Any kidney function you lose is lost forever. Once chronic kidney disease has set in it leads slowly – often very slowly and quite surely – to lower and lower kidney function.

However, with increased knowledge there is now some possibility of slowing the decline. But this doesn’t apply to everyone.

Some kidney diseases inexorably lead to the kidney function stopping altogether.

For others, it is possible to slow the development, more or less successfully.

For some it may even be possible to stop the deterioration, at least for a certain period of time.

It is impossible to tell which course the development will take until the person has given it a try, has done their very best to slow the decline.

In purely practical terms, the treatment comprises three equally important parts:

1. Various kinds of medicine to replace or compensate for the lost kidney function.

2. A special diet with less protein and more energy than normal.

3. A healthy life.

 

Dialysis

Cleansing the blood of the body’s waste is absolutely necessary. This is one of the most important functions of the kidneys. If the blood is not cleansed you die, not immediately but within a number of days. When the kidneys can no longer cleanse or ‘filter’ the blood themselves, the blood has to be cleaned in some other way, and the most common way is through dialysis. The alternative is a transplant.

Blood dialysis (haemodialysis) entails reclining or lying next to a dialysis machine at least three times a week. The blood is pumped from a blood vessel in the arm, through a tube to the dialysis machine, where it is filtered and then returned to the blood stream. Treatment takes four to five hours each time and is carried out at a dialysis clinic. Some people may also be taught how to do dialysis themselves, either at a clinic or at home.

Peritoneal dialysis entails putting a special fluid into the abdominal cavity through a tube on your stomach. The fluid cleanses the blood by absorbing the waste through the abdomen’s mucous membrane. The patient drains the fluid him or herself, and tops up with new fluid every few hours.

 

 

Transplants

A transplanted kidney can replace all or most of the functions that your own kidneys once had. Transplantation is a procedure whereby a kidney from a living or just deceased donor is transferred to the person who needs a new kidney.

With a living donor the kidney is removed and immediately inserted by surgery in the lower part of the recipient’s abdomen, quite close to the bladder. With a deceased donor, the kidney is kept cold during transport from the donor to the recipient. The transport time varies depending on the distance between the donor and the recipient.

A kidney from a living donor usually has better results, partly because there is greater certainty that the kidney is good quality, and because the operations take place simultaneously. The medical examination of the donor takes some time, but after that there is not usually a waiting time.

A shortage of organs from deceased donors means that waiting times for this type of transplant can vary from short to, more commonly, several years. Many different medical factors have to match between the donor and the recipient, which is why transplants cannot be carried out ‘in order’, as it were.

To help the transplanted kidney stay in (and not be rejected), the recipient has to take various medications, either for the rest of his or her life or for as long as the kidney works.

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3. Amazing organs performing multiple functions

Two fist-sized organs

Normally, us humans have two kidneys. They are ‘bean-shaped’ and usually the size of a clenched human fist. An adult kidney is around 10-12 centimetres long and weighs around 150-180 grams.

The kidneys are located just behind the abdomen, one on each side of the spine and beneath the lowest ribs.

The active part of the kidneys comprises some two million tiny nephrons, which contain blood vessels. The blood enters the kidney, filters through these nephrons, and then passes back out of the kidneys. During the process, water and different waste substances are separated off and pass through the ureter into the bladder, and then out of the body as urine.

 

Many important functions

The kidneys are both complex and sophisticated organs. They are not only a ‘filter’ for cleansing blood. They also perform many different and important functions that keep the body healthy and balanced. Here are some of the most important:

1. FILTERING THE BLOOD
Every minute more than one litre of blood passes through the kidneys. That’s almost a quarter of the body’s total volume of blood.

The first phase of the filtering process in the nephrons involves the production of a large amount of ‘primary urine’, around 180 litres a day. This urine is composed of water and soluble waste.

The body needs to reabsorb almost all of the water, as well as varying amounts of substances that pass through the kidneys, in order to maintain or adjust the balance in the body. This means that during the second phase, most of the primary urine goes back into the circulation.

The by-product of this filtration process is between 0.5 and 2.5 litres of urine a day. Urine contains residue from various processes in the body along with salt, phosphate, potassium, hydrogen, bicarbonate and ammonium, as well as toxins and drug residues. So basically, urine gets rid of water and waste.

2. BLOOD PRESSURE
The kidneys play a key role in regulating blood pressure. By secreting a particular amount of water, the kidneys can regulate the total amount of fluid in the body and thereby also regulate the blood pressure. A higher volume of fluid produces higher blood pressure, while less fluid results in lower blood pressure.

If necessary, the kidneys can use the hormone renin to contract the blood vessels and raise the blood pressure.

3. RED BLOOD CELLS
One type of cells found in the blood are red blood cells. Their most important task is to transport oxygen from the lungs to all the cells in the body.

When kidneys produce the hormone erythropoietin or EPO, they stimulate the production of red blood cells in the red bone marrow of some of the body’s bones. With reduced kidney function, production of EPO decreases and the person has anaemia and less energy. The more EPO, the more red blood cells and a higher Hb (haemoglobin value). Red blood cells help improve oxygen transportation, which is why manufactured EPO has been (illegally) used in sports where stamina is important (such as cross-country skiing and cycling events).

4. CALCIUM AND PHOSPHATE
Calcium is important for the skeleton. For the intestines to absorb calcium, they need vitamin D and it is in the kidneys that this vitamin is activated.

The kidneys play an important role in maintaining the calcium/phosphate balance in the body and they do so by excreting varying amounts of these substances. The parathyroid glands (located next to the thyroid gland at the front of the throat) are also active in regulating the balance between calcium and phosphate.

5. SALT AND WATER
The kidneys regulate the body’s balance of common salt (sodium chloride) and water. If you have too much salt in your body, you secrete more salt and the kidneys retain as much water as is needed to restore the balance. There is also a centre in the brain that makes sure you get thirsty.

When you lose a lot of fluid, due to heavy sweating for instance, the kidneys conserve salt and water by reducing the production of urine. On the other hand, if you have too much fluid in your body the kidneys increase urine production, so you need to pass water more.

6. POTASSIUM
Potassium is present in body cells in the form of a salt and is necessary to the functioning of nerves, muscles and the heart. Excessive or deficient levels of potassium can cause cardiac disorders, which is a serious problem.

The kidneys help to regulate the amount of potassium in the blood by adjusting secretion. If blood acidity rises, potassium levels in the blood also risk increasing, so the kidneys react by raising the secretion.

7. ACID AND BASE
The cells of the body function best when the acidity of the blood (the blood pH) is at the right level. Blood acidity is regulated by the kidneys as they secrete and reabsorb larger or smaller amounts of hydrogen ions. That way, the kidneys work to maintain blood acidity within balanced limits.

 

Kidneys for life

These examples show how the kidneys actively help with and also actively influence a wide range of important functions in the body.

With their intelligent design, enormous capacity and phenomenal endurance, kidneys are quite simply one of the most important organs in the human body. Vital in fact.

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4. You can reduce the risks

There is an old adage that says ‘Prevention is better than cure’. This holds true for all diseases, but it is particularly important with chronic kidney disease, because to date, no cure for chronic kidney disease has been found.

It is also better to discover the first signs of increased risk of disease early enough for the disease to be stopped – before it has properly taken hold. This applies to chronic kidney disease too.

By reducing the risk of kidney disease or stopping the disease at an early stage, you also reduce the risk of cardiovascular disease.

In some cases of acute chronic kidney disease, the disease can be stopped and the function can sometimes be restored. However, once someone has developed a chronic disease and their kidneys and kidney function have severely deteriorated, their disease can generally no longer be cured. Quite simply, they will never be healthy again.

 

The very first signs

The very first sign of an increased risk of both chronic kidney disease and cardiovascular disease is when increasing amounts of the protein albumin are present in the urine. This can be detected through a simple urine test, and these tests are generally taken regularly in patients with diabetes and high blood pressure.

An increased amount of albumin in the urine following repeated sampling is considered an indication that a disease has begun. It may be sensible at this early stage to chart, check and do something about other risk factors to reduce the risks.

The mere fact that albumin leaks into your urine is a sign that your capillary walls are being damaged for some reason, perhaps because of a general inflammation, high blood pressure and increased blood sugar levels (which in turn is an indication or an early stage of diabetes).

In other diseases, the first sign may for example be blood in the urine. With simultaneous severe atherosclerosis (hardening of the arteries), however, there is sometimes no protein in the urine.

 

Tests

Blood and urine tests are often taken during doctor’s appointments or health check-ups. Here are some of the most common tests:

Protein in the urine. The simplest way of finding out if there is protein in urine is with a dipstick test. The stick is dipped in the urine and changes colour depending on the amount of protein. There are also dipsticks for obtaining a more specific indication of the amount of albumin.

• Obtaining an accurate count of the amount of albumin at the clinic involves a special instrument that produces the correct result from a drop of urine within a few minutes. Alternatively, the urine sample is sent to a laboratory. If repeated tests show elevated levels of albumin, they can help your doctor assess whether you are at risk of a developing or a future kidney condition and whether further investigation is necessary

Blood pressure is usually taken after a few minutes of rest, and in a sitting position. A (too) high blood pressure (or ‘hypertension’) is an important underlying risk factor in both chronic kidney disease and cardiovascular disease. A small percentage of patients with high blood pressure develop chronic kidney disease, whereas nearly all people with chronic kidney disease develop high blood pressure.

Blood sugar. If your blood sugar level is higher than normal, this may indicate that you have or are about to develop diabetes. Many people show the first signs of diabetes without knowing about it, because the disease has no tangible symptoms in the early stages. One of the complications of protracted diabetes is that you may develop chronic kidney disease.

Weight and waistline. Excessive body weight and obesity increase the risk of diabetes and cardiovascular diseases, among other conditions. Intra-abdominal fat is considered a particularly dangerous risk factor, which is why some health check-ups also involve measuring the waistline and the abdominal height. Excessive body weight is also a risk factor for chronic kidney disease.

• The results from blood tests are also indicators of the amount of waste products that remain in the blood and therefore have not been filtered in the kidneys. ‘Creatinine’ is one such waste product generated from metabolising protein in the body. The concentration of creatinine is used as a measure of the kidneys’ cleansing function. A raised level of creatinine in the blood is a sign of chronic kidney disease.

Blood lipids, such as cholesterol, are also measured by blood test, and the results show values for both ‘good’ and ‘bad’ cholesterol.

 

Some people are more at risk

Some people may be more at risk of developing chronic kidney disease than others. If you have one or more of the following conditions, it is important to have regular health checks.

Protracted diabetes may lead to chronic kidney disease. But by controlling your blood sugar you will be able to protect your kidneys and reduce the risk of losing kidney function. Roughly one in four or one in three kidney patients also has diabetes.

High blood pressure. Protracted and uncontrolled high blood pressure (or ‘hypertension’) is an increased risk in both chronic kidney disease and cardiovascular disease. However, properly treated and controlled blood pressure reduces the risks.

Severely overweight people are more at risk of developing diabetes, high blood pressure and cardiovascular disease – and are therefore also exposed to higher risks of chronic kidney disease.

• The most important risk factors for atherosclerosis are genetic predisposition, high blood pressure, raised blood lipid levels and smoking.

Smokers run a higher risk of developing a long list of diseases, including chronic kidney disease.

The elderly may develop a relative reduction in kidney function as an attendant process of natural ageing. However, people over 50 are also more at risk of high blood pressure, atherosclerosis and kidney disease. Most kidney patients are found in the 60-70 age bracket.

• People who have chronic kidney disease, diabetes or cardiovascular disease that runs in the family are more at risk of chronic kidney disease. Some kidney diseases are hereditary.

 

Don’t rely on the symptoms

One of the problems with preventing kidney disease is that there are absolutely no symptoms for a long time. Your blood and urine samples may show ‘abnormal’ results and you may belong to all of the risk groups, but you may still feel perfectly healthy. You may, for example, be a diabetic with high blood pressure and the early stages of chronic kidney disease – without knowing it.

Therefore you cannot rely on the symptoms of these diseases. In fact by the time the symptoms appear the diseases are usually at quite an advanced stage. The first symptom of chronic kidney disease may be increasing fatigue, loss of appetite or slight nausea. By the time they start to show you will have already lost far more than half of your kidney function.

So people who feel fully healthy and do not have any symptoms are the very people who should go for regular checks, including kidney function checks. Such checks are intended to provide early detection and treatment and, hopefully, to prevent the disease taking hold and progressing. Once symptoms appear, the chance to prevent disease has passed.

 

Prevention by early treatment

So what should you do if and when ‘abnormal’ test results show that you are at increased risk? Especially if at the same time you belong to one or more of the risk groups?

Well, that depends on the overall prognosis, which has to be assessed by your doctor. However, here are some common and in many ways obvious examples of what you can do:

• If you already have diabetes – or if your test results indicate that you are about to develop diabetes – then you must keep your blood sugar levels under strict control, e.g. with medication or by increasing your physical activity, losing weight or changing your eating habits.

• If you have high blood pressure, you should lower it, for example through increased physical activity, less salt in your food, medication and other measures. Kidney patients should aim to have a blood pressure of 130/80 or lower.

Some medication for reducing blood pressure (ACE inhibitors and ARB) also have an effect on the amount of albumin in urine, and as such has a dual effect in that it particularly protects the kidneys.

• If you are severely overweight, you should try to lose weight. You should be aiming for a BMI of 20-25. More about this in section 23 below.

  • It´s recommend that men should maintain a maximum waistline of 94 cm and women of 80 cm. Men with a waistline larger than 102 cm and women with a waistline larger than 88 cm have a significantly higher risk of disease.
  • If you are a smoker you should do everything you can to stop smoking. It’s never too late to quit. This is the one change in a person’s life that has by far the largest and most positive impact on their health.
  • Regular physical activity has a host of positive, preventive effects on your blood pressure, weight, skeleton, well-being and other factors.

 

You are the key

You are the key to most of what has been covered above: from taking the initiative to go for regular health tests (even though you feel perfectly well), to getting into the good habit of doing physical exercise.

The results of your tests will equip your doctor with the necessary knowledge to assess the risk you run of developing disease. Abnormal test results may also prompt your doctor to write you a prescription and/or recommend that you take positive action to improve your health by changing your eating habits and lifestyle. Your doctor may also ‘prescribe’ physical activity.

The rest is up to you. You will significantly improve your chances of maintaining the life span and function of your body and kidneys if you take good care of them.

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5. The kidneys’ decline

Natural ageing

In the vast majority of people the filtering ability and other functions of the kidneys decline with age. Half of all healthy 65-year-olds are likely to have lost a third of their kidney function, whereas one in four people over 70 is likely to have lost roughly half of their kidney function. But this does not have to mean that they actually have any symptoms of their reduced kidney function, or indeed any problems at all. In a way, decreasing kidney function may be seen as a ‘natural’ part of the ageing process – just as many other bodily functions also decline with age.

 

Enormous overcapacity

Normal healthy kidneys have a very large overcapacity. They can do much more than they actually need to. This means someone can lose half of their kidney function and still feel well. Most people can also safely donate one of their kidneys to someone in need; we can get along perfectly well with one healthy kidney.

But this can also be a drawback, as you can lose much of your kidney function without actually noticing. Quite simply, there is no sign that something is wrong. For this reason, kidney disease often goes undetected until someone has less than half or one-third of their kidney function left.

 

Chronic kidney disease

Chronic kidney disease means that due to disease, the kidneys gradually lose their ability to perform their normal tasks. The kidney function becomes more and more reduced, and this process often takes a long time, several or many years.

Chronic kidney disease is not that uncommon a condition. Between 5 and 10% of the Swedish population (approximately 1 million Swedes) have some degree of reduced kidney function. And most of them are completely unaware of it. There are, however, a relatively small number – a few hundred people in Sweden each year – whose kidney function fails altogether.

 

Living with chronic kidney disease

Therefore, the great majority of people can live with reduced kidney function for a long time, partly due to the large reserve capacity of the kidneys and partly because often the disease progresses so slowly. But the problem is that even with moderately reduced kidney function the risk of developing cardiovascular disease is more than 10 times higher than for people with normal kidney function. And this is, if possible, even more severe.

 

The most common causes of reduced kidney function

In the long term, diabetes may cause a variety of complications, including chronic kidney disease due to damage in the blood vessels in the kidneys. This complication can occur both in people who developed diabetes in their youth (type 1) and those who develop it in later years (type 2). One in three people with chronic kidney disease also has diabetes.

Chronic kidney inflammation (glomerulonephritis) exists in a number of different types with different prognoses and different courses. More often than not the cause of the inflammation is unknown, but it means that the kidney tissue gradually loses its normal function. Approximately one quarter of all kidney patients is affected by glomerulonephritis. There are also kidney inflammations that are part of a general inflammatory disease.

In the long term, high blood pressure may damage the blood vessels in the kidneys and cause chronic kidney disease, which in turn almost always leads to high blood pressure.

Polycystic kidney disease is a genetic condition characterised by the presence of fluid-filled sacs (cysts) in the kidneys. The disease has a slow progression, with kidney disease symptoms usually occurring in middle age. With cystic disease the kidneys become enlarged (polycystic kidney disease), while with the other kidney diseases they can decrease in size (renal cirrhosis).

Pyelonephritis is often caused by repeated urinary tract infections in people who have had problems passing urine through the ureters in their childhood, due to bacterial invasion in the kidney tissue and the resultant damage.

Malformations, vascular diseases in the kidneys and other conditions can also lead to chronic kidney disease. There is no guarantee that your doctor will know exactly what has caused your kidney condition. This could be due to the late onset of symptoms and therefore the late detection of your kidney disease, as the fundamental disease may have started several or even many years ago. However, it may also be due to a combination of different factors.

But whatever the cause or causes of your kidney disease, the fact remains that you must now live with your condition and make the best of the situation.

 

Determining kidney function

Blood and urine tests can determine how well or poorly your kidneys are functioning.

A blood test can reveal, among other things, how much of the waste product creatinine there is in your blood. Creatinine is a waste product generated from muscle energy metabolism, and it is usually secreted through the urine. If your kidney function is reduced, creatinine is not filtered out of your body as it should be but remains in the blood. The level of creatinine in your blood rises.

So the concentration of creatinine in the blood depends on how much is secreted through the kidneys. However, the concentration also increases with larger muscle mass, the more protein you eat and with age. If your kidneys are healthy, the normal levels of creatinine range between 60 and 105 (millimoles per litre).

Cystatin C is another substance that can be found in your blood. Its concentration in the blood is an excellent measure of your kidney function, regardless of your muscle mass.

Urea is formed as a breakdown product of protein metabolism. The amount of urea in your blood reflects the build-up of waste products; it basically shows how contaminated your blood is. The amount of urea also gives an indication of the correlation between your protein intake and protein breakdown. Urea levels in the blood, however, can also rise or fall for many reasons other than reduced kidney function.

Another way of measuring your kidneys’ filtration ability is a special urine test, whereby you collect all your urine over a 24-hour period. This test gives us a measure of your kidneys’ filtration ability, called creatinine clearance.

Injecting a radio contrast agent (Iohexol) into your blood and then studying its rate of clearance from the body provides an even more accurate picture of kidney function (Iohexol clearance).

 

GFR or % of normal filtration

All of these methods can be used to calculate the filtration ability of your kidneys. The medical term is the glomerular filtration rate (GFR) and it is measured in millilitres per minute. In practice though, GFR is roughly the same as the percentage of your normal kidney function. And a percentage is of course easier for us amateurs to understand. So a GFR of 50% means that half the function has been lost. A GFR of 10% means not much function is left.

 

The different stages of chronic kidney disease

The symptoms of reduced kidney function

When the ability of the kidneys to filter blood becomes severely impaired, toxic substances build up in the blood and the person develops uraemia (urine poisoning). Other consequences are problems with the fluid and salt balances in the body. You may also build up an excess of some hormones but have a deficiency of others.

With a gradual decrease in kidney function, and consequently increasing uraemia, more and more signs or symptoms of kidney disease develop. These symptoms do not appear in all kidney patients – in some they may be more numerous and more severe, while in others they are less numerous and less severe. Many people may not notice the presence of any symptoms whatsoever until their kidney function becomes severely reduced, i.e. when they are left with less than 30% of full kidney function. The fact that you may not notice anything for a long time is a truly worrying aspect of chronic kidney disease.

Increased fatigue is probably the most common of all these symptoms. Other symptoms may appear at any time or not at all, and in no particular order.

But, as mentioned above, not all people will develop all the symptoms and any one of these symptoms could be caused by something else completely. Chronic kidney disease may only be detected when several of these symptoms appear in combination, and when you report them to your doctor.

Because chronic kidney disease may not be detected until quite a late stage, there is a possibility that the kidneys have already changed and shrunk. At this stage it is often difficult to determine the actual cause of the kidney disease, or the fundamental disease, and it could be too late to do anything about it.

The fact remains, however, that you have developed chronic kidney disease. The only thing you can do is try to make the best of a bad situation and focus on keeping the kidney function you have left. In fact that’s what the rest of this book will concentrate on.

 

Tests and analyses

As a person with chronic kidney disease, you will have to take regular blood and urine tests (at your health centre or at special sampling centres). The samples you provide will be analysed for all kinds of things at a laboratory. The results your doctor gets will consist of a long list of words, letters and figures that are quite incomprehensible to the lay person. But all these values mean something and will help your doctor evaluate your kidney function, your general state of health and the medication and treatment you require.

Feel free to ask your doctor for a copy of the lab report. You are entitled to a copy, as they are your tests and your test results. Then you can study your health figures in peace and quiet at home.

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6. What the tests show

Here are some brief explanations of what the different analyses are for and what the different results mean.

From the blood tests

Haemoglobin, Hb (blood count), is a protein found in red blood cells; it carries oxygen to all the body’s cells from the lungs. In chronic kidney disease the blood count drops, the number of red blood cells declines, because of insufficient production of the hormone EPO.

Transferrin saturation indicates the proportion of the iron-transporting protein transferrin, which binds iron.

EVF, haematocrit, the percentage of blood consisting of red blood cells.

Leukocytes, LPK. White blood cells are part of our immune defence system against infections. The proportion of white blood cells increases in infections and in intensive cortisone treatment.

Thrombocytes, TPK (platelets) are small blood cells that are very important for blood coagulation/clotting. In chronic kidney disease the function of the thrombocytes deteriorates, which causes an increased propensity to bleeding.

C-reactive protein (CRP) is a protein whose levels increase rapidly and significantly, especially during bacterial infections. Its levels increase moderately in viral infections, joint inflammations and surgical operations. In kidney care this test has replaced the old ‘erythrocyte sedimentation rate’ (ESR) test, in which the rate usually increases in kidney disease.

Ferritin is an iron-binding protein which is used as an indicator of the amount of iron in the body.

Potassium is an important substance needed by all body cells. Levels may increase in the blood in chronic kidney disease. Excess or deficient potassium levels can cause disorders in cardiac rhythm.

Creatinine is a muscle waste product. Levels rise in chronic kidney disease and it is routinely screened to assess kidney function. Muscular people have higher creatinine levels than thin, slender people.

Sodium is a substance which together with chloride makes up common salt. High levels of sodium may indicate dehydration, but sodium concentration is a poor indicator of the body’s total sodium content.

Albumin is an important protein. One of its functions is to keep the fluid in its place in the blood circulation. Albumin is formed in the liver and its levels are low during inflammations, liver diseases and malnutrition. In kidney diseases where large amounts of protein leak into the urine, albumin levels decline. When albumin levels are very low, there is an increased tendency to swelling or oedema in the body.

Carbon dioxide, total carbonic acid, is a test which indicates the acid-base balance in the blood. This balance is also regulated by the kidneys. In chronic kidney disease the blood may become acidified and the levels of bicarbonate or carbonic acid decrease.

Calcium is an important component in building the skeleton. In chronic kidney disease, calcium levels in the blood can either rise or fall. Vitamin D, which influences calcium balance, is activated in the kidneys, and this function is more or less eliminated in chronic kidney disease.

Phosphate. In conjunction with calcium, phosphate is instrumental in skeletal formation and also helps to regulate the acid-base balance in the body. In chronic kidney disease phosphate levels increase.

Parathyroid hormone, PTH, regulates the calcium balance in the body. If the PTH level is too high, calcium is released from the skeleton, triggering osteoporosis (literally ‘porous bones’), and the calcium level in the blood increases. In chronic kidney disease the PTH level is always affected by disorders in the calcium balance.

Cholesterol – Blood lipids. The overall cholesterol level is often normal or low in chronic kidney disease, and is not directly related to the risk of cardiovascular disease the way it is in people with healthy kidneys.

LDL-cholesterol is the ‘bad’ cholesterol. Levels do not necessarily increase in chronic kidney disease.

HDL-cholesterol is the ‘good’ cholesterol. In chronic kidney disease the HDL level is often low.

Urea is a waste and breakdown product of protein in the body and food. Levels increase in chronic kidney disease, but they decrease with lower protein intake.

GFR and creatinine clearance rates are measures of kidney function (filtration ability), which, in effect, may be considered roughly the same as the percentage of normal function.

Alanine aminotransferase (ALAT) is a substance secreted by the liver. Levels can increase sharply in acute liver diseases. A slight increase may be observed in, for example, obesity, heart failure, hepatitis and infections or, occasionally, as a side effect of medication.

Glucose, blood sugar, is raised in diabetes.

Glycosylated haemoglobin (HbA1c) indicates the amount of glucose bound to haemoglobin. Used as a measure of the blood sugar adjustment over the past few weeks.

From the urine tests

tU-Urea. Urea secretion is an indirect measure of how much protein you eat.

u-dipstick. Urine dipsticks can show, for example, if there is albumin, haemoglobin, leukocytes and/or glucose in the urine. There are also dipsticks which show if there is bacteria in the urine.

Leukocytes, white blood cells in the urine which may be elevated in urinary tract infections.

Erythrocytes are red blood cells in the urine which may be common in urinary tract infections.

Albumin/protein. Protein secretion in the urine.

Your own reports

Why not collect copies of your test results? They will help you see that the results of your efforts are nurturing your kidney function.

The less creatinine goes up and the less GFR goes down, the better the treatment is working. The urea value is affected by how much protein you eat.

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7. Collaboration for self care – your personal responsibility

Remember: it’s your kidneys, your body and your life that are at stake here.

You are the main person responsible for your body, as it is your body. Health problems are, therefore, also primarily your problem. It is chiefly in your own interest to remedy the problem in some way. And it is mainly you who will benefit from successful treatment.

So what about healthcare…?

Well, when something breaks down or stops working properly, we turn to someone who can fix the problem.

When a person ‘breaks down’ or falls ill, we do the same. We turn to the healthcare system and expect to get the treatment and drugs that will make us healthy again. For many diseases this is exactly what happens.

But when it comes to chronic diseases, and certainly when it comes to chronic kidney disease, it’s a little different. You can’t simply expect your doctor or the healthcare system alone to be able to solve the problem for you, and slow or stop your kidney disease. They can’t do that.

Chronic diseases do not go away, you have to live with them every day and night for the rest of your life. This also means that the required treatment continues all the time, 365 days a year. This is why treatment to slow your kidney disease can, in purely practical terms, only be carried out by you – with the support of your nearest and dearest.

There are 8760 hours in a year.

You may get 10 hours of professional care at the clinic

Then there are 8755 hours of self-care left for you

Three equally important parts

You will discuss and agree on the exact treatment you need with your doctor. Generally speaking, the ‘slowing’ treatment comprises three important parts which are often combined to achieve the best results:

1. Medication: When the kidneys no longer work as they should, different medicines can be used to replace or compensate for the lost function.

For example, if your kidneys are no longer able to regulate your blood pressure, your blood pressure will rise and this can be countered by taking a blood-pressure-lowering medication.

If your kidneys are unable to produce urine as they should, your body retains water and this can be countered by taking a diuretic.

2. A special diet: You may be recommended to follow a special diet to alleviate troublesome symptoms, such as nausea and loss of appetite, and to reduce the burden on your kidneys. The diet will contain less protein and more energy than normal.

To follow this kind of special diet, you and your family members will have to learn a great deal. You can begin by reading about what food actually contains and about the special diet for people with chronic kidney disease in sections 19 and 20 below. You will also receive good guidance from a dietitian.

3. A healthy life. The most serious risk with chronic kidney disease is cardiovascular disease. To reduce this risk, you need to lead a healthy lifestyle and focus on your health. Daily physical activity strengthens the heart, muscles and bones. Not smoking is good in all kinds of ways. Smoking lessens your chances of slowing your kidney disease. More examples are given later on.

The treatment for many of the problems caused by chronic kidney disease is a combination of measures in the three areas. For example, elevated blood pressure can be countered:

  1. Through medication.
  2. By reducing the amount of salt you eat.
  3. Through regular physical activity.

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Different perspectives

Different people view things differently. This is true of men and women, children and parents, the elderly and the young, employers and employees, patients and doctors, and so on. People see things from different perspectives, just like the man and woman in the picture, yet they are looking at exactly the same thing.

The point is that both of them are right. Neither of them is wrong. The figure on the table actually looks very different depending on which direction you look at it from. This is exactly how things are when people meet as well, they see and think about things differently.

Seeing, listening, discussing and accepting the other person’s perspective often enables us to understand the other person’s argument, find a consensus and agree.

When we use healthcare services as patients, obviously our perspective is different. The doctor is a professional, we are amateurs. They are care givers, we are care receivers. They’re in their element, we’re in unfamiliar territory – in more ways than one. They’re confident in their professional roles, we are anxious and vulnerable – and ill.

However, despite the different starting points you and your doctor should talk together and agree on what needs to be done.

Different starting points – the same goal

You doctor has a good knowledge of the kidneys and a lot of experience. You have good knowledge too – about yourself. After all, you have lifelong experience of exactly how you and your body work.

The doctor has a lot to say, but so do you, particularly when it comes to your own body and the treatment you need. Ideally your doctor and you can meet with mutual respect for each other’s different areas of expertise and ability to understand and make decisions.

Your doctor has examined you, analysed your test results and arrived at the treatment he/she thinks you need to slow your kidney disease. As it is you who will be responsible for carrying out most of the day-to-day treatment, you have to discuss together what has to be done and who does what.

You are fully entitled – also legally under Swedish law – to say yes or no to all or parts of the suggested treatment. One fundamental requirement for the treatment to have the best possible effect is that you yourself are convinced that it is the right treatment for you. You are undergoing the treatment solely for your sake, not because the doctor says it is what you need. So, it is best if you and your doctor are completely open and honest with each other.

When you have finished talking, you can agree on a plan for what has to be done. Your doctor will do exactly what he/she is best at, and you will do everything that only you can do. You will work together, as partners, and you have exactly the same goal – the best possible health for you.

Treating yourself

Once you have left the clinic, no doctor will come home with you to give good advice, no nurse will be there to check if you are taking your medicine properly, no dietitian will be preparing your food for your special diet, and no physiotherapist will be there to go on brisk walks with you. It’s you, and you alone, who can do all this. In other words, you are not only the patient, you’re also the healthcare provider – for yourself.

The help and support you need to carry out your day-to-day treatment can be found among your immediate family, the person or people you live with. Your family may have more energy than you and, therefore, find it easier to take in information and provide the support you need. Moreover, no doubt they are equally interested in ensuring you feel as well as possible.

Training in slowing your disease

As your own healthcare provider you do, of course, need training. No one wants to be treated by someone without the proper training – and you will be the one providing your own healthcare. Having information is important, but far from enough. In order to do the right thing and do them the right way, you must both know and understand why the different parts of the treatment are important.

Some people do not wish to or need to know that much to still carry out the treatment in the right way. For example, you don’t have to know exactly how a car works technically to be able to drive well and safely. And you don’t need to know exactly how a medicine works either, as long as you take it.

Other people want to know everything and all the details to feel peace of mind. How much you want to learn is up to you. The only important thing is that you are completely convinced that the treatment you are undergoing increases your chances of getting where you want to be.

The vast majority of general facts you need are in this handbook. You and your immediate family can read the different parts and then talk about what you will do in purely practical terms. For example, ways of reminding you exactly which medicine you need to take and when. With a special diet for you, you also need to talk about and plan meals so they suit everyone.

Discuss to understand

It is very helpful to meet and speak with others in the same situation. Many clinics for people with kidney conditions therefore arrange such discussion sessions for small groups of kidney patients and their close friends and family. The discussions are led and co-ordinated by staff. Participants share their knowledge and experiences. The subjects discussed are the very issues and thoughts raised by the participants themselves. The group discussions teach you more and, above all, help you understand more. You can get good tips from others about how to carry out your care in practical terms. After all, they are in exactly the same situation as you.

Also, why not take the time to find out if there is an association for kidney patients where you live? This provides another opportunity to meet and speak with other people in the same boat. Other patients and their families and friends tend not to mince their words; they will always tell you exactly how things are.

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8. Medications– for YOUR best interests

Various types of medicine will be a vital part of your day-to-day life for a long time to come; that is a certainty. All medicines are designed to alleviate your specific troubles and combat your particular disease. The best you can do for yourself is therefore to take exactly the medicines your kidney doctor has chosen for you and your situation. So, trust your doctor and take your medicine, just as the doctor prescribes!

 

Medicines a challenge

Taking your medicine can be tedious, it’s certainly not the highlight of anyone’s day. When you feel ill and unwell and take your medicines for chronic kidney disease, you don’t feel any immediate effect. And the days you feel relatively well and upbeat, all the tablets are like an unwanted reminder that you’re actually quite ill. Which is no fun at all.

For many people it is therefore hard to summon up any kind of joy or enthusiasm about taking their tablets. They know inside that the medicines are essentially good, but that doesn’t mean they like having to take them. Yet they still understand that they must – just for their own sake, not for anyone else’s. It may also be that people take their tablets to avoid the horrors that might be experienced sooner or later if they don’t take them.

Whatever your feelings about your medicines, they are an important part of the treatment you are giving yourself. And you must therefore find a way of making your medicine a natural part of your normal daily routine, so natural and obvious that you barely even think about it.

The responsibility you have to yourself is to take your medicine every day, and exactly how you should, even without positive motivation. This is your challenge.

 

Routines for taking medicine

How many tablets you need to take is written clearly on the container or packaging. It may also say at what time of day the medicine should be taken, and whether or not it should be taken with a meal. It is essential to follow these instructions. They are not issued by chance, they are specially written for you.

If and when you have several different medicines, you must find a way of ensuring you take exactly the right number of tablets. How you go about it isn’t important, it’s up to you. Some people like to get out all the packs and pick out exactly the right number of tablets each time. Others buy some kind of dose-dispensing device available from pharmacies. They can be used to prepare a whole week’s doses of tablets all at once, which then makes it easier for you on each particular day. It’s also a good way of checking that you don’t miss a dose.

Kidney patients often have ever such a lot of tablets to take. Some swallow them all in one go. Others take them one at a time, smallest first, most difficult last. In fact there are probably as many ways of taking medications as there are patients. Obviously you should do what feels best for you.

Some people always take the medicine with a gulp of water. This makes it easier to swallow them, and stops tablets from getting stuck in the roof of your mouth (and tasting bad). Others find it far easier to take the tablets with something thicker in texture, such as a drinking yoghurt, soup or porridge. Again, do what you want, as long as you take them.

Without a doubt, it is far easier to establish a routine for taking medicine by linking it to something else, something you always do, regularly – for example, by linking it to mealtimes or brushing your teeth in the mornings. Combining medication with something else makes it easier to remember – and harder to forget.

 

No medicine – no effect

If you don’t take the medicine, you won’t feel any effect – this goes without saying. You are doing yourself a disservice.

Certainly, different medicines have different levels of importance. With some medicines it might not be that important if you skip the odd one. But with others, taking them exactly as prescribed could be a matter of life or death. As patients, however, we don’t know which are which, so the basic rule applies: take all your medicines as though each were a matter of life or death.

If you have missed a dose of one of your medicines, it will show up in your tests. Then your doctor will say you need to take more of that medicine, i.e. increase the dose each day, but that would be wrong. Stop this happening by being honest with your doctor and telling him or her what’s happened, and what medicines you’ve skipped.

 

Paper or digital prescriptions

In the past prescriptions were always in paper format, and you had to take them to the pharmacy. Nowadays, in Sweden, prescriptions are sent direct from the doctor’s computer to the pharmacy’s computer system.

You used to keep the paper prescription and take it to the pharmacy when you needed more medicine. The prescription also stated how many times it could be used, and an expiry date for the prescription. You can now ask the pharmacy to print out a paper copy with the equivalent information about all the medicines you have been prescribed. All you prescriptions from all the doctors you have seen are stored in the pharmacy’s computer system.

 

Different types of medicine

Picking up your medicine from the pharmacy can be a bit daunting. This is because of the system in place to save national and local government costs for medicines, i.e. saving taxpayers’ money.

Developing a new medicine requires a lot of research, many tests over a long period of time (many years) and massive financial resources. When the medicine is ready and approved, the company therefore has the sole right to manufacture it for a certain period in order to recoup its investment. At the end of this period, any company whatsoever can produce copies of the original. These copies are called generic medicines. Obviously they are far cheaper. So this is why there are copies of original products.

Your doctor may have written one name of medicine on your prescription, there could be another name in the pharmacy booklet and a third name on the medicine you receive from the pharmacy. They say that all are equally good, the only difference is that the medicine you receive is the cheapest (on that day or month).

When this happens, you will be asked at the pharmacy if you would like the (cheaper) alternative, or if you would like to have the medicine your doctor has named on the prescription and pay the difference yourself. It you assume that both medicines are equally good, it is easy to choose the cheaper option. However, you can always ask what the difference in price is. It could be anything from one krona upwards, and sometimes there is quite a vast difference. If the difference seems reasonable, you may prefer to choose the make chosen by your doctor. The choice is yours.

 

List your medicines

You must keep an eye on exactly which medicines you have and take. Your renal specialist will not know exactly which medicines you have been prescribed by other doctors, or exactly which ones you actually take. The pharmacy only knows which prescriptions you have been given and have now, but it has no idea if your doctor has changed your dose or said you no longer need to take a particular medicine. Only you, and you alone, know for certain.

Every time you visit your renal specialist, you should take with you a list of the medicines you have. If there are any changes you should ask for an updated list of the medicines you have to take, to replace the old list. You should add any medicines you have been prescribed by another doctor so the list is always complete and up to date. You should also take the complete list when you visit another doctor.

 

Important points

  • Always take your medicines in the right doses and at the times stated on the container or packaging. Don’t skip doses.
  • Never change the amount of medicine you take without consulting your doctor.
  • If you have any problems that could be linked to your medicines, consult your doctor.
  • Never take any over-the-counter drugs or natural remedies without consulting your doctor.
  • Store your medicines in a cool, dry place out of reach of children.
  • Never give your medicine to anyone else.
  • Any medicines you no longer take or which pass the expiry date should be taken to the pharmacy. Do not throw them away with normal rubbish as the remnants of the medicine will end up in the water courses.

With a firm handshake, you and your doctor agree on the treatment and who will do what. Then, JUST TAKE THE MEDICINE, exactly as the doctor says and prescribes!

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9. Planning and training

The slowing treatment is based on preserving the capacity your kidneys do have – as much as possible for as long as sensible. It’s a question of ‘save what can be saved’. This is how planning and treatment may proceed.

 

The goals are:

  • To prevent the onset or alleviate the symptoms of chronic kidney disease so that you feel better, eat better and have more energy.
  • To prevent the onset or alleviate complicating illnesses, such as cardiovascular disease.
  • To slow or ideally stop the deterioration of your kidney function, thereby gaining valuable time.

 

Doctor’s analysis

The results of all your examinations and tests are analysed by your doctor. Some measures may be more important than others and may, therefore, need to be prioritised – such as measures to lower high blood pressure. Other measures may come later.

The doctor’s analysis usually results in a list of different medicines for different purposes, recommended changes in eating habits, and recommendations to quit smoking and be more physically active, for example.

 

Discuss and agree

The specific treatment you need may be relatively simple or more complicated. The treatment plan drawn up by your doctor must be properly explained to you so that you understand why the various measures need to be taken. If you do not understand, keep asking until you do understand.

Ideally, see the doctor with a close friend or family member. Four ears hear better and more than two. It may also be that your companion, who does not have chronic kidney disease, finds it easier to take in more information than you. Furthermore, chronic kidney disease is an illness that affects the entire household, so it is more than fair that he/she also hears the information straight from the doctor’s mouth.

When you have finished talking, you can mutually agree on a plan for treatment, what will happen and who does what. The result will be a treatment plan specifically tailored to you.

 

Training

The next step is for you and your companion to have proper training in the art of caring for your kidney function and yourself. The details of the training will depend on the procedures at the clinic where you are a patient. It is important that both you and your companion go to the training – just as important as taking your medicines. Miss the training and you’ll reduce the chances of success.

 

Advice from a dietitian

If your treatment includes changing your eating habits, you and your companion will be asked to see a dietitian. What you eat plays a very important role in your chances of feeling better and could help slow your kidney disease. Your diet is an important part of your treatment. The dietitian will give you and your companion detailed advice about what should be included in your diet – and also what should be excluded.

 

Advice from a physiotherapist

If part of your treatment plan is to get more exercise, be more physically active, you may be asked to meet a physiotherapist who will help you draw up an exercise programme.

 

Advice from a welfare officer

A welfare officer can help you with emotional issues and with queries about health insurance, for example.

 

Care at home is your responsibility

Your treatment plan has been agreed and you have been given training. Now it is your task and responsibility to follow the plan as well as you possibly can. Your close friends and family have good reason to help you – and you have good reason to accept this help.

 

Follow-up visits

The kidney clinic will continue to provide the support, advice and encouragement you need. At many clinics, patients regularly see a specialist nurse between their follow-up appointments with the doctor. The aim of these appointments is to talk about how things are going, to get answers to your questions and any other support you may need. No doubt you will be given information about what happens at your particular clinic. You will also have new tests regularly and then meet your doctor.

 

You’re the boss – and you have good advisors

You are ‘the boss’, you’re the one in charge of your own body, and it’s you who ultimately makes the decisions. But in order to make wise decisions, you need good advisors. Your doctor has a lot of knowledge that you don’t have, and is, therefore, your most important medical advisor. Your nurse, dietitian and physiotherapist are also your professional advisors. All these professionals will do their utmost to help and support you in your self-care. The best chance of success comes from working together.

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10. High and low blood pressure

Having your blood pressure taken is one of the most common procedures when you go to see your doctor or nurse. Many people also buy their own blood pressure machine and take their blood pressure themselves. This is both simple and practical, and enables you to check your blood pressure as often as you like.

 

So what exactly is blood pressure?

Blood pressure is quite simply the pressure in the blood vessels, much like the pressure in a bike or car tyre. Like atmospheric pressure, blood pressure is measured in millimetres of mercury (mmHg). In fact there are two values that are measured with a blood pressure gauge:

  • The systolic pressure is the pressure when the heart contracts and pushes the blood out into the blood vessels. Normal systolic values range from 120 to 130 mmHg.
  • The diastolic pressure is the pressure between heart beats – the heart works like a pump. Normal diastolic values range from 80 to 85 mmHg. So a normal blood pressure may for example be 120/80, or ‘one twenty over eighty’. The following terms are used to denote high blood pressure, also known as hypertension:
  • Mild hypertension – when the pressure exceeds 140/90
  • Moderate hypertension – when the pressure exceeds 160/100
  • Severe hypertension– when the pressure exceeds 180/110

Roughly one in five adults has high blood pressure. The percentage of people with high blood pressure increases with age – the older you are, the higher the pressure. So high blood pressure is a common complaint.

On the whole, there is no single specific cause of high blood pressure. It can depend on a number of factors, often in combination. It could be hereditary, it may depend on eating habits, physical inactivity, excess body weight or stress. In kidney conditions, however, blood pressure is almost always higher.

 

Make friends with your blood pressure

You can easily measure your blood pressure yourself using the simple blood pressure machines on the market today. They run on standard batteries, and the only thing you have to do is wrap the cuff around your upper arm and press the button. The cuff pumps up and deflates again, completely automatically. The gauge shows both blood pressure and pulse. Blood pressure gauges can be bought from pharmacies and other stores, by mail order and online.

Your blood pressure varies a lot depending on what you are doing. There is a big difference between blood pressure when you’re up and physically active compared to when you are lying down. And that’s completely natural, that’s the way it should be. You also have higher blood pressure when you feel stressed than when you’re at home relaxing in your favourite armchair.

To be able to compare your blood pressure from one time to the next, you must therefore do roughly the same things each time. Sit down for a while, say 10 minutes or so. Take it easy, breathe deeply, try to relax and then measure your blood pressure, preferably several times. You can then compare the pressure with the readings from yesterday and last week. The blood pressure machines save previous results in the memory.

Take your blood pressure as many times as you like and in different situations – standing, sitting, lying, however you like. This will show you how much your blood pressure can change. And you’ll see how much you can lower your blood pressure by, for example, relaxing by breathing slowly and deeply.

Your family and friends may also want to measure their blood pressure. Everyone should do so from time to time. Read later on in the book about what you can do yourself if your blood pressure starts getting a bit high.

 

High blood pressure is not good

High blood pressure is bad for you because it significantly increases the risk of many different diseases, including cardiovascular diseases. Your blood vessels may become thicker and your heart and eyes may also be adversely affected. The higher your blood pressure over an extended period of time, the greater your risk of getting heart disease or having a stroke.

 

High blood pressure and kidneys

High blood pressure is bad enough in its own right, but high blood pressure with chronic kidney disease is worse. The reason is that high blood pressure itself can cause chronic kidney disease; it is one of the causes of the condition. But it works the other way round too. Sooner or later chronic kidney disease leads to elevated blood pressure, partly because the kidneys’ role in controlling blood pressure becomes impaired. So in other words: high blood pressure and chronic kidney disease compound each other in a very adverse way.

It is important for everyone to try to achieve and maintain as normal a blood pressure as possible. It’s even more important for kidney patients. Chronic kidney disease itself triggers elevated blood pressure, and this in turn increases the risk of lowering the kidney function and generating attendant cardiovascular diseases.

Therefore, for most patients keeping blood pressure down is the most important sub-goal in slowing kidney disease.

Certain special hypertension drugs have proved particularly valuable in controlling kidney disease. They are medications of the ACE inhibitor and ARB type, which lower blood pressure and protein excretion in urine and thereby protect kidney function from deteriorating. The lower the blood pressure, the lower the protein excretion, the slower the deterioration. And vice versa: the higher the blood pressure, the faster kidney function deteriorates.

 

Your ‘ideal’ blood pressure

A ‘normal’ blood pressure is the best possible scenario. The next best is an ‘ideal’ blood pressure, i.e. as low as possible.

One target that people with chronic kidney disease should aim to achieve is a blood pressure of 140/90 or lower. Even if this cannot always be achieved, the same basic rule applies: the lower your blood pressure, the better the protective effect.

 

Keep your pressure down

So what can you do to try and keep your blood pressure at a low and comfortable level, bearing in mind it’s harder for kidney patients? Or perhaps you even need to lower your blood pressure because it’s already too high.

Because you are probably unaware exactly what caused your hypertension – apart from your chronic kidney disease of course – you may need to try out various solutions, including some or all of the following:

  • It is very important that you take the hypertension medication prescribed by your doctor and strictly follow the doctor’s dosage instructions. You may be prescribed one, two or more hypertension drugs that have different effects, jointly intended to bring down your high blood pressure.
  • Make sure you take regular physical activity, preferably every day, as this can lower your blood pressure by up to 10-20 mmHg.
  • If you are severely overweight, you should try to lose weight. Excess body weight usually increases blood pressure, whereas weight loss can lower it.
  • Stop smoking and/or using moist snuff. Nicotine constricts your capillaries – so when you smoke your skin may for example become cold and white (especially when you inhale deeply) – thereby raising your blood pressure. Stop smoking and your blood pressure will go down.
  • Eat less salt, stop eating salty sweets and other salty snacks, stop adding extra salt to your food, and prepare your own meals using as little salt as possible. Salt makes you accumulate water which increases your blood pressure. You will soon get used to the taste of food with less salt and you will feel better.
  • Don’t drink too many fluids. The more you drink, the higher your blood pressure becomes. Reduce your salt intake and you will be less thirsty.
  • Reduce your stress levels, do more of the things you enjoy and less of the things you dislike doing. Needless to say, stress increases blood pressure.
  • Learn different relaxation techniques and take some time every day to relax properly. Breathing deeply and releasing the air slowly is one way of learning to relax.
  • Sleep well and for long enough at night.

As you can see, there are a wide variety of things you can do to help yourself lower your blood pressure. The more of these methods you use, the greater your chances of success.

Once again, remember: the lower your blood pressure, the more effectively you slow down the progress of your kidney disease.

 

Physical activity for lower pressure

Physical activity can both prevent the onset of high blood pressure and reduce blood pressure if and when it does become too high. Therefore, the following are recommend:

• Fitness training, 3-7 days a week, 30-60 minutes per session and ‘moderate exertion’ such as a brisk walk. If you are unused to physical training, you should make a careful start and then, as your fitness levels improve, increase the level of exertion and try out some of the following activities: pole walking, jogging, table tennis, cross-country skiing, badminton, football, cycling, tennis and other similar activities.

When training to lower your blood pressure, a good guiding principle is that your exercise should not be such a strain that you can no longer chat to a friend at the same time. So the key is a good ‘chatting speed’. Exercising with a friend, or even another person with chronic kidney disease, is a good way of combining ‘business’ with pleasure. If you also step up the level of exertion once a week or so until you’re sweaty and slightly out of breath, this will increase the effect of your training.

 

Everyday training

If you think some of the above activities are too ‘sporty’ or lively, you can achieve the same or similar beneficial effects by doing many everyday activities. For instance cleaning the house, mowing the lawn (with a hand mower!), doing the gardening, chopping wood, decorating, playing tag and other games with your children or grandchildren, doing traditional dances like the jive and tango, getting yourself a dog that needs plenty of exercise, raking leaves, walking or cycling rather than driving or taking the bus, picking mushrooms and berries in the woods, taking the stairs instead of the lift, walking to a shop that’s a bit further away than you’re used to, cleaning windows… the list is almost endless. Your imagination is the only limit when it comes to ways of taking healthy physical exercise.

You could also get a basic pedometer, or step counter. Around 10,000 steps a day is considered a ‘good’ dose of physical activity. You may not be able to do 10,000 steps a day at first, but as you increase the number of steps your fitness levels will rise and you will be able to manage more and more.

Moreover, it has been proven that sitting down is more harmful to health than previously thought. So never sit down for hours and hours, get up and get moving!

 

Low pressure can cause trouble too

The most common cause of low blood pressure, or hypotension, in the elderly is heart failure. Blood pressure can sometimes become too low because of fluid loss and intensive treatment with diuretics (or ‘water tablets’), and with drugs that reduce blood pressure.

If your blood pressure is too low, you may feel dizzy or nauseous when you stand up after sitting or lying down. If so, your doctor can advise you and prescribe the drugs you need.

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11. Diabetes and chronic kidney disease

One of the complications of protracted diabetes is chronic kidney disease. Roughly one in three of all people with diabetes also experiences chronic kidney disease. Roughly one-third of all kidney patients also has diabetes.

Furthermore, the prevalence of diabetes is increasing around the world. This is why the proportion of diabetics is also increasing among people with chronic kidney disease. In other words, one good way of avoiding chronic kidney disease is to do everything you can to avoid diabetes.

 

Why diabetics may develop chronic kidney disease

There are several important factors that determine whether or not a diabetic develops chronic kidney disease. Here are some of the main ones:

  • Elevated blood sugar damages the blood vessels in the kidneys and causes protein (albumin) to leak into the urine. Elevated blood sugar also means the kidneys have to work harder, and it is this excessive function that in the long run leads to increased wear on the kidneys. For this reason, it is very important to keep an eye on your blood sugar levels: the lower your HbA1c value, the better.
  • High blood pressure is a contributing factor to diabetics developing chronic kidney disease. Good control over blood pressure is therefore even more important for diabetics. All diabetics should have a blood pressure of 130/80, or preferably lower.
  • High cholesterol levels in the blood entail an elevated risk of atherosclerosis (hardening of the arteries). This is why you need to control your cholesterol carefully if you are diabetic and have signs of chronic kidney disease. High cholesterol levels should be lowered in order to prevent heart disease.
  • Smoking among diabetics increases the risk of developing kidney disease. High tobacco consumption may also cause your kidney function to deteriorate more rapidly.
  • Hereditary factors may also be involved if diabetes or high blood pressure run in your family.

 

Kidneys damaged by diabetes don’t heal

Once the kidneys have been damaged as a result of diabetes or diabetic complication, the deterioration of kidney function becomes permanent. This underlines the importance of detecting the first signs, i.e. albuminuria, as early as possible and taking immediate action.

 

Prevent diabetes = prevent chronic kidney disease

Ideally try to prevent diabetes any way you can – because that way you will also avoid diabetic chronic kidney disease and reduce the risk of cardiovascular disease. Therefore, when you go for a check-up or medical examination with your doctor you should always have a blood sugar test in order to detect the precursors to diabetes, or early diabetes, as early as possible.

If an increased risk of diabetes is detected early on, preventive and treatment measures might include changes to the diet, increased physical activity, weight loss, improved blood lipid values and quitting smoking.

 

Early intervention

When early kidney damage is detected due to protein/albumin leaking into the urine, your priority should be to lower your blood sugar level and check your blood pressure, and lower it if necessary. It may even be appropriate to start a course of treatment involving particularly kidney-protecting blood pressure reducers, even if your blood pressure is not (yet) elevated. This is done to reduce albumin leakage.

In Sweden, all diabetes patients are obliged to undergo regular tests for albuminuria at least once a year. If the values are elevated, the test is retaken several times because the values may vary over time. The less albumin in the urine, the better the effect of the treatment.

In short, keeping a close eye on your blood sugar – and blood pressure – reduces the risk of developing kidney failure.

 

Diet and healthy eating for diabetics

What diabetics can and should eat can be a complicated, even problematic, business. The diets prescribed for diabetics and kidney patients are very different, almost completely opposite in fact.

On the one hand the diet should not cause blood sugar to increase too much after a meal, which means the food should not contain too many carbohydrates.

On the other hand, if you also have a kidney condition you may be advised to eat a low-protein, high-energy diet to alleviate your symptoms of chronic kidney disease, i.e. a diet containing less protein but more carbohydrates and fat.

Clearly these two dietary recommendations are contradictory, and they may lead to conflict and, necessarily, compromise. For this reason it is essential as a diabetic that you not only learn as much as possible about the contents of your diet, but also that you consult a dietitian to put together a more detailed diet that can best help slow your kidney disease.

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12. Calcium and phosphate in balance

With progressive kidney disease, the kidneys’ ability to eliminate phosphate is reduced. As a result, the amount of phosphate in the blood (phosphate value) rises, while the calcium level falls.

Vitamin D is usually activated in the kidneys, but if your kidney function is reduced their ability to activate vitamin D decreases. High phosphate, low calcium and low levels of vitamin D trigger the parathyroid glands to produce larger amounts of parathyroid hormone (PTH). Initially, the raised levels of PTH offset the disproportion in the calcium-phosphate balance and help keep levels normal. But some of the long-term effects may be blood vessel calcification and osteoporosis.

A diet containing less protein counters this development as it decreases the amount of phosphate in the blood.

Treatment may also include some other kind of phosphate-reduced diet, phosphate-binding medication and vitamin D.

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13. Anaemia

In the more advanced stages of chronic kidney disease, you may develop anaemia.

Your kidneys usually produce EPO (erythropoietin), the hormone that stimulates the formation of red blood cells. As the kidney function decreases, so does production of EPO. As a result, your total number of red blood cells decreases and you become anaemic. This means that the oxygen-transporting ability of the blood decreases, and this causes increasing fatigue and reduced physical performance.

Your blood’s concentration of haemoglobin, the substance that carries oxygen in red blood cells, is obtained from one of your blood samples. A normal Hb value for men is 130-160 and for women 120-150. If your haemoglobin level falls below 100-110 it may be because your kidneys are not producing enough EPO, in which case your doctor may recommend an EPO supplement. You will usually be asked to administer the EPO yourself by a simple injection.

Anaemia can also be caused by an iron deficiency. In this case you will have to increase your iron intake in the form of tablets which you take yourself, or an injection administered by a nurse.

Optimal haemoglobin values in chronic kidney disease are slightly lower than when you have healthy kidneys, and are in the range of 100-120. This is why your haemoglobin levels are checked with every blood test, so you can start the appropriate treatment in good time if necessary.

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14. Fight acidosis

In advanced chronic kidney disease, your kidneys are no longer sufficiently capable of cleansing your blood and other bodily fluids of hydrogen ions and you risk developing acidosis. Acidosis affects the protein metabolism in your body, it may cause osteoporosis and contribute to a general deterioration in health.

Generally, a low-protein diet will improve the situation. Acidosis may also be effectively counteracted if you take sodium bicarbonate tablets which your doctor can prescribe.

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15. Salt and water

This has to do with the balance in your body between salt, i.e. common or table salt (sodium chloride), and water. Typically, patients with chronic kidney disease accumulate sodium. This sodium binds water in the body, which may lead to elevated blood pressure. As a result, they can also develop oedema i.e. swelling on the shins, for example. You can test the presence of oedema by pressing the skin on your shins with a finger: if this leaves a temporary indentation in the flesh, you have oedema. In more severe cases, the lungs may also be affected and you may develop heart failure.

For this reason people with chronic kidney disease should first of all limit their intake of salt. The fact is that we need only a very small amount of salt every day. Therefore add less, or preferably no salt at all to the food you eat. Processed and semi-processed foods often contain a lot of salt and are therefore not that good for kidney patients. Avoid salty dishes and snacks. Use a range of different herbs to season your food instead of salt (but make sure you avoid herb salt).

Naturally, adding less salt or no salt to your food will make your food taste ‘different’, but you’ll soon get used to it and learn to appreciate it, especially because by then you will know that salt really is bad for you.

Also keep an eye on your shins. If they swell slightly and you develop oedema, this could be caused by an imbalance in your salt/water ratio. Exercise, such as walking, may have a positive effect, but if nothing else helps your doctor may prescribe a diuretic.

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16. Potassium, the right amount

Potassium is a mineral found in the body’s cells and it is vital for nerve, heart and muscle function. Too little or too much potassium may cause complaints, such as heart disorders.

As potassium levels in kidney disease have a tendency to increase in people with chronic kidney disease, it is important that they are regularly checked and, if necessary, adjusted. Also, checking and curbing potential acidosis may be helpful in keeping your potassium at a normal level.

 

Avoid or reduce

If your potassium levels tend to increase and become excessive, the following general recommendations should help:

  • Avoid foods with a high potassium content (e.g. bananas, strawberries, dried fruit, avocado).
  • Juices, such as orange and tomato juice, are made of fruit and vegetable concentrates and are therefore rich in potassium. Avoid these and eat fresh fruit instead.
  • Boil peeled potatoes and other vegetables in plenty of water. Then get rid of the water, as it always contains a lot of potassium after boiling. Baked potatoes retain all their potassium, so don’t eat them.
  • Limit your intake of milk/soured milk/gruel to 200 ml a day. Dairy products contain a lot of potassium.
  • Tinned fruits contain very little potassium, so those are fine to eat plenty of.
  • Limit nuts, chocolate and crisps.
  • Eat less rye/granary bread.
  • Low-sodium salt substitutes such as (in Sweden) Seltin contain a lot of potassium, so avoid them completely.
  • If you have access to a computer and the Internet, you can check the potassium content in hundreds of foods on the Swedish National Food Administration website, www.slv.se.

 

If nothing else helps

If you have tried following these recommendations but your potassium levels remain high, a more detailed analysis of your eating habits may be required. Your doctor may also prescribe you a drug called resonium which binds potassium, thereby reducing its content in the blood. Resonium is a vanilla-flavoured powder which you dissolve in water (or some other liquid, depending on taste) before drinking.

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17. Good and bad fats

Elevated levels of blood lipids increase a person’s risk of developing cardiovascular diseases. This risk is far higher in all kidney patients. In other words, having a combination of high blood lipid levels and chronic kidney disease is particularly risky and detrimental to your health.

For this reason your blood is also screened for triglycerides, ‘good’ cholesterol HDL and the ‘bad’ cholesterol LDL. It is therefore particularly important for kidney patients to maintain good blood lipid values. You can try to do this by changing your eating habits and through medication. If you have difficulty with this, your doctor will probably recommend that you see a dietitian who will analyse your eating habits and recommend any necessary changes.

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18. Itching

Many kidney patients experience itching; the skin itches for no apparent reason. It can occur anywhere on the body and be a genuine torment for many. There is no doubt that the itching is linked to chronic kidney disease, but it is not known exactly what causes the itching.

A low-protein diet can help alleviate it. There are also a number of medicines that can help. Talk to your doctor or nurse for the best advice.

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19. Diet is an important part of the treatment

What we actually eat

What we eat? Well, food! Simple home cooking, sandwiches, hot-dogs, meatballs, potatoes and gravy, black pudding; perhaps something a bit more special at the weekend, barbecued food in the summer, crisps with beer or a Danish pastry with coffee in front of the TV. Just food, everyday food.

When we’re fit and healthy and eat a varied diet, we don’t generally pay much attention to what the food we eat actually contains. We eat what we like. We eat more or less what other members of our family eat, or what our colleagues at work eat. So what the food actually contains doesn’t feel that important.

But the minute we fall ill for whatever reason, we suddenly start paying far more attention to what we eat and drink. The types and quantities of food we eat and how often may provide a solution to the problem, and in many cases they make up an important part of the treatment.

This also applies to you as a person with chronic kidney disease, because the kidneys act as the body’s filtering machine. Everything we put in eventually has to come out again one way or another, some of it via our kidneys. It is therefore important that you, as a kidney patient, have an in-depth knowledge about what you eat and drink. This will help you to keep the symptoms of your kidney disease at bay and prevent, or at least alleviate, potential complications associated with your condition.

 

The stuff we’re made of

The human body consists of a multitude of different substances.

  • 55-60% of our body weight is water.
  • 17% is made up of proteins (in muscles and other tissues)
  • 14% is fat (women have a little more than men)
  • 1.5% is carbohydrates
  • 6% of our body weight consists of minerals (e.g. in the skeleton)

All these substances are also found in what we eat and drink.

 

Constant transformation

The human body is in a gradual yet constant process of transformation. Used cells are broken down and new ones formed. This goes on all the time without us even being aware of it. For example, we secrete water by breathing, sweating and urinating, which is why we need to replenish our water supplies.

Our muscles are constantly being rebuilt. If we don’t eat enough protein and energy, our muscles could diminish in volume and strength.

If we consume more energy than we burn off, our bodies will store the surplus, primarily in the form of fat. The reverse applies too. If we burn off more energy than we consume, our bodies use up our energy reserves and we lose weight.

Now let’s look at these nutrients a little more closely.

 

Protein

Proteins perform many important functions in the body. Muscles, tissue, blood and skin predominantly consist of protein. Many of the enzymes and hormones in the body are made up of protein. Protein is one of the body’s most important building blocks.

All proteins are made of long chains of amino acids. There are 20 different amino acids. Eight of them (ten for people with chronic kidney disease) cannot be produced by the body, so they have to be added in our diet. These are therefore called essential amino acids.

The protein containing the highest nutritional value (the highest content of essential amino acids) is found in fish, meat, eggs, milk and dairy produce. Leguminous plants contain lower amounts of protein and this protein is of lower nutritional value for humans. Still smaller amounts can be found in potatoes, rice, spaghetti, flour, bread, porridge and other foods.

This clearly shows that a proper diet, certainly also for people with chronic kidney disease, must be balanced and varied. The easiest way to achieve this is through a varied diet consisting of foods from both the animal and plant kingdoms.

If you are a strict vegetarian, you must pay even more attention to your protein intake to make sure you get enough essential amino acids.

If you don’t eat enough protein over a long period of time, particularly from the essential amino acids, this will lead to loss of strength and muscle mass. Your muscle tissue will break down a little every day, but will not be built back up because of a lack of protein (and energy). This can happen when a person is suffering from prolonged nausea or loss of appetite, for example.

You can find out more about protein in the next section.

 

Fats

There are several different types of fat and they are usually divided into the following categories:

  • saturated fat, found in dairy produce, cream, butter, cheese, meat and delicatessen products etc.;
  • monounsaturated fats, found in olive oil, almonds, nuts etc.;
  • polyunsaturated fats, found in sunflower oil, corn oil, margarine and fatty fish.

A high intake of saturated fats is considered to be a risk factor for cardiovascular diseases. The general recommendation for healthy people is therefore to eat only a little of this type of fat and to make sure that their fat intake contains predominantly monounsaturated and polyunsaturated fats.

Body fat is our most important energy reserve. However, if you eat more fat and other energy than you’re able to burn off, you risk becoming overweight or obese and developing other complaints. Obesity in turn increases the risk of cardiovascular diseases, high blood pressure, diabetes, gall disorders and joint problems. Intra-abdominal fat (increased fatty tissue in the abdominal region) is particularly detrimental.

 

Carbohydrates

Carbohydrates vary in complexity from simple sugars to more complex compounds like starch and cellulose. The simplest sugars are easily absorbed by the intestines, whose most important task is to supply the body with energy.

The most complex carbohydrates are also called dietary fibre. They are ‘good for the stomach’ in different ways. They improve intestinal function and slow down the absorption of simple sugars through the intestinal walls, which is considered beneficial.

Many of the standard foods we eat contain a lot of carbohydrates such as sugar, fruit and berries, honey, potatoes, root vegetables and products like rice, bread and pasta.

A frequent intake of high carbohydrate foods provides a lot of energy, but must be combined with meticulous dental care.

 

Read the label

The great majority of foods carry clear nutrition information. They state how much protein, carbohydrates and fat a product contains. These values are almost always expressed in grams per 100 grams of product. Occasionally you will also find the number of grams per standard portion for each nutrient, which is easier to understand.

Getting into the habit of always ‘reading the label’ is an excellent way to learn more about what you eat. This applies to everyone, but for people with chronic kidney disease it is even more important because diet is such a crucial part of your treatment.

 

Energy

Energy is necessary to keep the body’s normal functions in working order, whether at rest or performing day-to-day activities. That energy is generated chemically from the food we eat in a process whereby fats, carbohydrates and proteins are ‘burnt up’ or metabolised. Fats give you more than twice as much energy as carbohydrates and proteins. Alcohol metabolism also generates energy.

1 gram of fat generates 9.3 kcal
1 gram of protein generates 4.1 kcal
1 gram of carbohydrate generates 4.1 kcal
1 gram of alcohol generates 7.1 kcal

The body’s need for energy varies from one individual to the next depending on age, gender, level of physical activity and other factors. The energy output of a healthy, physically active adult woman is around 2,000 calories (kcal) a day, whereas that of a healthy, physically active adult man is around 2,500 calories a day.

Kidney patients on a low-protein diet need a lot of energy. This is absolutely crucial to their well-being and prevents them losing weight. So the standard recommendations for healthy people simply do not apply to people with chronic kidney disease. A standard recommendation for you as a kidney patient on a low-protein diet is that you need at least 35 calories per kilo of body weight per day.

If your energy intake is proportionate to your energy output, you will neither gain nor lose weight.

If your intake exceeds your output, the excess energy will be deposited as fat – whether that excess comes in the shape of fat, protein, carbohydrates or alcohol.

If you burn off more energy than you consume you will lose weight, and you will have less body fat. But if your body has deficient energy for a long time, it will have to use protein too as a source of energy. The long-term effect of this is that you will lose muscle mass and become weaker and more prone to infection, and your rehabilitation capability will diminish. Your dietitian can recommend various supplements which you can buy at a low cost.

 

Vitamins

There are many different types of vitamins, and they can generally be divided into the following categories:

  • Fat-soluble: vitamins A, D, E and K are found in fat-containing foods. Vitamin A is also found in liver and other offal.
  • Water-soluble: vitamin B is found in meat, milk, bread, vegetables etc. Vitamin C is found in fruit, berries, vegetables and root vegetables, for instance.

Vitamins are necessary to maintain vital processes in the body. They are also found in many enzymes. In addition many vitamins have an important protective function, partly due to their role in the body’s immune system. In a nutshell, vitamins are vital. We only need vitamins in small amounts, but without vitamins the body would not function.

If you’re healthy and eat a balanced, varied diet – containing foods of both animal and plant origin – you will easily meet your entire vitamin requirement. This is partly because some foods are intentionally enriched with vitamins.

A balanced diet virtually eliminates the need to take extra vitamins in tablet form, for example. However, the same is not true for people with chronic kidney disease. Frequently, kidney patients need an added boost of vitamin B and may also need adjusted doses of vitamin C and active vitamin D. On the other hand, it is very easy to take in too much vitamin A. For this reason you should only take the vitamins prescribed by your doctor, and no others.

As a kidney patient, you are more prone to infection than fully healthy people. Your body may be more susceptible to colds and you may find that they are more persistent. At such times you may feel tempted to take a lot of vitamin C because you’ve heard it’s good for colds. However, the jury is still out on whether vitamin C is in fact effective against colds, because the body absorbs the amount of vitamin C it needs and discharges the rest through the urine.

 

Minerals

Minerals are inorganic elements found in the body and in nature. They include calcium, magnesium, phosphorus, sodium and potassium.

Calcium is the predominant mineral in the body. Most of it, around a kilo, is found in the skeleton and teeth. Calcium is also found in other parts of the body where it is used in blood coagulation and the transmission of nerve impulses. Calcium levels in the blood are regulated by the combined mechanisms of parathyroid hormones and vitamin D. Calcium is secreted via the kidneys, and calcium deficiency manifests itself as osteoporosis.

Phosphate is found in the skeleton and in the blood. In chronic kidney disease, phosphate levels in the blood may become too high, but can be reduced if you cut down on milk and cheese and by medication. A low-protein diet is also low in phosphates.

Magnesium is found in the skeleton, muscles and some other parts of the body. It activates many enzymes and is necessary for the functioning of nerve and muscle cells. Magnesium deficiency partly manifests itself as muscle weakness and occurs in gastro-intestinal diseases, for instance.

Sodium is a mineral we consume in the form of salt (sodium chloride). Sodium plays an important role in regulating the body’s fluid balance. Sodium deficiency occurs in connection with fluid deficiency, dehydration, heavy sweating or persistent diarrhoea. If your kidney function is reduced and you consume too much salt, you are more at risk of developing high blood pressure. That is why as low a salt intake as possible is recommended.

Potassium is found in the body’s cells and is vital for nerve, heart and muscle function. Excessive levels of potassium may cause serious disorders in your heart function.

 

Trace elements

Several other inorganic elements are present in the body in minute amounts, which is why they are called trace elements. They include iron, zinc, copper, manganese, iodine, fluorine, selenium, molybdenum, chromium and cobalt. The function of trace elements is comparable to that of vitamins: they are part of the enzyme system and play a role in transmission and protection.

Some trace elements may accumulate in chronic kidney disease, so make sure you do not take extra minerals unless on medical advice.

 

Would you like to know more?

As you will have gathered, what we actually eat and drink is a science in itself. So as a person with chronic kidney disease, it’s worth developing something of a ‘scientist’s mindset’ about yourself. The diet we consume is an important part of the treatment, and knowledge can be particularly useful in understanding what’s happening. However, do not experiment. Instead discuss your diet with your doctor and dietitian.

The first piece of advice is: Always read the label! It contains clear information about what’s in your food.

The second piece of advice is to borrow or get your own copy of a dietary table which shows the content of many different foods. Consult your dietitian for advice.

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20. Protein – less is better

Low-protein diet

One of the measures your doctor may recommend for you, as a kidney patient, is to eat a protein-reduced or low-protein diet. This means that every day you must follow a diet that does not contain more than a certain amount of protein. This usually means less protein than is considered ‘normal’.

So what’s the point of that?

One major reason why people feel ill and have troublesome symptoms is the waste products that are produced when the body metabolises protein. They build up in the blood because the kidneys can no longer manage to get rid of them. If you reduce the amount of protein you eat, it stands to reason that the amount of waste products will also go down. And this might mean:

• the symptoms improve or disappear, which in turn means you won’t feel as unwell any more, you’ll get your appetite back, eat better and more and, therefore, get stronger.

• that the reduced burden on the kidneys enables them to do more and for longer, and the deterioration in the kidneys may thereby be slowed.

• that complications related to chronic kidney disease can be alleviated or avoided.

It is not guaranteed that all this will actually happen. However, there is everything to gain and nothing to lose by trying. If you do NOT reduce the symptoms and continue to feel unwell, there is a risk of becoming undernourished because you eat too little and too unbalanced a diet – and that makes matters worse.

So when should you start on a low-protein diet? It depends on what levels of waste products you have in your blood, how unwell you are feeling and how many symptoms you have. In other words, each case has to be assessed individually. You must only start and follow a low-protein diet on the advice of your doctor, so this is one of the things you and your doctor need to talk about and agree on.

 

Think twice

A lot of column space is devoted every week, every month and every year to two very popular subjects: food and slimming. The media give all manner of possible and impossible tips about what to eat and what not to. One of the standard slimming tips is to eat more pure proteins and less fat and carbohydrates. More pure meat (and salad) and less sauce and potatoes. More fish and vegetables and less fatty and sugary foods. A lot of ‘lite foods’ have also been developed for the same reason and purpose.

If you have chronic kidney disease and need to stick to a low-protein diet, you have to think completely differently! You should eat less protein and more fat and more carbohydrates(!) – the exact opposite of most slimming advice.

 

We need protein

Protein is absolutely necessary for you to lead a healthy life, because all your muscles and so many other parts of your body are built up by protein. If you have chronic kidney disease and in order to feel better, you can eat foods that contain a less than normal amount of protein, but only on two conditions:

• that at the same time you consume a sufficient amount of energy (fat and carbohydrates). This is because you need quite a lot of energy for your body to take in the protein you eat.

• that you eat a sufficient amount of the protein that your body cannot produce itself, i.e. essential amino acids. You can do this by eating a balanced diet and by complementing your diet with special tablets for people with chronic kidney disease which contain the essential amino acids. Your doctor can prescribe these tablets (known as Aminess in Sweden).

Recommendations for a low-protein diet are completely the opposite of the diet recommended for diabetics. So if you are a diabetic it is even more important to learn a lot, talk to your dietitian and come to a sensible compromise.

 

Nutrition information

If you have never thought that much about what’s in the food you eat, now’s the time to start. As a person with chronic kidney disease you will need to become a bit of an expert on what different food and dishes contain.

To begin with, almost all the foods and dishes you buy carry nutrition information. In fact it’s the law. You must be able to know in advance exactly what you may or are about to be eating.

Of all the variations and brands of the same types of food in the shops, you will soon become a specialist in finding the one that contains the least protein.

For example: your local supermarket probably sells very many different kinds of breakfast cereal. To begin with you probably won’t know that some of them contain no protein whatsoever, while others contain as much as 7 grams of protein per portion. Take a look at the tables further on in this section to see how big the difference can be.

 

How much is 100 grams?

All nutrition tables and information always indicate the amount of protein in grams per 100 grams of product. This is standard practice and it seems quite simple, but in reality it isn’t.

The problem is that most people don’t have the slightest clue about how many grams of a given food they eat. The only reliable way of finding out is to weigh the portion you are about to eat. Certainly the ingredients that contain the most protein would have to be weighed separately.

You can do this using a good set of scales and a calculator, but most people find this hard work and too much hassle. The result being that they rarely do it, if ever.

Some foods also carry information about the protein content in a standard portion, which does make life a bit easier for you. You can directly see how much protein a standard portion contains.

One thing is for certain: if you want to succeed in maintaining a low-protein diet and make sure you know how much protein you’re eating, it has to be easy.

 

Weigh and calculate

To find out what the food you plan to eat actually weights you can, of course, weigh it, before or after you cook it depending on what it is. For this you need to have some kitchen scales handy. Take away the weight of the plate, cup, glass or packaging, for example, to find out what just the product weighs before you do your calculation.

Once you’ve weighed different foods a few times you’ll learn to estimate the weight of different products – without actually weighing them. You decide if and when you want to weigh, depending on how confident you are of estimating the weight fairly well.

 

‘Reduced’ – how much is that?

A low-protein or protein-reduced diet means that you should not eat more than a certain amount of protein every day – an amount below what is considered normal. However, it is hard as an individual kidney patient to know what ‘normal’ means, and of course we all have different eating habits. Some people frequently eat large amounts of meat, fish and dairy produce, thereby consuming a lot of protein. Others eat more vegetables and root vegetables, which also contain protein but in smaller amounts.

But one thing we all have in common is that we don’t know how much protein we consume on a daily basis. So if you’re going to start on a low-protein diet, the first thing to do is find out how much protein you get from your ‘normal’ diet.

If you normally eat a lot of protein, you will probably have to alter your eating habits quite substantially. On the other hand you may find that you’re already close to your ideal daily intake of protein, or even below it. If so, you won’t have to change your diet that much.

Determining your own specific situation is one of the things your dietitian can help you with. You can also check things out for yourself by using a computer program or the tables further on in this section.

The recommendation given most commonly to patients with severe chronic kidney disease is not to eat more than 0.6 grams of protein per kilo of body weight per day. For instance, if you weigh 75 kilos, you should therefore be aiming for around 45 grams (i.e. 0.6 x 75) of protein a day. You can also calculate how many grams of protein you should be taking in:

Your weight in kilos multiplied by 0.6.

So how can you keep an eye on your protein intake?

 

Get yourself a computer program

If you have access to a the internet, you may benefit greatly from special dietary software for people with chronic kidney disease, kindly available free of charge from Kost och Näringsdata AB. Please note that the website and program are in Swedish only. What to do:

  • Go to www.kostdata.se
  • Click on the program ‘Dietist XP gratisversion 2’
  • To download the program enter the password ‘sommar’
  • You will receive the program and a user manual

The program shows the nutrients it is most important for kidney patients to keep an eye on: protein, phosphate, potassium, calories/kilocalories/kcal and water.

You start by adapting the program to your circumstances – see the manual. For instance, how much protein a day you should keep to.

You can then click on a wide variety of foods and dishes and the program immediately shows you the portion amount and how much protein the portion contains – in both grams and as a percentage of what you should eat each day. You can do the same for the other nutrients.

It is of course up to you how much and for how long you use the program. After a while you may learn to judge how much you should eat of different dishes – even without the software.

 

Learn to count ‘in your head’

If you’re unable or prefer not to use a computer program, you will still have to keep an eye on your protein intake and keep count ‘in your head’. This may not be as hard as it sounds.

• Firstly, you have to learn how much protein there is in different foods and dishes.

• Secondly, you have to learn to choose which foods you eat.

At the end of this section there are various tables specially compiled for kidney patients on a low-protein diet. They only show values for protein in different foods and dishes.

Wherever possible, we have used practical and easy-to-understand measures and amounts. They are based on what you can see, such as: each/per piece, per slice, per glass, per tablespoon, 100 ml, per plate/bowl, but also per (normal) portion. Needless to say the amounts are not always 100% exact, but this drawback is offset by the simplicity of the method.

The principle is that it’s better to have a reasonable knowledge of protein content than to always know it down to the exact milligram. It’s a quick and easy way of working out the approximate protein content in grams of the food you’re about to eat.

 

By heart? No thanks!

Obviously, no one needs to learn these tables by heart. That would be silly. Even so, you can learn a great deal by using them as a source of reference. For example:

  • Take any one of the tables and find the foods you normally eat and enjoy.
  • If the food you like contains only a little protein, then no problem.
  • If the food you like contains a lot of protein, you’ll probably be able to find an alternative higher up in the table that contains less protein but otherwise does much the same thing.
  • Either way, you will soon learn to work out the grams. A slice of soft bread, two grams. A small meatball, one gram. A glass of milk, seven grams.
  • In the tables you’ll find quite a lot of foods that contain a lot of protein. Look up, for example, the values for a double hamburger in a bun with cheese and salad – 30 grams. That’s a lot of protein for a kidney patient on a low-protein diet.
  • You’ll also find many foods that contain only a little protein or none at all. You can eat a lot of foods like this.

By looking through these lists, you can assess whether you can carry on eating the foods you previously ate most of, or whether you should choose something else. After a while you’ll have learnt the values for the most common foods and dishes and will find it easy to add up the grams. Here’s an example of the protein values for a breakfast:

  • One portion of porridge (4 grams) with milk (100 ml, 3 grams)
  • One piece of crispbread (1 gram), margarine (0 grams) and a slice of creamy cheese (2 grams)
  • One soft slice of bread (2 grams), margarine (0 grams) and marmalade (0 grams)
  • One cup of coffee with one sugar (0 grams)
  • Total: 12 grams of protein. It’s as easy as that!

 

Less high-protein, more low-protein

As you certainly already know, it’s very important to eat as balanced a diet as possible. You should eat food of both animal and plant origin. But how can you do that when, at the same time, you’re not supposed to exceed a certain amount of protein?

Well, just carry on eating a balanced and varied diet, but always think twice and keep a closer eye on what you eat. You must never exceed your recommended protein intake too greatly. To achieve this, do the following:

  • Eat only a little of the foods that contain a lot of protein (smaller portions).
  • Eat more of the foods that contain less protein.
  • Then be sure to top up with more energy (fats and carbohydrates).

For example: Only eat a small amount of meat. You may choose to have one fillet of herring or one stuffed cabbage roll instead of two (or three). Eat only one chicken drumstick rather than a whole portion of chicken. Small meatballs are easy to count – one gram of protein per meatball. Some of the products at the very bottom of the tables, i.e. those with most protein, should be consumed in even smaller amounts or perhaps even avoided altogether.

With protein-free pasta you can have a little more bolognese sauce. With less meat or fish, you can take one or two more potatoes or a bit more salad to fill you up instead. If a standard portion of minute steak contains 22 grams of protein, you know that a half portion contains about 10 grams – which is probably just about right for you.

You can get more energy by eating, say, cream sauce, savoury jam and a dessert high in carbohydrates.

 

Eating at home – on your own

When you’re at home, you’re basically free to choose what you eat. You can plan your meals so they contain the right amount of protein, especially if you cook them yourself.

In the tables further on you will find protein values for many foods and dishes. There you can find out which foods you can eat a lot of, and which you should be careful with.

 

Eating at home – with your family

If you are a family who normally eat together, things become a little more complicated because you can’t be sure that those special low-protein dishes will hold much appeal for everyone in the family. There are at least two ways of getting round that problem:

  • The first is to make slightly different food for the kidney patient and the rest of the family. For example: a saucepan of protein-free pasta for the person with chronic kidney disease and another saucepan of ordinary pasta for everyone else. The kidney patient takes less bolognese sauce than the others – and has no cheese on top. Low-protein pasta is generally not available in standard supermarkets. Your dietitian can, however, prescribe this type of pasta at a subsidised price.
  • The other option is to make the food that most of the family likes, without special regard for the person with chronic kidney disease. It is then up to the kidney patient to help him or herself to a large or small portion of each component, or to avoid certain components altogether. For example: the kidney patient takes more potatoes, more vegetables, fewer meatballs and ideally more cream sauce (or an extra knob of butter).

Most families will probably opt for a combination of these two methods. Occasionally the family will prepare a dish particularly suitable for the person with chronic kidney disease, but for the most part everyone eats the same food, but in different quantities. Ultimately you are the person with chronic kidney disease and you must decide what you can and should eat. Only you can keep an eye on the amount of protein you consume.

 

Eating at work

If you take your own food to work, you decide what you eat – food and drink suitable for a person with chronic kidney disease.

If you eat in a staff canteen or at a restaurant, there will ideally be a variety of dishes to choose from. Again, it is up to you as a kidney patient to know enough to choose the right meal, and the right quantity of food – something you know roughly how much protein it contains.

 

Eating out

Being able to choose which restaurant you eat at is ideal. A person with chronic kidney disease at a steakhouse where they mostly serve large rare steaks will certainly not be in an ideal environment. The best restaurant is one that has a wide and varied menu, one where you’re more likely to find ‘kidney-friendly’ dishes.

Again, the most important thing is that you familiarise yourself as much as possible with the protein content of various foods so that you may know which dishes to avoid, which to eat in small amounts only and which you can more or less indulge in. You can do this by regularly using the tables further on in this section.

 

Dining at a friend’s or relative’s place

Inevitably, all good hosts will wonder: What kind of food do you serve a person with chronic kidney disease? What can he or she eat and not eat? This is of course very considerate.

One possible answer to that question is: “I basically eat everything, but I only have a small helping of the food that contains a lot of protein and bigger helpings of everything else. So cook whatever you like.” Then, as usual, you adjust the size of your portions: small portions of the food that contains a lot of protein, and more of everything else.

Another possible answer of course would be to say what you like and explain your low-protein diet to your host. Most people who invite a person with chronic kidney disease over for a meal probably want to serve something suitable for that person – after all, that’s why they ask.

 

Flying and eating on board

Eating on board an aeroplane can be a challenge because there’s not generally a wide variety of food to choose from, at least not in economy class. You usually just have to accept the food you’re given, and once again it’s up to you to decide what to eat and how much.

Another solution may be to pre-order a special dietary meal in advance, such as a vegetarian dish, which is likely to contain a little less protein than the standard meat or fish dish. Check the tables further on to see what the differences are. However, take care with soy dishes as they contain a lot of protein.

Some airlines even offer special low-protein food provided you order it well in advance.

 

A lot and a little

The most important thing is that every day you stick to the amount of protein you have been recommended. So if for example you eat a bit more protein for lunch, you should eat less in the evening – and vice versa. It’s your total daily intake of protein that counts. All assuming you feel well, of course.

 

You and your doctor can check your progress

The laboratory report from your blood tests includes a parameter referring to ‘tU/Urea flow’. This figure clearly shows how well you are getting on with your low-protein diet.

 

Protein in tables and recipes

After the tables showing protein content on the next few pages, there are a few examples of the protein content of various meals. Together with your family or close companion, you should practise composing your own meals using the tables to ensure the amount of protein is right for you.

Recipes with a declaration of contents, specially developed for people with chronic kidney disease, can be obtained through your dietitian.

 

A warning

Finally, a word of warning: do not eat star fruit (carambola) or drink the juice because it can be poisonous for people with chronic kidney disease.

Back to Contents

Grams of protein content in foods

Special tables for people with chronic kidney disease.

  1. Bread – soft bread, hard bread/crispbread, wheat bread and crisp rolls, cakes and gateaux, biscuits and cookies
  2. Potatoes and cereals – potatoes, pasta, rice, breakfast cereals, porridge, gruel
  3. Dairy produce – milk and cream, soured milk and yoghurt, cheese, dairy produce, eggs
  4. Minced meat and delicatessen – meatballs, sausages, delicatessen products
  5. Meat – beef, pork, poultry, other meats
  6. Fish – fish, fish dishes, shellfish
  7. Vegetables – vegetables, vegetable dishes, root vegetables, peas and beans
  8. Desserts – ice creams and sorbets, stewed fruit and fruit soups, pies and puddings
  9. Fruit and berries – fresh fruit, tinned and dried fruit
  10. Drinks – water, soft drinks, beer, alcohol
  11. Chocolate and sweets – chocolate, sweets, marmalade and jams
  12. Other

 

1. Bread

Soft bread

Gluten-free, light or dark, slice <1
Multigrain bread made with water, slice 1-3
Tin loaf, slice 2
Sweetened rye bread, slice 2
Unsweetened wholemeal bread, slice .2
Three-seed bread, slice 2
Fibre-rich white bread, slice 2
Coarse farmhouse bread, slice 2
Coarse wheat and rye bread, slice 2-3
Barley bread, slice 2
Soft thin bread, slice 2
Unsweetened rye bread, slice 2
Hot-dog bun, each 2-3
White bread, slice 3
Croissant, each 3
Multigrain scone, each 3
Cheesebread roll, each 3
Tortilla, small, each 3
Baguette, small, each 4
Pita bread, each 3-6
Hamburger bun, each 4-5
‘Rallarhalvor’, each 4
Tortilla, large, each 5
White roll, whole, each 6
Ciabatta, whole, each 10

Hard bread/crispbread

Finn crisp, piece 1
Delikatessknäcke, piece <1
Flatbread, piece <1
Hard thin bread, piece <1
Rice cakes, piece <1
Leksand crispbread, piece 1
Gluten-free crispbread, piece 1
Multigrain crispbread, piece 1
Husmans crispbread, piece 1-2
Hard blood bread, piece 1-2
Hard fibre bread, piece 1-2
Sportknäcke crispbread, piece 1-2
Wheat crispbread, piece 1-2
Croustade, each 2
Oat crispbread, piece 2-3
Croutons, 100 ml 5

Wheat bread and crisp rolls

Crisp rolls, piece 1-2
Unsweetened wheat bread, slice 2
Sweet plain wheat bread, slice 2-4
Saffron bun, each 3-4
Sweet wheat bun, each 4

Cakes and gateaux

Chocolate Swiss roll, slice 1
Soft sponge cake, slice 1
Light sponge cake, slice 1
Apple cake, slice 1-2
Ambrosia cake, each 2
Chocolate cake with coconut, piece 2
French chocolate cake, piece 2
Jam Swiss roll, slice 2
Muffin, each 2
Sponge cake, slice 2
Tosca cake, piece 2-3
Fruit cake, piece 3-4
Cream gateau, piece 3
Soft chocolate cake, slice 3
Soft nut cake, slice 3
Fruit gateau, piece 4
Prune cake, piece 4
Sachertorte, bit 6
Semla almond/cream bun, each 8

Biscuits and cookies

Loprofin low-protein biscuits, each <1
Marie biscuits, each <1
Digestive biscuits, each <1
Filled biscuits, each <1
Cookies, biscuits, wafers, each <1
Gingerbread biscuits, each <1
Sandwich biscuits and wafers, each <1
Arrack balls, each 1
Coconut balls, each 1
Soft gingerbread biscuits, each 1
Pyramid cake, portion 1
Chocolate balls, each 2
Baker’s cakes, each 2
Almond buns, each 2
Punch rolls, each 2
Mazarine/bakewell tart, each 3
Danish pastries, each 4
Doughnuts, each 4

2. Potatoes and cereals

Potatoes

Boiled potatoes, egg-size, each 1
Tinned potato, each 1
Leek and potato soup, bowl, 200 ml 2
Potato balls, each 2
Potato salad, portion, 250 g 2-4
Potato pancakes, each 2
Baked potato, each 3
Roast/fried potatoes, portion, 150 g 3
Chips, oven-heated, portion, 150 g 3-5
Chips, deep-fried, portion, 150 g 4-5
Potato salad, portion, 225 g 3-4
Chips, fast-food outlet, portion, 150 g 5
Potatoes in white sauce, portion, 225 g 6
‘Palt’ potato dumplings, each 6
Potato dumplings stuffed with chopped pork, each 7
Potato gratin with egg and spinach, portion, 225 g 7
Potato gratin, skimmed milk, portion, 225 g 10
Jansson’s Temptation, portion, 275 g 10
Potato gratin with cream and cheese, portion, 225 g 12

Pasta

Mung bean noodles, pack 0
Loprofin low-protein pasta, portion, 150 g <1
Pasta cooked without salt, portion, 150 g 6
Wholemeal pasta, portion, 150 g 9
Express noodles, pack 9
Egg noodles, portion, 150 g 10
Minestrone, portion 10
Soy macaroni, portion, 150 g 10
Ravioli, portion, 350 g 13
Macaroni in white sauce, portion, 225 g 13
Tortellini, portion, 165 g 15
Tagliatelle bolognese, portion, 165 g 15
Pasta bolognese, portion, 225 g 17
Lasagne, portion, 350 g 17
Pasta with spinach and mushrooms, portion, 350 g .21
Pasta with tuna, portion, 350 g 22
Pasta with gorgonzola sauce, portion, 350 g 24
Vegetarian lasagne, portion, 350 g 24
Macaroni pudding, portion, 350 g 28
Pasta with peas and ham, portion, 350 g 31

Rice and grains Portion = 120-180 g

Sago, portion 0
Barley grains, boiled, portion 3
Polished rice, portion 3
Express rice, portion 3-5
Unpolished/brown rice, portion 4
Rice boiled in salted water, portion 5
Risotto made of brown rice, vegetarian, portion 6
Non-stick rice, portion 6
Jasmine rice, portion 6
Couscous, portion 6
Arborio rice, portion 6
Basmati rice, portion 8
Wholegrain rice, portion 8
Durra, portion 9-11
Paella, portion, 325 g 29

Breakfast cereals Portion = 30-40 g

Loprofin low-protein cereal, portion <1Weetabix, piece 1
Puffed toasted rice, portion 1
Risdiet cereal, portion 1
Frosted flakes, portion 2
Sugar puffs, portion 2
Rice Krispies, portion 2
Muesli, fruit and nuts, portion 3
Muesli, wheat flakes, portion 3
All-Bran Regular, portion 4
Cornflakes, portion 4
Breakfast cereals, muesli type, portion 4
Quaker Oat Crunch, portion 4
All-Bran Plus, portion 5
Special K Red Berries, portion 5
Kruska porridge with wheat bran and raisins, portion 5
Rye flakes, portion 6
Special K, portion 7

Porridge Portion = 220 g

Barley meal porridge, portion 2
Rye meal porridge, portion 2
Multigrain porridge, portion 4
Oatmeal porridge, portion 4
Rice pudding, skimmed milk, portion 7
Rice pudding, portion 8
Molino porridge, portion 8
Semolina pudding, portion 11

Gruel Bowl = 200 ml

Oat gruel, bowl 4-5
Rice gruel, bowl 7
Sugar-free adult gruel, bowl 7-8
Wholegrain adult gruel, bowl 9-10
Semolina gruel, bowl .9-10
Wheat meal gruel, bowl .9-10

3. Dairy produce

Milk and cream Glass = 200 ml

Whipped cream, tbsp <1
Coffee cream, tbsp <1
Cooking cream, 100 ml 3
Medium-fat cream, 100 ml 3
Kelda Lagalätt, 100 ml 4
Milk powder, tbsp 5
Gammaldags old-fashioned milk, glass 6
Buttermilk, glass 6
Standard milk, all types, glass 7
Condensed milk, 100 ml 7-8

Soured milk and yoghurt Bowl = 200 ml

Weight Watchers Drinking yoghurt, 100 ml 3
Delikatessyoghurt, beaker 4
Cooking yoghurt, 100 ml 4
Flavoured yoghurts, 100 ml 4
“Filbunke” soured milk, whipped cream, bowl 6
“Filbunke” soured milk 3%, bowl 6
Yoghurt fresh Risifrutti, each 7
Soured milk 3%, bowl 7
”Långfil” ropy milk, bowl 7
Fruit yoghurt, bowl 7-8
Kefir soured milk 3%, bowl 7-8
Low-fat soured milk, bowl 7-8
A-fil soured milk 3%, bowl 7
Beestings pudding, 100 ml 9
Low-fat yoghurt, natural, bowl 9
Medium-fat soured milk, 1.5%, bowl 7
Dofilus, bowl 10

Cheese

Creme Bonjour, tbsp 1
Philadelphia Extra Light, tbsp 1
Whey cheese, tbsp 1
Boursin, tbsp 1
Creamy cheese, 39%, slice 2
Low-fat cream cheese, 4%, tbsp 2
Hard cheese, 31%, slice 2
Grated parmesan cheese, tbsp 3
Parmesan, slice 3
Hard cheese, slice 3
Margarine cheese, 24%, portion, 15 g 4
Blå Castello, tbsp 6
Cantadou, tbsp 6
Goat’s cheese, slice 7
Philadelphia Original, 100 ml 7
Philadelphia Light, 100 ml 8
Feta cheese, 16%, 100 ml 11
Camembert, piece, 50 g 13
Cheese soufflé, portion, 100 g 13
Brie, piece, 50 g 13
Blue cheese, piece, 50 g 14
Mozzarella, piece 18
Ricotta, 100 ml 20
Cheese and ham quiche, milk, cream, piece 22

Dairy produce

Mayonnaise, tbsp <1
Low-fat margarine, tbsp <1
Low-fat crème fraîche, tbsp <1
Margarine, tbsp <1
Butter, tbsp <1
Whey cheese, tbsp 1
Ädel vanilla whip, tbsp 1
Cottage cheese, 4%, tbsp 1
Ädel whip, 100 ml 3
Crème fraîche, 100 ml 3
Soured cream, 100 ml 3
Very low-fat crème fraîche, 100 ml 4
Risifrutti, all types, each 5
Kesella quark, 10%, 100 ml 10
Cottage cheese, feta and olives, 100 ml 10
Cottage cheese, pesto, 100 ml 10
Low-fat Kesella quark, 100 ml 13

Eggs

Crispy waffles, whipping cream in the mix, each 2
Yolk, each 2
Egg white, each 3
Egg waffles, each 3
French toast, piece 4
Crêpes with mushrooms in cream sauce, each 5
Crêpes with prawn sauce, each 6
Fried or boiled egg, each 7
Baked egg, portion, 125 g 8
Omelette with potato, diced pork and onions,150 g 10-13
Egg cake, portion, 150 g 12
Scrambled eggs, portion, 100 g 12
French omelette, portion, 150 g 14
Oven pancake, portion, 200 g 18-21
Pork pancake, portion, 200 g 22

4. Minced meat and delicatessen

Meatballs etc.

Small fried meatballs, each 1-3
Fried beef patties, each 7
Hamburgers à la Lindström, each, 50 g 7
Fried hamburgers, each, 50 g 8
Minced meat croquettes, each 9
Fried stuffed cabbage rolls, each 9
Minced meat sauce, pork mince, portion, 200 g 10-12
Cabbage pudding, portion, 225 g 13
Meatloaf, portion, 125 g 14-17
Hamburgers, medium-sized in a bun, each 15
Cheeseburgers, medium-sized in a bun, each 19
Double cheeseburger in a bun, each 30

Sausages

“Falukorv”, slice 1
Cooked mettwurst, slice 1
Sandwich sausage, slice 1
Smoked mettwurst, slice 1
Chipolatas, each 2
Salami, slice 2
Frankfurters, each 6
Grilling sausages, each 7
Boiled hot-dog sausages, each 7
Cooked Värmland sausage, portion, 100 g 7
Cooked pork sausage, portion, 100 g 9
Cooked meat sausage, portion, 100 g 9
Breakfast sausage, portion, 100 g 10
Hot-dogs with ketchup and mustard, each 10
Chorizo, piece, 100 g 11
‘Isterband’ coarse-ground pork sausage with barley and potatoes, piece, 100 g 12
Hot-dog sausage, mash, mustard, ketchup, gherkin, each 13-15
Sausage casserole with vegetables, portion, 250 g 16
Sausage Stroganoff, portion, 250 g 17
Thin-bread rolls with 1 hot-dog sausage and mash, each 18

Delicatessen products

Smoked sandwich turkey, slice 1
Liver pâté, slice 1-2
Sandwich meat, slice 3
Pork brawn, slice 4
Blood sausage, slice 6
Black pudding, slice 7
Household brawn, slice 9
Bread baked with blood and rye flour, portion 10
Veal brawn, slice 13
Minced meat and chicken liver pâté, slice 17
Hash of offal and grain, portion, 150 g 21
Pork roulade, portion 31

5. Meat

Beef Portion = 150-250 g

Meat soup, bowl, 200 ml 7
Liver casserole with vegetables, portion 12
Prime rib, portion 19
Entrecôte, portion 20
Rump steak, portion 21
Beef stew in sauce, portion 21
Fillet steak, portion 21
Roast beef, portion 21
Minute steak, portion 22
Wiener schnitzel, portion 23
Beef casserole of beef, potatoes and onions, portion 24
Beef goulash, portion 27
Beef Stroganoff, portion 30
Chilli con carne, portion 31
Roast veal, portion 32
Cooked beef, portion 37
Cooked lean beef, portion 43

Pork Portion = 120-150 g

Fried bacon, slice 2
Cooked Christmas ham, slice 3
Cooked salted ham, slice 3
Smoked pork, slice 4
Smoked ham, slice 4
Grilled spareribs, each 9
Smoke-cured loin of pork, slice 11
Ham sauce, 100 ml 12
Roast pork, portion 12
Pork bone, portion 18
Salted ham, portion 18
Breaded pork chop, fried, piece 20
Grilled marinated pork steak, portion 22
Pork fillet, portion 28
Pork joint, portion 36

Poultry Portion = 120-150 g

Goose liver pâté, tbsp 2
Cooked turkey, slice 2
Fried chicken livers, each 7
Fried chicken burgers, each 12
Clear chicken soup, bowl, 200 ml 12
Duck, with skin, portion 12
Chicken casserole with onions and mushrooms, portion 13
Duck, portion 18
Chicken, with skin, portion 19
Chicken drumstick, portion 20
Duck breast, portion 21
Chicken, portion 21
Turkey, portion 22
Pheasant, portion 23
Goose, portion 23
Bought grilled chicken, portion 25
Chick salad, portion 27
Cooked chicken, portion 35
Turkey casserole, portion, 250 g 35
Chicken fricassee, portion, 250 g 40

Other meats Portion = 120-150 g

Horse meat, slice 2
Smoked salt horse meat, slice 2
Minced meat mix for tacos, tbsp .2
Smoked reindeer meat, slice 2
Minced lamb patties, each 7
‘Paris’ hamburger on fried bread, without eggs 8
Meatloaf, slice 14
Minced elk meat sauce, portion 15
Minced meat pasties, each 15
Lamb chop, portion 18
Thinly sliced reindeer meat, portion 19
Thinly sliced elk meat, portion 20
Dried reindeer meat, portion 20
Meat and potato hash, portion 21
Venison, portion 21
Minced elk meat, portion 22
Soy mince, portion 32
Oven-baked reindeer meat, portion 33
Roast lamb, portion .35
Cooked reindeer meat, portion 35
Roast elk, portion .37

6. Fish and shellfish

Fish Portion = 125 g

Anchovies, each <1
Marinated herring, piece <1
Arctic caviar, tbsp <1
Caviar, tbsp 2
Sardines, each 3
Smoked Baltic herring, piece 5
Boiled ling, portion 6-15
Hake, portion 17-20
Burbot, portion 17-20
Turbot, portion 17-20
Cod, portion 17-25
Eel, portion 18
Tuna, portion 18-30
Char, portion 18-22
Salmon, portion 18-25
Pike, portion 18-22
Squid, portion 19
Zander, portion 19-25
Perch, portion 20-25
Baltic herring, portion 20
Flounder, portion 22
Plaice, portion 22-25
Whitefish roe, 100 ml 23

Fish dishes

Smoked Baltic herring pâté, tbsp 1
Boiled fish balls, each 1-2
Fish fingers, each 3
Breaded fish fillets, each 3
Fried breaded Baltic herrings, each 5
“Gravad lax” raw spiced salmon, slice 9
Two breaded fillets of Baltic herring with dill or parsley 9
Fish gratin with mash and sauce, portion 10
Deep-fried fish, portion 17-20
“Kräftströmming” Baltic herring,tomato,dill, portion 14-18
Fish casserole with vegetables, portion 19
Cooked cod fillet, portion 18-25
Hot-smoked char, portion 20-25
Fried breaded herring, portion 21
Deep-fried squid, portion 22
Tuna salad, portion 24
Pickled herring, portion 20-25
Smoked Baltic herring bake with baked egg, portion 30
Cooked mackerel, portion 20-32
Cooked pike, portion 30-33

Shellfish

Mussels, each <1
Prawns, each 1
Oysters, each 1
Snails, each 1
Scampi, each 2
Lobster soup, 100 ml 2
Crayfish, each 3-4
Sea mussels, each 3
Prawns in white sauce, portion 5
Tinned mussels, 100 ml 6
Scallop Saint-Jacques, portion 8
Norway lobsters, each 9
West Coast seafood salad, portion 18
Cooked crab, half 21
Blue crab, half .22

7. Vegetables

Vegetables Portion = 75 g

Chicory salad, portion <1
Cucumber, portion <1
Iceberg lettuce, portion <1
Onions, each <1
Bean sprouts, 100 ml <1
Carrots, each <1
Beetroots, each <1
Radishes, each <1
Tomatoes, each <1
White cabbage, portion <1
Lettuce, portion <1
Red cabbage, portion <1
Button mushrooms, portion 1
Capsicum peppers, each 1
Mushrooms, 100 ml 1
Asparagus, portion 2
Spinach, portion 2
Avocadoes, each 3
Cauliflower, portion 3
Brussels sprouts, portion 3
Vegetable mix, portion 2-3
Globe artichokes, each 2-3
Fennel, each 3
Peas and carrots, portion 3
Frozen corn on the cob, each 4
Tinned brown beans, portion 9
Soy pillows, 100 grams 16

Vegetable dishes Portion = 150-250 g

Lettuce, leaves, cucumber, tomato, portion <1
Pizza salad, portion <1
White cabbage salad, lingonberry jam, portion <1
Cooked beetroot, portion 1
Salad with soured cream, portion 1
Fried button mushrooms, portion 1
Browned cabbage, portion 2
Clear vegetable soup, portion, 200 ml 2
Carrot soup, portion, 200 ml 2
Carrots in white sauce, portion 3
White cabbage in white sauce, portion 3
Cauliflower in white sauce, portion 4
Fried spinach, portion 4
Spinach in white sauce, portion 4
Vegetables in white sauce, portion 4
Carrot and pea soup, portion, 200 ml 5
Nettle soup, portion, 200 ml 3-5
Cream of mushroom soup, portion, 200 ml 5
Button mushrooms in white sauce, portion 6
Gratinated cauliflower, portion 7
Vegetable gratin, portion 10
Lentil soup, portion, 200 ml 10
Greek salad, portion 10
Vegetable bake, portion 12
Cauliflower gratin, cream, milk, cheese, portion 12
Broccoli gratin, milk, cheese, portion 15
Capsicum pepper stuffed with minced meat, each 15
Vegetarian casserole, portion 21
Chicken and ham salad, portion 27
Cauliflower bake with ham and cheese, portion 35

Root vegetables Portion = 150-250 g

Jerusalem artichokes, each <1
Black salsify, portion <1
Celery, portion <1
Celeriac, portion 1
Parsnip, portion 1
Mashed turnips, portion 2
Root vegetable casserole, portion 2
Fried root vegetable patty, portion 3

Peas and beans Portion = 150-200 g

Green beans, portion 1
Haricots verts, portion 1
Green peas, portion 3
Tinned soy sausages, each 3
Fried soy patties, each 3
Green beans in white sauce, portion 3
Broad beans, portion 4
Peas and carrots in white sauce, portion 4
Tofu, 100 ml 5
Boiled chick peas, portion 7
Black-eyed peas, portion 9
Tinned brown beans, portion 10
Lentils, boiled, portion 12
White lentils in tomato sauce, portion 12
Vegetarian pea soup, portion 12
Cooked yellow peas, portion 15
Cooked brown beans, portion 17
Cooked white beans, portion 17
Pea soup with pork, portion 19
Soy beans, dried and boiled, portion 20
Large white beans, portion 20
Boiled soybeans, portion 24
Soy dishes, portion 27
Soy protein 50 %, 100 ml 30

8. Desserts

Ice creams and sorbets

Ice lollies, each 0
Sorbet, portion 0
Coated ice lollies, each 1
Vegetable ice cream, portion 2
Ice lollies, each 2
Ice cream gateau, portion 2
Ice cream, portion 3
Ice cream with meringue, portion 3
Ice cream pastries, each 3
Low-fat ice cream, portion 3
Parfait, portion 3
Chocolate ice lollies, each 4
Ice cream cones, each 4
Full-cream ice, portion 4
Milkshake, glass 4
Ice cream sweetened with sorbitol, portion 5

Stewed fruit and fruit soups Portion = 100-125 g

Stewed fruit and fruit soups, portion <1
Stewed berries and berry soups, portion <1
Stewed apricots, portion 1
Stewed dried fruit, portion 1
Stewed prunes, portion 1
Stewed rhubarb, portion 1
Orange soup, 200 ml 2
Vanilla custard, portion 2

Pies and puddings Portion = 100-150 g

Apple rice, portion 1
Deep-fried apple pie, portion 2
Lemon mousse, portion 2
Meringues with whipped cream and chocolate sauce, portion 2
Orange rice, portion 3
Apple pie, portion 3
Apple rice crumble, portion 3
Banana fritters, portion 4-5
Rhubarb pie, portion 4
Cold creamed rice, portion 3-4
Thin pancakes made with skimmed milk, each 4
Crème caramel, portion .6
Semolina pudding, portion 7-8
Vanilla blancmange, portion 7
Pineapple mousse, portion 7
Rice pudding, portion 8
Prune soufflé, portion 10
Swedish cheese curd cake, 9 %, portion 15
Swedish cheese curd cake made with green cheese, portion 16
Low-fat unsweetened Swedish cheese curd cake, portion 18

9. Fruit and berries

Fresh fruit and berries

All, each, portion 0 or <1

Tinned fresh fruit and berries

All, each, portion 0 or <1

Dried fruit and berries

Dried fruit, 100 ml 2
Raisins, 100 ml 2

10. Drinks

Glass = 200 ml

Water, glass 0
Tea, cup 0
Cordial, glass 0
Alcohol, glass 0
Coffee, cup <1
“Svagdricka” (“small beer”, low-alcohol drink), glass <1
Beer 1.8%, 33 cl bottle <1
Orange juice, glass 1
Beer 2.8%, 33 cl bottle 1
Carrot juice, glass 1-2
Non-citrus juices, glass 1
Beer 4.5%, 33 cl bottle 2
Milkshake, glass 4
Fitness protein, bottle 50

11. Chocolate and sweets

Chocolate Glass = 200 ml

White chocolate, piece <1
Chocolate pralines, each <1
Milk chocolate, piece <1
Dark chocolate, piece <1
Chocolate sauce, tbsp <1
Chocolate drink made with water, glass 2
Chocolate balls, each 2
“Kexchoklad” chocolate crisp, each 5
Chocolate cream, portion, 150 g 6
Chocolate drink made with milk, glass 7
Chocolate pudding, portion, 150 g 7
Chocolate mousse, portion, 150 g 7

Sweets

Almost all sorts 0 or <1
Popcorn and cheese doodles, 100 ml <1
“Mumsmums” chocolate marshmallows, each 1
Coconut balls, each 1
Bar Energy Cake 2
Sweets including chocolate, pack 3
Assorted Saturday Sweets, pack 4
Almond paste/marzipan, piece 6
Sweets sold in health food shops, 100 ml 8
Hazelnuts, 100 ml 8
Peanuts, 100 ml 8
Bar Power-Pack 35 grams 9
Bar Fitness-Pack 45 grams 11
Sweet almonds, 100 ml 13

Jam and marmalade

All, 0

12. Other

Pizzas, each 20-35
Pizzas, vegetarian, each 20-25

 

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21. Exercise is the best thing for you

“Everyone should engage in some form of physical activity for at least half an hour, preferably every day”. This is what medical science tells us. The activity you do should be at least moderately intensive, such as a brisk walk. If you later increase your daily level of activity or if, now and again, you exert yourself a little more and get properly hot, your health will improve even further.

Physically active people run half as much risk of death from cardiovascular disease as inactive people. The physically active also run a lower risk of developing high blood pressure, type 2 diabetes and colon cancer.

Your quality of life will improve if you do physical activity, increasing your mental well-being as well as your physical health. Finally, physically active people are less at risk of osteoporosis, blood clots, obesity and mental illness – and they also benefit from a boost in their immune system.

 

Physical activity and chronic kidney disease

One of the most palpable symptoms of chronic kidney disease is increasing fatigue, which quite often leads to greater inactivity. Quite simply you don’t have as much energy as before, which can easily translate into passive sitting – you don’t bother moving around and gradually become even more tired. You end up in a vicious circle whereby the feeling of fatigue overrides the natural need to move around.

So physical activity is in many ways even more important for kidney patients because it breaks the vicious circle and counteracts the disease’s effects on the body and spirit.

In fact physical activity has neither a positive nor a negative effect on the actual kidney disease. But one major concern for anyone with chronic kidney disease is the increased risk of also developing a severe cardiovascular disease. The most important thing with physical activity is, therefore, to strengthen the heart and blood vessels.

Positive effects from physical exercise include better blood pressure control (i.e. lower blood pressure). Diabetics with chronic kidney disease also benefit from physical activity because they are better able to control their blood sugar levels. These effects may very well slow down the progression of the disease. Moderate physical training also increases a person’s mental well-being and the general ‘feel-good’ feeling. This may be due in part to the fact that during physical activity a person produces more of the body’s own endorphins, popularly known as ‘happy hormones’. Moreover, physical activity reduces any excess amounts of the stress hormones adrenalin and noradrenalin.

Other effects frequently ascribed to chronic kidney disease include the loss of muscle mass and the attendant decrease in muscle strength. If left untreated, chronic kidney disease may cause the loss of nearly half the patient’s muscle strength. Part of the reason for this is related to the fact that if you have a kidney disease, poor appetite and nausea, you are unable to store up enough energy in your body so your body has to use muscle tissue to supply it with energy.

So if you have chronic kidney disease, both your general fitness/stamina and your muscle strength will diminish, and this is one of the unfortunate aspects of your condition. But the good news is that kidney patients are in just as good a position as fully healthy people to build up their strength and fitness (although starting from a lower level). The more your fitness and strength decrease because of your kidney condition, the harder you may find it to build them up again – but it’s not impossible.

Physical training is therefore important for healthy people if they want to lead longer, better and healthier lives. For the very same reasons, physical training is even more important for people with chronic kidney disease.

 

Positive health effects from physical exercise

Many organs in the body benefit from physical training – more than you might think, in fact. The following section presents a few more good arguments for taking up and maintaining reasonable physical exercise tailored to your situation:

The heart works more effectively after training for a while. The heart muscle gets stronger, the amount of blood pumped out with each heart beat increases and the pulse slows down.

The blood vessels in the heart and in the muscles being exercised improve with training. Their volume and the number of capillaries increase. More blood can be directed to the working muscles and the oxygen uptake in the muscles increases.

The blood volume increases through regular stamina training and you may develop more red blood cells. The composition of the blood lipids improves.

Training also improves the lungs’ ability to rapidly transfer oxygen from the air into the blood stream. Once you have been exercising regularly for some time, your breathing slows considerably at the same level of exertion thanks to the more effective heart function.

Training also produces tangible results on the muscles. Weight training expands the muscle fibres. The long-term effect of stamina training is that it changes the balance between fast and slow muscle fibres, resulting in more slow fibres. The transfer of energy to muscle cells is improved.

The gastro-intestinal tract works more efficiently.

The hormonal system in the body undergoes changes as you exercise more.

The immune system improves even with moderate physical activity and you may become less vulnerable to infection.

The skeleton becomes stronger when the body is allowed to work and when exposed to a fair amount of mechanical exertion.

Cartilage and connective tissues in the joints benefit from reasonable exertion.

The brain and nervous system benefit from regular physical activity. For instance co-ordination, balance and reaction time all improve. More physical movement reduces the symptoms of depression and boosts self-esteem.

With physical training the skin becomes better at producing sweat, which means that a well-trained person can tolerate heat better.

 

Build up your muscles

The vast majority of people with chronic kidney disease experience a clear decrease in muscle strength and have less energy than before. Most can also immediately see that their muscles have shrunk and that they no longer “fill out” the skin as they used to.

To counteract this weakening and build up your muscles again if possible, we therefore recommend weight training, or interval training as it is also called. This means that several times a week you work the different muscle groups (arms, legs etc.) by performing a certain number of repetitions against resistance, such as weight cuffs or thick elastic bands.

A physiotherapist (preferably a specialist in kidney patients) may test your muscle strength and help you draw up a training programme tailored specifically to your situation and strength. Having this kind of support and ongoing encouragement may prove invaluable to your well-being. A good therapist specialised in physical activity as a method of disease prevention and treatment can also give you advice and guidelines on your training.

 

Get fit

‘Fitness’ generally refers to how well or poorly trained the heart and lungs are for physical work, and the ability of the muscles to metabolise oxygen and convert nutrients into usable energy.

Fitness also has a short shelf-life. If you don’t move for several days, the beneficial health effects from the previous exercise will diminish. Therefore, the most important thing for improving your fitness is to engage in physical activity regularly, preferably every day.

The general recommendation is therefore that we should do some kind of physical activity for at least half an hour every day (but not less than 10 minutes per session). Clearly though, physical activity has more beneficial health effects if you exercise longer (each day or each session) or if it is a little more intensive (so you get sweaty).

Standard recommendations to improve our fitness and increase the health effects include performing one of the following activities for 30-60 minutes three times a week: a brisk walk (preferably pole walking because it engages your arms and upper body and thereby increases the effect) or bicycle interval training, ‘slightly strenuous’ but still at a level of exertion where you can chat to someone.

It is also important to remember all those simple everyday opportunities for physical activity: cleaning, playing with the children or grandchildren, getting a dog that needs plenty of exercise, using the stairs instead of the lift, cycling to the shops rather than driving, walking instead of taking the bus, mowing the lawn and shovelling snow (perhaps even for a neighbour). All these activities count as exercise.

 

Train your balance and co-ordination

Balance and co-ordination are functions that naturally decline with age, and a kidney disease does not improve the situation. However, it is possible to train both your balance and co-ordination on a daily basis – for example by repeatedly standing up from a sitting position without using your hands, by always cleaning your teeth standing on one leg, by always putting on your socks and trousers standing up, ‘walking the tightrope’ along the lines in the pavement and, of course, building up your fitness by dancing.

 

Get started and keep it up

All scientific evidence and good advice suggest that engaging in regular, preferably daily, physical activity is extremely good for you – and even more beneficial for people with chronic kidney disease.

In the beginning, make sure you take it very easy if you have not been particularly active before. The important thing is to get started. Warm up properly, slowly increase the pace and do not over-exert yourself past breaking point. As a person with chronic kidney disease your body is more fragile, your muscles and tendons can take less strain and you can easily pull a muscle. Therefore take it easy, wind down gradually and stretch properly afterwards. In time you will increase both your strength and stamina – and become a happier person (which is an added bonus).

Physical training is a very important part of your treatment – and you do it all on your own.

Remind yourself of the benefits

 

Keep an exercise diary

One practical way to keep up your motivation, i.e. to ‘cheer yourself on’, may be to keep an exercise diary. You can use a standard pocket diary or a notebook and write down the physical activities you have done. Day by day, kilometre by kilometre, minute by minute or hour by hour for each of the different activities. After a while you can look back with contentment and pride at how much exercise you have done – and it’s quite a wonderful feeling!

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22. No smoking is by far the best policy

Most of us are already aware that smoking and taking moist snuff are bad for your health. The effects on kidney patients are even worse. To begin with, smoking is one of the risk factors for developing kidney disease. So not smoking in the first place means one less risk factor for kidney disease and a range of other illnesses.

Then, if you have developed kidney disease, smoking reduces the possibility of slowing the disease. If you want to slow your kidney disease, you simply cannot smoke.

If your kidney function deteriorates to the extent that you need dialysis, smoking increases the risk of complications. You will also find that smoking is completely incompatible with any possibility of a kidney transplant in the future. Smoking before undergoing surgery is extremely foolish. If however you do, you run the risk of complications developing and of losing the new kidney. Smoking is truly asking for problems – all the way.

 

It’s never too late to start quitting

Stopping smoking is easier said than done, but if you have chronic kidney disease you have a very good reason to make every effort to stop smoking – and to make sure you really succeed. Do whatever you have to, use any method you like, but stop now and fully enjoy a healthier life and a better chance of success with your treatment.

Say goodbye to tobacco and snuff products – it’s the best favour you can do yourself and your health. And remember, it’s never too late to start quitting.

 

Many benefits

Being tobacco free is an important part of your kidney disease treatment. The reason you are reading this book is that you want to slow your kidney disease. And smoking has absolutely no part to play.

What’s more, you’ll discover many other benefits from not smoking, such as:

  • better fitness even a few days after stopping
  • no more smoker’s cough – it will soon disappear
  • an improved sense of taste and smell
  • better immune defence and a lower propensity to colds
  • a stronger back and skeleton
  • less risk of atherosclerosis, heart attack, stroke, chronic bronchitis and cancer
  • better skin, no more ‘grey tan’
  • a better voice, no more hoarseness
  • whiter teeth and less risk of loose teeth
  • better finances, more money to spend on other things
  • happier friends and family
  • a cleaner, fresher home environment
  • a healthier and probably longer life

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23. The importance of weight

When it comes to chronic kidney disease and body weight, the guiding principle is that too much or too little is bad for you.

Truly excessive body weight increases the risk of many diseases, such as diabetes, cardiovascular diseases, high blood pressure and high levels of bad cholesterol in the blood. One way or another, all of this is detrimental to everyone, and that includes kidney patients.

If as a person with chronic kidney disease your body weight is too low, it probably means you are not getting enough protein and energy and are therefore losing fat and muscle mass. Nausea, loss of appetite and diarrhoea can also cause continued weight loss. You may lose a lot of weight if you do not get treatment for your kidney condition.

So body weight and chronic kidney disease are interdependent – in more ways than one.

 

Overweight and underweight

We all have our own ideas about what constitutes overweight and underweight, so our perceptions of ‘normal weight’ vary greatly. There is a system for assessing body weight called BMI or Body Mass Index. BMI is defined as the individual’s weight in kilograms divided by the square of his or her height in metres, as shown in the example below:

Go ahead and calculate your BMI!

(KG)   75 kg

————  = BMI        Example   ————–   = 23.15 BMI

(M) X (M)       1.80 x 1.80 m

 

However, there is a small catch: If you have (built up) quite a lot of muscle, your BMI may be slightly high but this may not necessarily mean you are overweight.

 

Waistline rather than scales

Given that intra-abdominal fat is considered the biggest risk factor to your health, we recommend that:

  • Men aim for a waistline of no more than 94 centimetres. If a man’s waistline exceeds 102 centimetres, he is at a considerably higher risk of developing a disease.
  • Women aim for a waistline of no more than 80 centimetres. If a woman’s waistline exceeds 88 centimetres, she is at a considerably higher risk of developing a disease.

 

Kidney patients who have lost weight

Poor appetite, vomiting and diarrhoea are some of the symptoms of chronic kidney disease. If you have these symptoms, you are at a greater risk of under-nourishment, i.e. of not getting as much food and energy as you need and use.

Deprived of energy, your body will start using proteins stored up in your muscles as an energy reserve. Your muscles degrade and are not built back up again, so you lose weight and strength. However, if at the same time you retain water in your body, your weight may not go down in any case.

One of the objectives of kidney care is to alleviate or preferably eliminate the symptoms of chronic kidney disease. This can be achieved in a variety of ways: through diet, medication and physical activity. Patients who achieve this objective feel better, they can retain food and build more energy, and their appetite is restored.

It is best when chronic kidney disease is detected at an early enough stage that muscle loss is at a minimum when real treatment begins. The more muscles lost, the more difficult it is to build them up again – but it can be done, even though it takes time.

You need energy to build your muscles back up. This is one of the reasons why you, as a person with chronic kidney disease, must make sure you get enough energy every day in the form of fat and carbohydrates.

You can ask your doctor, nurse or dietitian for advice, help and guidelines about what you, as a kidney patient who has grown thinner, can do to fill out and restore your muscles.

 

Overweight kidney patients

Having chronic kidney disease and being moderately overweight is a good combination. But if your BMI is above 30, you should try to lose some weight. If your chronic kidney disease goes untreated you will lose weight long-term – but not in a healthy way.

One thing is for certain, however – no one finds losing weight easy. And it’s no easier for people with chronic kidney disease, but no harder either.

The simple and perhaps sad truth is that, as a kidney patient, if you want to lose weight you have to use more energy than you consume.

It sounds so simple, and the best idea is to do both, i.e. to eat a little less and do a little more exercise. You will then expend more energy than you take in and lose weight as a result. Slowly but surely. Losing weight shouldn’t be rushed. If you manage to lose half a kilo a week you have made very good progress. But even if you lose less, there’s still every reason to be happy with yourself.

As a person with chronic kidney disease, you may have been advised to consume more rather than less energy. If you need to consume more energy and still want to lose weight in a healthy way, you have to burn off even more energy. Of course this can be quite tricky, but if losing weight is important enough to you it’s certainly worth giving it a serious try.

The process will be far easier if you work closely with all the members of your care team. If you have access to internet, you may also benefit by using dietary software that shows protein and energy content in food.

 

Everything in moderation

The conclusion of all this is really quite obvious:

  • If you’re too thin you need to gain weight. It’s better to be slightly overweight than underweight.
  • If you’re very overweight you should try to lose weight.

That may sound easier said than done, but one thing is certain – only you and you alone can do it!

To be considered for a kidney transplant, you cannot be either too overweight or too underweight.

 

Weight change and fluid balance

Typically, rapid weight fluctuation in chronic kidney disease is caused by changes in the body’s fluid balance, either because fluid accumulates in the body or because fluid loss increases. If you notice this happening, immediately contact your kidney clinic. If the changes you undergo are sudden and substantial, you may have to be admitted to hospital and put on medication to adjust your fluid balance.

Slow weight loss may also be concealed by a corresponding accumulation of fluid in the body. This means that a person stays the same weight but that the body composition has changed. The increased fluid volume in the body increases the risk of high blood pressure and heart strain.

 

Keep an eye on yourself

Get into the habit of weighing yourself once a week, for example, and do it at the same time of day and under the same circumstances so you can compare the results. Make a note of what you weigh; keeping a record will help you maintain your motivation.

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24. Alcohol – take it easy

Alcohol has no adverse effect on kidney function. Small quantities of alcohol, such as a glass of wine a day or equivalent, will therefore not damage the kidneys, nor will it aggravate chronic kidney disease. In some cases alcohol may even have a slightly positive effect on kidney function.

Having said that, patients with chronic kidney disease do not, as a rule, tolerate alcohol very well and may feel ill even after consuming a very small amount. So if you have chronic kidney disease it is advisable to take care with alcohol. Moreover, some of the medications you take may require you to abstain from alcohol altogether, so be sure to double-check.

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25. Healthy teeth – healthy gums

Most of us brush and take care of our teeth and gums every day; in fact we do it more or less automatically, it is a good habit. But for kidney patients it is even more important as they run a higher risk of developing problems with their teeth.

You’re probably wondering how that can be. How can the kidneys and chronic kidney disease affect the teeth and oral cavity?

Well, it’s related to the two most common oral diseases: caries – or tooth decay – and periodontitis (loosening of the teeth).

We all have a multitude of bacteria in our mouths. They like to accumulate on the teeth, especially between the teeth and where the teeth meet the gums. When you eat or drink, especially sugary foods, these bacteria produce a weak acid which corrodes the dental enamel. If this corrosion occurs frequently and for relatively lengthy periods, the dental enamel is damaged and a cavity results.

These bacteria can also irritate the gums, which become red and inflamed. This is the beginning of periodontitis. If you do not remove the bacteria properly every day, the gum inflammation can progress deeper into the flesh. Gradually the jawbone surrounding your teeth can start to decay and you may ultimately risk loose teeth, or periodontitis. This process can take a long time, years, but if you clean your teeth properly the inflammation is generally held back.

The best thing about dental hygiene is that you can do so much yourself to avoid both tooth decay and periodontitis. The trick lies in cleaning your teeth frequently and thoroughly enough to prevent the build-up of bacterial plaque on and around your teeth. The less plaque you have and the less time it stays there, the less risk you run of developing caries and periodontitis. Of course, this applies to everyone.

People with chronic kidney disease are more at risk of developing caries and periodontitis than other people. As you may feel nauseous and even vomit occasionally, you may find it harder than others to brush your teeth effectively all over. If you eat less protein you have to eat more carbohydrates, and more often. This can cause the plaque to start producing a lot more acid, thus speeding up decay.

In these circumstances, the bacteria also multiply much faster and produce far more plaque, which puts you at higher risk of periodontitis. In addition, many people with chronic kidney disease take drugs which inhibit the production of saliva, thus drying out the mouth and making the situation even worse.

Therefore, it is more important for kidney patients than for many others to regularly have their teeth and gums checked and their mouths properly cleaned by their dentist or dental hygienist. But again, it is you yourself who can take charge of your oral hygiene by making sure you clean your teeth properly two or three times a day, and by always using a toothpaste containing fluoride, which strengthens the teeth. You may also need an extra boost of fluoride, so please consult your dentist or hygienist about this.

Three good pieces of advice every person (with kidney disease) should follow:

  • Really clean teeth, at least twice a day.
  • Always use fluoride toothpaste. Spit out but never rinse your mouth with water after brushing. This will allow the rest of the fluoride to continue working for a long time.
  • Visit your dentist and hygienist as often as they say you need to.

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26. Libido and sexual function

People with chronic kidney disease, both men and women, may encounter problems in their sex lives. This is a problem that may appear long before you even suspect or know that you have chronic kidney disease.

The vast majority of male kidney patients experience a substantial loss of libido or ‘sex drive’, as well as difficulty in achieving and maintaining a good erection. This may be down to increasing uraemia and anaemia, among other factors, along with the attendant fatigue, but it may also be related to nausea, vascular disorders and the side effects of medication. However, these problems could of course just as easily be due to any number of other physical and psychological factors.

The psychological effects of chronic disease may also be a factor, such as worry, anxiety, guilt, a feeling of loss, a change in body image and lower self-confidence.

Male kidney patients are also affected by a number of hormonal changes, such as testosterone deficiency. In diabetics, effects on the nervous system can also lead to a loss of sensitivity, resulting in erectile dysfunction.

Women with chronic kidney disease may also experience a loss of libido for partly the same reasons as men – uraemia, anaemia and fatigue. The hormonal effects of chronic kidney disease may also lead to changes in the menstrual cycle or missed periods (amenorrhoea). Women may also experience dryness in the mucous membranes, difficulties in achieving orgasm and psychological effects such as a change in body image, depression and a drop in self-esteem.

Women with chronic kidney disease find it harder to fall pregnant due to hormonal changes, while in men the sperm count decreases. However, that is not to say that women with chronic kidney disease cannot get pregnant. They can generally carry their pregnancies to term in stages 1-3, but a stage 4 pregnancy may present complications. In women with stage 5 chronic kidney disease pregnancy is considered inappropriate, so contraception should continue to be used.

The overall experience of reduced libido and sexual function can cause additional stress and conflict in an already tense situation, particularly if either the patient or his/her partner is unaware that chronic kidney disease may be at the root of the problem. However, knowledge of this correlation increases understanding and reduces the risk of conflict.

Many people, including people with chronic kidney disease, do not feel particularly comfortable discussing their sex lives with ‘strangers’. Nonetheless, help is available for both men and women. Your doctor should be your first port of call – he or she can offer you advice, examine the causes and recommend the best way to a better sex life.

The basic principle underlying all treatment in men and women is to limit the general effects of chronic kidney disease as far as possible. In order to improve their sex lives, women may also consider hormone replacement therapy or other therapies on the basis of a thorough examination of the underlying factors. Men with renal failure who are suffering from erectile dysfunction have the option of using a variety of drugs which may help, such as Viagra, Cialis, Bondil, Caverjet and others.

So talk to your doctor. He or she will usually know what you can and should do.

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27. All these emotions

“Sit down and wait for your soul”

Having an illness is never a pleasant experience. And having a chronic disease for which there may be no cure is even worse. Being diagnosed with chronic kidney disease arouses strong feelings in most people – from great anger and despair to total surrender and a complete inability to act. And this is only natural. Chronic kidney disease brings about major changes in the body, and also in the spirit, because the body and spirit are interdependent. If you feel physically ill your mood can easily reach rock bottom – and vice versa: if you’re feeling cheerful and energetic, your physical problems appear less serious and more tolerable.

 

Temporary or chronic illness

Many illnesses are more or less temporary. A common cold passes in a week or ten days thanks to the body’s own defence mechanisms. An inflamed appendix can quite easily be removed by surgery. A wound can be stitched so it heals. There is a wide variety of effective drugs for most illnesses. We often know from the start that we’re not going to be ill for a long time. We soon get well again and are back to our normal routine, both at home and at work.

But with a chronic condition, i.e. a disease that in all probability will not simply ‘pass’, things are different – very different. Quite simply, you are never going to be restored to full health again, and never as hale and hearty as you were before. If you’ve been diagnosed with chronic kidney disease, this realisation hits you like a punch in the stomach, or worse. Suddenly you’re forced to come to terms with the fact that nothing will be the same again. You risk no longer being a person, but a permanent patient with an uncertain future. The image you had of yourself changes completely, and you become alternately sad and angry.

 

Your whole life upside down

And that’s not all. Your whole life changes, turned upside down. You may not be able to go back to work, at least not to the same extent as before, and what happens to your finances and family life, loan repayments and leisure pursuits? Everything seems to go down the drain. And apart from all that you feel poorly and are constantly running to the toilet, struggling with the itching and feeling desperately tired and grumpy. Life isn’t fun any more, neither for you the person with chronic kidney disease nor for your friends and family.

Chronic kidney disease not only affects the actual patient, but everyone around him or her: immediate family, relatives, friends and work colleagues.

 

A shock to the soul

When you’re first told you have chronic kidney disease, you live in a state of shock. You can’t think clearly and your thoughts wander off in all directions. How is it possible? Why me? What have I done to ‘deserve’ this? And the fact that many kidney patients have no confirmed cause for their kidney disease doesn’t make things any easier. Surely there must be a reason?

In that kind of situation, it’s not unusual to see chronic kidney disease as a ‘punishment’ for something you did (or didn’t do) earlier on in life. In any circumstances, it’s painfully unfair. You have every reason to feel quite sorry for yourself – and it may even feel quite comforting to feel truly sorry for yourself a while, thus letting out all kinds of negative feelings.

 

“No, it can’t be true!”

Many people find it hard to believe their doctor when they’re given the news that they have chronic kidney disease. They find it incredible, too immense and incomprehensible to cope with. They can’t comprehend the sheer enormity of what chronic kidney disease is and how it will affect them for the rest of their lives. “No, it can’t be true, it can’t possibly be that bad,” says the mind, and subconsciously they think it will all go away if they just close their eyes for a few minutes.

This is an excellent and perfectly normal defence mechanism: to first be in a state of denial, and then gradually take in the news bit by bit. This is not a conscious process, it’s simply a common way to absorb unpleasant news in stages, and it can take a long time for the mind to fully comprehend what it’s all about.

Developing a severe illness is a major change in anyone’s life. In fact it’s the sixth most stressful life change according to a classic scale used to measure distress (see below). Looking at the change for family members, severe illness ranks eleventh. Not so strange then that both the person with chronic kidney disease and his or her family react strongly to the new situation.

Life changes, from most to least stressful:

  1. Death of spouse/partner 100
  2. Divorce 73
  3. Separation from spouse/partner 65
  4. Imprisonment 63
  5. Death of a close relative 63
  6. Personal injury or illness 53
  7. Getting married 50
  8. Losing your job 47
  9. Reunion with spouse/partner following separation 45
  10. Retirement 45
  11. Major change in the health of a family member 40
  12. Pregnancy 40
  13. Sexual problems 39
  14. Addition to the family 39
  15. Major change at work 39
  16. Major change in financial situation 38
  17. Death of a close friend 37
  18. Changing jobs 36
  19. Argument with spouse/partner 35

 

“I want to know everything!”

Once the worst of the initial shock has worn off and you’re gradually forced to come to terms with the fact that you have chronic kidney disease and are not going to ‘get better’ again, your mind slowly but surely starts working through the new situation.

By this stage you will probably have realised that you can’t just sit around feeling sorry for yourself for the rest of your life. You realise you have to do something about your situation. The first thing many people do at this point is to seek out more information. They try to find out as much as possible about their condition and what they can do about it.

They immediately pay far more attention to everything their doctor, nurse and others tell them and try to absorb and remember as much as they possibly can. And this is no easy task, as there are so many unfamiliar words and terms and it’s hard to see how everything fits together. Information is also available in brochures and on the internet, and many hospitals run special courses for people with chronic kidney disease.

Talking to someone who knows, someone who can answer your questions and help you find the solutions you need, is tremendously important. Besides your doctor, you may initially also get the chance to speak to a nurse and a welfare officer, and later on you may even get to meet a dietitian and a physiotherapist – it depends on your particular needs and on the resources available at your clinic.

 

Talking to other patients

Meeting and talking to other people with chronic kidney disease can be very rewarding. After all you’re in the same boat, as it were, and generally speak the same language, you face more or less the same problems and understand just as little about what’s happening.

However, by exchanging experiences and discussing things, you can gradually piece the puzzle together and keep learning more about your condition, what can be done about it and what you can do yourself.

 

Here and now!

Quite soon after you’ve found out you have chronic kidney disease, you will be told about dialysis. The procedure will be explained to you in great detail. You’ll be told that you can achieve a good, high quality of life when on dialysis. And this is of course perfectly true, because without dialysis once your kidneys stopped working, you would die.

However hopefully you, the reader, still have a certain (high) percentage of your kidney function left. You should take good care of your kidney function and preserve as much of it as possible. Right here, right now, the most important thing for you by far is the treatment that can check the progress of your disease, and not the treatments, such as dialysis or a kidney transplant, you may need at a later stage. So the question you should be asking is: What can I do to live as well as possible, for the longest time possible, with my current level of kidney function? And that is precisely the treatment you need, and no other, here and now.

The reason dialysis comes up so early is that in the past there was no alternative. At many hospitals you will still be regarded as a ‘predialysis patient’, i.e. someone in some kind of queue for dialysis, soon or as soon as possible.

For many kidney patients who have some of their kidney function intact, being immediately put in the predialysis category can feel tremendously depressing and far too fatalistic. Having such a label pinned on you and encountering an attitude like that makes it very easy to simply give up and not care any more. After all, the message seems to be that there’s no point in even making an effort (!).

But that may not be true. Giving up is something you don’t have to do, and in fact shouldn’t do. You should receive the treatment you need and look after your remaining kidney function – it may serve you long and well.

 

Cry out or keep it in?

When it comes to emotions, everyone is different. For some it comes naturally, and may even be irrepressible, to give full expression to their emotions, to protest against trials and injustices by crying and shouting. Others who are more introverted find it more natural to suffer in silence or be more withdrawn.

In other words, there are many different ways for people to react emotionally and process an unexpected, undesired and unpleasant situation. The beauty of it is of course that all these reactions are ‘right’ – there are no ‘wrong’ ones – and that applies both to you the person with chronic kidney disease and to your family and friends.

 

This is how it is

After a while you must begin to realise that ‘this is how it is’, i.e. that you have chronic kidney disease, that you may as well accept it and that it will not go away. Some people reach this point quickly, while for others it can take a long time. So where do we go from here?

Well, I may have chronic kidney disease, but there’s nothing much wrong with the rest of my body. The majority of me is in decent health, and I still have a head to think with and a heart that beats the way it did before. There are relatively good solutions available for most conditions, and many other people have coped with chronic kidney disease before me. In your best, most upbeat moments, you will start to realise that you can’t just sit around with a long face, you have to do something.

Imagine if this new situation in your life could even bring new opportunities and new and different experiences. Perhaps, from this point on, life may present opportunities for reflection and consideration, and content that you never even thought of before…

 

Seize the day…

‘Take each day as it comes’ says an old maxim, but we easily forget it when we’re healthy and active because there’s always so much to do. The situation changes, though, with chronic kidney disease because other things come into focus, and you gain a new perspective on life.

You have to find solutions to problems you’ve never thought about before. You may perhaps want to and have to find interesting and exciting alternatives to the things you used to occupy yourself with. Nothing is impossible, says the optimist. Thinking something is impossible simply because you’ve never done it before is no good reason not to try it.

There are no two ways about it, you have to seize the day… It’s time to make the most of the opportunities at hand. Indeed, perhaps it’s even time for you yourself to create new opportunities for your own happiness and satisfaction.

 

Relax

“All these feelings” is the heading of this section. And it’s certainly true that as a person with chronic kidney disease, you will have to think differently and think along new lines compared to before. Quite simply, your brain will have to completely reset its parameters. You will have to learn a lot of new stuff you never even thought of before. You will have to cope not only with your own feelings and reactions, but also those of the people around you. No one said this was going to be easy.

One of the effects of chronic kidney disease is that you may find it harder to concentrate; another is that you may have difficulty sleeping. Learning and training yourself to relax can therefore be extremely useful. There are many different simple relaxation techniques which virtually anyone can learn. Your nurse/welfare officer/physiotherapist may be able to offer help in this respect, although you may also find relaxation CDs to buy from the pharmacy or borrow from the library. A quarter of an hour every day spent relaxing can work wonders for the soul of a person who feels tense and finds it hard to relax.

 

Support from a welfare officer

All kidney patients have the chance to meet and talk to a doctor and a nurse, and at many clinics there is also a welfare officer who can help you with many of the ‘secondary’ issues, such as:

  • Social information and advice on areas such as health insurance, long-term sickness benefits, insurance issues, sick leave, mobility services and so on
  • Support sessions, particularly in the initial stages
  • Co-ordination of support measures (with other clinics and authorities)
  • Co-ordination with friends and family
  • Rehabilitation

As a person with chronic kidney disease there are many aspects of your life that you may have to gradually change, either quite soon or at a later stage, if and when you need dialysis or a kidney transplant. Your welfare officer can be of invaluable help and support in many of these kinds of issues.

 

The voice of your soul

All manner of likely and unlikely thoughts can enter your head when you have chronic kidney disease; things you’re thinking about and would like to know more about or discuss with someone.

All too often people go to see their doctor and forget the things they’ve been wondering about earlier in the day or the previous night, whereas just a simple note could help them remember. Therefore, if you like, you can write down some of the thoughts you would like to discuss with your doctor at your next appointment, or with somebody else.

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28. Glossary of terms

A

ABDOMINAL CAVITY – Where the stomach, intestines and other abdominal organs are.

ACIDOSIS – Tendency towards increased acidity in the blood.

AMINO ACIDS – Organic acids that are the building blocks of protein.

ANAEMIA – a lack of blood, or more specifically a deficiency of red blood cells.

ANTIBODIES – Protein substances produced by the body to neutralise bacteria and viruses, for example.

AORTA – The largest artery in the body.

ARTERY – Blood vessel that carries blood from the heart to other organs. The kidney artery transports blood to the kidneys.

B

BLOOD CELLS – Cells found in the blood.

BRITTLE BONES – Tendency towards bone fractures, osteoporosis.

C

CALCIUM – A mineral, found in the skeleton and teeth.

CALORIES – See KILOCALORIES

CARIES – Tooth decay. Dental cavities.

CHOLESTEROL – One of the lipids found in blood.

CREATININE – A breakdown product of protein metabolism. The concentration of creatinine in the blood is used as a measure of kidney function.

CREATININE CLEARANCE – A test used to measure kidney function.

CYSTIC KIDNEY DISEASE – A genetic kidney disorder characterised by multiple cysts in the kidneys.

D

DIABETES – A metabolic disorder that occurs as a result of an absence or deficient effect of the hormone insulin.

DIETITIAN – An expert in food and nutrition.

DIURETIC – Drug that increases the excretion of water from the body. Increases the production of urine. Diuretics are also known as water tablets.

E

ENZYMES – Proteins that control metabolic processes and break down foreign substances in the body, for example.

EPO – Erythropoietin.

G

GFR – Glomerular filtration rate. A calculated measure of kidney function. Roughly the same as a percentage.

GOUT – A metabolic disease characterised by elevated levels of uric acid and sometimes severe joint pain. Chronic kidney disease entails an increased risk of gout.

GLOMERULONEPHRITIS – Inflammation of the kidney’s nephrons.

GLUCOSE – Blood sugar.

H

HAEMOGLOBIN – Hb. Found in the red blood cells, it transports oxygen.

HORMONES – Substances that regulate various functions in the body.

HYPERPARATHYROIDISM – Excess production of parathyroid hormone.

HYPERTENSION – High blood pressure.

HYPOTENSION – Low blood pressure.

I

IMMUNE SYSTEM/IMMUNOLOGICAL DEFENCE – The body’s natural defence against foreign substances.

INTRAVENOUS – Administered directly into a blood vessel, a vein.

K

KILOCALORIES/KCAL – A unit of energy, generally known simply as calories.

L

LYMPHOCYTES – Blood cells in the body’s immune system.

N

NEPHRONS – Kidney corpuscles and tubules.

O

OEDEMA – Swelling caused by the accumulation of fluid in the tissue.

OSTEOPOROSIS – Reduction in bone mass and density, also known as brittle bones.

P

PERIODONTITIS – Loosening of the teeth.

PERITONEUM – The mucous membrane lining the abdominal cavity.

PHOSPHATE – a mineral found in the blood and skeleton.

PLATELETS – Thrombocytes. Cells that facilitate coagulation.

POTASSIUM – In the form of a salt, needed for nerves and muscles.

PROPHYLAXIS – Prevention (preventive treatment).

PROTEIN – Substance found in e.g. meat, fish and cheese.

PTH – Parathyroid hormone.

R

RENIN – A hormone produced in the kidneys which helps raise the blood pressure.

S

SIDE EFFECTS – Adverse reactions to a medication.

SODIUM – Found in regular salt and balanced against water in the body.

SYMPTOM – Sign of a disease.

T

THROMBOCYTES – A type of blood cell (platelets).

U

UREA – A waste product of protein metabolism. URAEMIA – Urine poisoning.

V

VEIN – Blood vessel that carries blood back to the heart.

VIRUS – Small microorganism that causes certain infections.

W

WHITE BLOOD CELLS – Blood cells that e.g. form part of the immune system.

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29. Acknowledgements

Thanks to Dr Peter Barany for all your excellent guidance and for your unwavering support.

Thanks to RN Kerstin Bergström and Dietitian Gerd Faxén-Irving, MD, for your constant encouragement and for sharing so generously your extensive knowledge.

Thanks also to all other professionals and kidney patients who have shared their knowledge and experience.

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