Detailed dietary taboos for renal insufficiency

Strictly control the intake of high-salt, excessively high-protein, high-potassium, and high-phosphorus foods. Kidney-tonifying folk remedies and nephrotoxic drugs/health products with unknown ingredients are prohibited. Other taboos must be dynamically adjusted based on one's own renal function stage and current blood test indicators. There is no unified "one-size-fits-all" standard.

I have been working in the Department of Nephrology for almost 8 years and have seen at least hundreds of patients whose kidney function deteriorated sharply due to eating indiscriminately. Many pitfalls can really be avoided. Let’s talk about the most common high-salt pit first. Many elderly patients always feel that their meals are tasteless, so they just eat pickles, fermented bean curd, and salted eggs. Some like to use light soy sauce, chicken essence, and oyster sauce for seasoning, thinking that “it’s fine without adding much salt.” In fact, these invisible salts add up to exceed the recommended daily amount of 3g in minutes. There was a 52-year-old patient with stage 3 chronic renal failure. His indicators were originally under stable control, but because he liked to drink salty porridge with mustard in the summer, his eyes became swollen to the point that he could not open them in half a month, and his blood pressure soared to 180/110. He was hospitalized for a week before he recovered. Of course, there are different clinical opinions here. For patients who have been taking diuretics for a long time and suffer from frequent hyponatremia, the standard of 3g is not required. They can be appropriately relaxed according to the blood sodium results, thereby avoiding the danger of hyponatremia.

A more common pitfall than eating salty food is many people’s obsession with “supplements”. Patients who have just been diagnosed with renal insufficiency either go to extremes and eat sea cucumbers and stewed pig trotters every day to replenish their "vital energy", or they are so scared that they dare not touch eggs and milk and lose ten pounds in three months. There are actually two different opinions on protein intake in the domestic nephrology community. One group strictly follows the KDIGO guidelines. The daily protein intake of patients with stage 3 or above renal insufficiency should be controlled at 0.6-0.8g per kilogram of body weight. Try to choose high-quality proteins such as eggs, milk, and lean meat to reduce the production of metabolic waste. ； For patients over 65 years old and losing muscle mass quickly, the other group will appropriately relax the dosage to 0.8-1.0g. As long as the changes in urea and creatinine are regularly monitored, there is no need to starve to the point of becoming sallow and thin. I met a 40-year-old patient before. He was on a vegetarian diet for three months as soon as he was found to have high creatinine. The albumin dropped to 28g/L on a follow-up test, which accelerated the progression of kidney damage and was not worth the loss. Oh, by the way, there is also the often asked question of whether soy products can be eaten? I used to say that you should not eat soy products if your kidneys are not good, but now you have changed your conclusion. Tofu and soy milk from soybeans are high-quality proteins. It is perfectly fine to eat them in moderation. On the contrary, you should avoid processed vegetarian meat and yuba. Too much sodium and phosphorus are added, which will put a burden on the kidneys.

Let’s talk about the problems of high potassium and high phosphorus that are most common in summer. Don’t think that these two are academic terms that are far away from you. The freshly squeezed juices, milk teas, sports drinks that you like to drink, the soup that has been simmered for three or four hours at home, and even avocados, coconuts, and bananas that you think are healthy are all high-potassium consumers. Last summer, there was a 28-year-old patient with polycystic kidney disease who ate half an iced watermelon every day after get off work. After a week, he felt flustered and his hands and feet were numb. He came to the hospital to check that his blood potassium had soared to 6.2mmol/L. He was immediately prescribed emergency medicine and almost had dialysis. This is really not an alarmist. However, not all people with poor kidneys need to strictly limit potassium. If you have renal tubular acidosis and usually have low blood potassium, you need to supplement potassium appropriately. There is no need to avoid bananas and oranges. The safest way is to check the electrolytes during each review and just follow the indicators. As for the pitfalls of high phosphorus, they are mainly found in processed foods, such as ham sausages, instant noodles, potato chips, and the chewing gum that many people love to chew. They all contain phosphate additives. The human body’s absorption rate is much higher than the phosphorus in natural foods. Eat as little as possible.

There are also points that many people tend to overlook: Don't blindly take so-called "kidney health products" and "detoxification remedies", as well as unknown painkillers prescribed by roadside clinics and antibiotics you buy casually. Many of them are nephrotoxic and can secretly damage your kidneys without you noticing. When drinking water, you don’t need to listen to what is said on the Internet, “Drink more water to detoxify if your kidneys are not good” or “Drink less water if your kidneys are not good”. If your urine output is normal and there is no edema, it is absolutely fine to drink 1500-2000ml normally. If you have oliguria and lower limb edema, you must strictly control your water, including the water in porridge, soup, and fruits, otherwise you will suffer from swelling.

In fact, in the final analysis, diet for renal insufficiency is never a torture of "you can't eat this and you can't eat that". It is nothing more than following your own goals. Occasionally, it's okay to be greedy and eat a bite or a half of taboo foods. Just don't eat blindly for a long time. The most common thing I tell patients is, don’t blindly listen to the experiences of relatives and friends when it comes to what to eat, and don’t blindly search for unified standards on the Internet. It’s better to ask a nephrologist or clinical nutritionist for every review. They can make adjustments based on your current situation. After all, you can't have any fun in life just because you're sick, right?