The most important step in treating diabetic nephropathy, a form of chronic kidney disease associated with type 1 and type 2 diabetes, is to lower blood sugar, followed by regulating blood pressure and taking prescribed medications, say two experts from Mubadala Health’s Imperial College London Diabetes Centre (ICLDC), ahead of World Kidney Day on 11 March.
ICLDC consultant nephrologist Dr Mustafa Ahmed explains that around 25% of people with diabetes eventually develop kidney disease. Diabetic nephropathy is a serious complication as it affects the kidneys’ ability to remove waste products and extra fluid from the body.
He says that the best way to prevent or delay diabetic nephropathy is by maintaining a healthy lifestyle and treating the underlying cause of diabetes and high blood pressure. “To assess how a patient is managing diabetes, we give them a glycated hemoglobin test, also known as an HbA1c test, which assess blood sugar control over the past two to three months. Even if patients bring the result down from 9% to 7%, for example, they will reduce their risk of kidney disease by 50%-70%.”
Dr Ahmed says that chronic kidney disease often has few signs or symptoms in the early stages, and might not become apparent until kidney function is significantly impaired. He says for this reason, as soon as patients are diagnosed with diabetes, their kidneys should be checked. Initially, this can be done with simple blood and urine tests.
He adds that it is vital to catch chronic kidney disease and treat the underlying causes as early as possible as it could progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.
Other risk factors that can reduce the risk for kidney disease or help prevent further deterioration include maintaining a healthy weight and not smoking.
If someone already has kidney impairment, in addition to managing their diabetes and high blood pressure, there are specific foods they reduce, he explains. Patients will need to review how much protein, fat, potassium, sodium, and phosphorus they eat, and adjust if necessary.
“At ICLDC our multidisciplinary team also includes nutritionists to create eating plans for these patients, and we have even created a recipe book as it is important that patients understand they can still eat well while optimizing their kidney health.”
Nutritional review for kidney disease
Dr Ahmed’s colleague, ICLDC consultant nephrologist Dr Bahaa Shaath, explains the impact of various nutrients on the kidneys as follows:
Protein: Most people, whether they have chronic kidney disease or not, can get the daily protein they need by eating two 85-gram servings of meat or meat substitute - about the size of a deck of cards. However, Dr Shaath says, when kidney function declines to the point where dialysis becomes necessary, patients should include more protein in their diet because dialysis removes large amounts of protein from the blood.
Fats: While everyone needs dietary fat, Dr Shaath stresses that some fats are healthier than others and people with chronic kidney disease are at higher risk of having a heart attack or stroke so should avoid unhealthy fats such as trans-fats and opt for healthier monounsaturated fats such as olive oil and nuts.
Sodium: Salt causes the blood to hold onto fluid, raising blood pressure and putting a strain on the heart and kidneys. People at a risk of heart attacks or strokes should not eat more than 1,500 grams of sodium daily. They should watch out for items such as ready-made processed foods, which often contain large amounts of salt, and should read all food labels carefully.
Potassium: Problems can occur when blood potassium levels are either too low or too high. Damaged kidneys allow potassium to build up in the blood, causing serious heart problems.
Dr Shaath says that with an adequate low-potassium diet plan, he can help patients to avoid potassium accumulation.
Phosphorous: Damaged kidneys allow phosphorus, a mineral found in many foods, to build up in the blood. Too much phosphorus in the blood pulls calcium from the bones via diverse mechanisms involving vitamin D, calcium and parathormone, making the bones weak and likely to break, Dr Bahaa explains.
SAMPLE MEALS FROM ICDLC’S HEALTHY RENAL RECIPE BOOK
1. LOW-PHOSPHOROUS MEAL: CHICKPEA TABOULEH
• ½ cup bulgur wheat • 1 cup hot water (to cover and soak bulgur) • 2 bunch fresh parsley (about 0.5 kg), thick stems removed) • 4 tablespoons fresh mint (minced) • ½ cup cucumber(s) (peeled, seeded, and diced) • 3 green onion (scallion, finely minced, about ½ cup) • 3 small tomatoes (about 1 pound), diced (about 2 ½ cups) • ½ medium red bell pepper (seeded and diced, about ½ cup) • 1 cup canned chickpeas (garbanzos, drained and rinsed) • 3 tablespoons fresh lemon juice • 3 tablespoons olive oil
1. Rinse the bulgur wheat and add it to a small bowl. Pour hot water over the bulgur, cover, and let soak for about 20 minutes, until doubled in size. Drain excess liquid, if any, and place the bulgur in a large bowl.
2. Chop the parsley to a medium-fine consistency. It should have some texture left in it and should not look pureed. Add the parsley to the bulgur wheat, and add all the remaining salad ingredients. Cover and set aside.
3. For the vinaigrette, in a small bowl, whisk together the ingredients. Add to the salad; taste and adjust any seasonings. Add more lemon juice if desired. Turn the tabbouleh out onto a platter to serve
Servings per recipe: 10 cups; serving size: 1 cup
Nutrients per serving: Calories 95 kcal; total fat 4.5 g; saturated fat 0.5 g; cholesterol 0 g; sodium 110 mg; total carbohydrate 12 g; fibre 3 g; total sugars 3 g; protein 3 g; phosphorus 55 mg; potassium 280 mg
2. LOW-PROTEIN MEAL: CHICKEN AND CORN SOUP
• 6 cups chicken stock • 1 large chicken breast fillet (boneless) • 300 g canned corn kernels • 300 g canned creamed corn • 1 tablespoon cornflour (cornstarch) • 2 tablespoons light soy sauce • 2 eggs (beaten) • 2 spring onions (finely sliced) or 2 scallions (finely sliced) or 2 green onions (finely sliced)
1. Bring the stock to the boil in a large saucepan (depending on your taste or needs you may wish to substitute some of the stock for water).
2. Add chicken breast fillet to the stock, turn the heat off and cover the pain with a lid for 15 minutes.
3. Remove chicken breast from the stock and leave to cool for a few minutes then shred.
4. Add corn to stock and bring to the boil over a medium heat.
5. Combine soy sauce and cornflour into a paste then stir into the soup to thicken slightly.
6. Add shredded chicken to soup.
7. Slowly pour beaten eggs into the soup in a steady stream, stirring constantly with a fork.
8. Serve topped with the sliced spring onions and enjoy! NB: Cooking time includes the 15 minutes for "poaching" the chicken breast.
Servings per recipe: 4 - 6 Serving size: 1 cup
Nutrients per serving: Calories 283.4 kcal; fat 6.0g; cholesterol 109.4 mg; sodium 842.9mg; carbohydrates 39.6g; fibre 2.8g; sugar 5.5g