Our friends with kidney disease often suffer from "hidden hunger" because of impaired renal function, side effects of drugs and dialysis, or because the level of toxins in the body is too high, which leads to complications and accelerated progress of kidney disease.
At this time, targeted nutrition supplementation is needed, which is helpful to delay the progress of renal function and improve the course of disease and prognosis.
There are eight main types:
1. calcium
2. Iron
3. Zinc
4. Vitamin B6 (pyridoxine)
5. Vitamin B9 (folic acid)
6. Vitamin B 12 (cobalamin)
7. Vitamin Bt (L-carnitine/L-carnitine)
8. Calcified alcohol
Let's start with priorities.
As an immunomodulator, vitamin D may be the most commonly needed nutrient for patients with nephropathy. Studies have shown that after taking vitamin D, the urinary protein of patients with nephropathy decreased 15%-20%, which has a positive effect on preventing nephropathy from progressing to uremia.
Vitamin D can reduce urinary protein by negatively regulating renin-angiotensin system, resisting inflammatory reaction, inhibiting mesangial cell proliferation, inhibiting podocyte apoptosis and inhibiting tubulointerstitial fibrosis.
Now people's living conditions are better, but vitamin D is even more scarce. Vitamin D can be supplemented by sunlight, but nowadays people, especially city residents, stay indoors for a long time and seldom get sunshine.
Moreover, vitamin D originally supplemented in the sun has no activity, and vitamin D3 can only be used by the human body after being activated by the kidney. In patients with impaired renal function, the ability of kidney to activate vitamin D is reduced, and it is easier to lack active vitamin D (vitamin D3), so it is necessary to supplement active vitamin D, such as calcitriol.
If the liver function is normal, α calcitriol can also be added, which is an analogue of calcitriol. After entering the human body, it can be converted into calcitriol through the liver.
CSPPT research shows that 0.8mg folic acid supplementation every day can delay the decline of glomerular filtration rate (renal function) in chronic nephropathy.
Some countries have forced folic acid to be added to food for national supplementation. Because the absorption rate of natural folic acid is only about 50% (the absorption rate of synthetic folic acid can reach about 80%), and more than half of folic acid will be lost during cooking.
Especially patients with kidney disease. Folic acid is common in high-protein foods, but patients with kidney disease need a low-protein diet, which is easy to make kidney friends lack folic acid.
The above two nutrients have obvious benefits to renal function and are recommended. It seems that there is no problem for kidney friends to "eat without brains" even if the relevant indicators are not detected. However, if you want to supplement the following nutrients, you should pay attention to whether you are deficient.
Kidney disease patients who are prone to calcium deficiency include:
(1) massive proteinuria (calcium combines with albumin and loses with urinary protein);
(2) taking glucocorticoids (causing decreased intestinal calcium absorption and increased urinary calcium excretion);
(3) Renal failure (the ability of kidney to activate vitamin D is decreased, and fibroblast growth factor 23 is increased);
(4) Secondary hyperparathyroidism; Wait a minute.
Calcium can be supplemented by calcium carbonate D3 tablets, which should be taken at meals or after meals, because calcium tablets can be fully absorbed and utilized by decomposing into calcium ions under the action of gastric acid.
Dairy products are the best way to supplement calcium in diet, and one cup of milk is better than two jars of bone soup (bone soup does not supplement calcium). Secondly, although the absorption rate of calcium in green leafy vegetables and bean products is low, the consumption is large, and it also has a certain calcium supplement effect.
However, it should be noted that if calcium-containing drugs such as calcium-containing drugs and high-calcium dialysate are used, hypercalcemia is prone to occur, so don't blindly supplement calcium.
Patients with renal diseases, especially those with renal failure and uremia, suffer from poor appetite and high toxic environment, which may lead to iron deficiency, which is one of the causes of renal anemia.
In the daily diet, the food with the best iron supplement effect is red meat (pig, cow, mutton), which is rich in iron and the iron absorption rate is as high as 20%. Eating red meat in moderation is good for friends with iron deficiency.
However, patients with kidney disease, especially those with renal failure, should not eat a lot of meat, and need to supplement iron agents when necessary, such as ferrous sulfate, ferrous fumarate tablets, ferrous lactate, polysaccharide iron complex and other iron elements.
Zinc deficiency in uremic patients generally leads to loss of appetite, rough skin, growth retardation and anemia, and long-term zinc deficiency can also lead to sexual dysfunction and even infertility.
Dialysis patients should regularly check serum zinc and give oral preparations such as 10% zinc gluconate in time.
The symptoms of vitamin B6 deficiency are very similar to uremia.
In patients with stage 4-5 chronic kidney disease, the higher toxin level in the body will interfere with the absorption and utilization of vitamin B6, so vitamin B6 can be supplemented, and the daily dose is not less than 10mg.
Both vitamin B9 and vitamin B 12 are related to hematopoietic function. However, compared with vitamin B9, the content of vitamin B 12 in patients with common kidney disease is higher, so it is unnecessary to supplement it deliberately.
If accompanied by anemia, vitamin B9 and vitamin B 12 can be supplemented at the same time.
If accompanied by hyperhomocysteinemia, vitamins B6, B9 and B 12 can be supplemented at the same time.
L-carnitine, also known as L-carnitine and vitamin Bt, is a special vitamin, which is similar to choline and amino acid in chemical structure and can be synthesized by human body.
However, when entering renal failure, the synthesis of L-carnitine is insufficient, especially in dialysis patients. L-carnitine will be lost during dialysis, and it is difficult to maintain the normal level even if you eat more red meat.
Most dialysis patients need intravenous drip of L-carnitine to improve anemia and prevent cardiovascular diseases and other complications.
The lack of these nutrients will have adverse effects on various organs (including kidneys), but patients with nephropathy have no particularity and are not discussed much. If it is lacking, it can be supplemented appropriately.
Daily diet can meet the human body's demand for vitamin A. Vitamin A in patients with kidney disease often rises and generally does not need to be supplemented.
Minerals and vitamins do not require "satiety" like staple foods, but "eating right".
Many people have an idea that China people generally lack minerals and vitamins, and need to supplement calcium, iron, zinc, selenium and vitamin ABCDE, so it is wrong to buy all kinds of comprehensive nutritional supplements.
In fact, our living conditions are better now, and the lack of nutrients has greatly improved compared with the past. For example, most children are taller than their parents. Many middle-aged and elderly patients with nephropathy are diabetic nephropathy. Studies have shown that comprehensive supplementation of B vitamins will increase the cardiovascular incidence of patients with diabetic nephropathy.
Not everyone and all kidney friends should fully supplement all kinds of nutrition, and it is the best choice to follow the doctor's advice and supplement accurately.