- In the past, doctors may have reassured kidney donors that they are not at higher risk of end-stage renal disease (ESRD).
- But the risk of ESRD at 15 years after donation was 30.8 per 10,000 among kidney donors.
- A diet low in protein and sodium may reduce the risk of chronic kidney disease (CKD) and ESRD after nephrectomy.
Nephrectomy or the surgical removal of kidney, either for kidney donation or cancer, did not appear to be associated with a higher risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD).
The more recent literature, however, has been relatively consistent in suggesting that both donor and cancer nephrectomy are associated with a several-fold higher risk.
‘Lowered dietary protein intake of 0.8-1.0 g/kg per day combined with moderately low sodium diet of less than 4 grams per day might have a reduced risk of end stage renal disease.’
Risk of End Stage Renal Disease After Nephrectomy
For example, a study by Abimereki D. Muzaale, MD, MPH, of Johns Hopkins University in Baltimore, found that the risk of ESRD at 15 years after donation was 30.8 per
10,000 among kidney donors compared with 3.9 per 10,000 in a group of matched healthy non-donor counterparts
Based on a meta-analysis, Morgan E. Grams, MD, also of Johns Hopkins, and colleagues found that the 15-year observed risks for ESRD were 3.5 to 5.3 times as high as the projected risks in the absence of donation.
"Not infrequently, both urologists and nephrologists provide follow-up and continuity of care to patients after cancer nephrectomy. Patients invariably ask us what to eat to protect the remaining kidney. We deal with the same question from kidney donors."
In the past, doctors may have reassured kidney donors that organ donors are not at higher risk of ESRD.
It would be naive for physicians to believe that patients with a solitary kidney after nephrectomy do not have a serious condition and do not need dietary advice or diet and lifestyle modification. In fact, many contemporary patients who undergo donor or cancer nephrectomy demand nutritional advice.
Nutrition Management to Reduce Risk of ESRD
No controlled clinical trial, however, has examined whether dietary approaches, such as a low-protein and low-salt diet, are effective in mitigating the higher risk of CKD and ESRD, but there are extensive data suggesting that higher protein intake is associated with glomerular hyperfiltration and higher risk of CKD.
Nephrologists invariably suggest slightly lowered dietary protein intake of 0.8-1.0 g/kg per day combined with moderately low sodium diet of less than 4 grams per day.
This slight dietary modification is pragmatic, as many of the patients do follow these recommendations. But there is an urgent need for studies on more specific recommendations.
Dietary Suggestions To Avoid Renal Failure
The diet for patients with kidney failure will depend on their weight, blood tests and dialysis choice. The diet may change as the disease progresses. So, it is necessary to seek the advice of a health care provider or a renal dietician for diet guidance.
- Avoid foods with high sodium content: Too much sodium in the diet can cause fluid retention and raise your blood pressure. Seasonings like soy sauce and teriyaki sauce, canned foods, processed meats, snack foods, pizza, hot dogs, pickles, cheese, and even frozen vegetables with sauce are high in sodium.
- Reduce Salt intake: The best way to cut back on sodium is to avoid excess intake of salt. Fresh food contains only 10 percent of sodium and the rest comes from the salt used in cooking.
- Cut down on Potassium: Potassium levels of 6.5 or higher can lead to a cardiac arrest. Apricot, banana, prunes, kiwi, melon, raisin, orange and orange juice are the fruits rich in potassium. Vegetables such as potato, tomato, sweet potato, cooked spinach, baked beans, lima bean, kidney bean, pinto bean, and dried peas contain potassium.
- Restrict protein intake: Although protein is an essential part of a diet, the waste products from the protein breakdown is cleaned from the blood by the kidneys.
So, eating more proteins puts extra burden on the kidneys leading to faster decline in kidney function. It is better to avoid high protein animal foods such as ground beef, halibut, salmon, tuna and chicken breast and substitute them with lower protein animal and vegetable alternatives.
- Limit fluids: To prevent fluid and waste from building up in the body, it is necessary to restrict fluids as one of the main functions of the kidney is to get rid of excess fluid.