“There is so much conflicting

information about diet & PKD...

What is the right approach ?”

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manage symptoms medication find a Dr info on diet

You are not alone !

This presentation will cover:

1. What diet to follow and why

2. What to avoid and why

3. FAQs about diet and PKD

4. Where to get more info

THE BASICS

PKD results in damaged kidneys

We measure the damage to kidneys using the eGFR (estimated Glomerular Filtration Rate)

We categorise kidney function into 5 stages using eGFR

WHAT DOES THIS HAVE TO DO WITH WHAT I EAT ?

The dietary recommendations are based on the stage of kidney disease

The dietary prescription will change over time

Knowing what stage of kidney disease you have is important if you are looking for dietary info

Stage of kidney disease eGFR range Role of diet

1 kidney damage normal function

> 90 ml /min Control risk factors and prevent disease progression

2 kidney damage mild loss function

89-60 ml/min

3a mild-moderate 59-45 ml /min

3b moderate-severe 44- 30 ml / min Symptom control

4 severe 29 – 15 ml /min

5 kidney failure < 15 ml / min Symptom control & manage side effects of treatment

WHAT DIET DO I FOLLOW IN ONE SENTENCE ?

Stage 1-3a or transplant: Healthy diet in accordance with AGHE or Mediterranean pattern. Reduced salt. Adequate fluid.

Stage 3b-5: Diet reduced in protein, salt, phosphate, with modification of fluid and potassium. Still adequate fruit, veg, breads & cereals but reduced in meat & dairy

If on dialysis: Diet high in protein, low in salt, phosphate, with modification of fluid and potassium. Still adequate fruit, veg, breads & cereals but increased in meat & reduced dairy

WHAT FOODS CAN I CHOOSE ?

Stage 1-3a or transplant:

✓ 2 pieces fruit (fit in palm of hand)✓ 2.5 cups vegies (5 handfuls)✓ 4-6 serves bread/ cereals ✓ Palm size portion meat / chicken / fish / eggs / legumes✓ 3-4 serves dairy eg 1 cup milk, 1 piece cheese✓ Fluid to thirst eg 2-2.5L of water ideally each day✓ Reduced salt and do not add at table

WHAT FOODS CAN I CHOOSE ?

Stage 3b-5:

✓ 2 pieces fruit (fit in palm of hand). Low-mod potassium✓ 2.5 cups vegies (5 handfuls). Low-moderate potassium✓ 4-6 serves bread/ cereals. May be low-mod potassium✓ Very small portion meat /chicken / fish / eggs / legumes✓ ~1 serve dairy eg 1 cup milk, 1 piece cheese✓ Usually fluid restricted eg 1500ml. SEE YOUR NEPHROLOGIST

AS THIS IS INDIVIDUALISED . Ideal fluid water✓ Reduced salt and do not add at table

WHAT FOODS CAN I CHOOSE ?

If on dialysis:

✓ 2 pieces fruit (fit in palm of hand). HD:Low-mod potassium ✓ 2.5 cups vegies (5 handfuls). HD:Low-moderate potassium✓ 4-6 serves bread/ cereals. HD:May be low-mod potassium✓ Large portion meat / chicken / fish / eggs / legumes✓ ~1 serve dairy eg 1 cup milk, 1 piece cheese✓ Usually fluid restricted eg 1500ml. SEE YOUR NEPHROLOGIST

AS THIS IS INDIVIDUALISED . Ideal fluid water✓ Reduced salt and do not add at table

IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?

YES1. Osmolar load is important

Diets high in animal protein increase urea, acid load, phosphate and solutes = increase cyst growth

Plant based diets do not have the same effect

High osmolar diet ie lots of salt, protein and molecules

WHAT DOES THIS ALL MEAN ?

Avoid high protein diets and reduce animal protein intake eglarge serves of meat, chicken, fish

Don’t need to be vegetarian but eat lots of plants and plant based products

IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?

2. Ketogenic diets – experimental evidence in mice only

If followed as 90% fat/ very small protein & carbs…can lead to increased B-hydroxybutyrate (BHB) …leads to reduced cyst growth

Authors: added BHB to normal diet of mice and found positive effects on cyst growth

IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?

2. Ketogenic diets – experimental evidenceIf we were to translate these experimental findings to humans…It would mean:No fruit, breads, cereals, Very small protein, limited vegiesLots & lots & lots of fat

Warning: Commercial BHB supps- can be high in protein and osmolar load

IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?

3. Intermittent fasting – experimental evidence in rats

Depriving body of glucose in PKD slows cyst growth

Only experimental evidence – unsure in humans

IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?

4. Caffeine – experimental evidence

Shown to increase cAMP = increase cyst growth

No studies in humans to demonstrate this

Recommendation: drink 2 or less cups of coffee / 4 or less cups of tea/day. Limit cola drinks to small amounts

IS THERE ANYTHING SPECIFIC TO PKD THAT IS DIFFERENT FROM OTHER PEOPLE WITH CKD ?

5. Oxalate – increased risk kidney stones in PKD

Can cause injury to kidney

Recommendation: Avoid large volumes of fruit juice esp green leafy juices

What are the take home messages ?

1. EAT LESS ANIMAL PROTEIN

2. REDUCE OSMOLAR LOAD

- read and use food labels to eat less salt - do not add salt at table- target high salt items and reduce or do not use

Nutrient Average contentPer serve (30g)

Average contentPer 100g

Energy 420 kJ 1400kJ

Protein 3.6g 12g

Fat 0.8g 2.8

Carbohydrate (total) 19g 64g

Sugars 0.9g 3.2g

Sodium 85mg 280mg

Potassium 100mg 340mg

They are all still salt !

DO NOT USE THESE

**HIGH IN POTASSIUM**

https://usafoods.com.au/products/mrs-dash-seasoning

https://usafoods.com.au/products/mrs-dash-seasoning

1. EAT LESS ANIMAL PROTEIN

2. REDUCE OSMOLAR LOAD

- read and use food labels - do not add at table- target high salt items

Top 10 contributors to salt intake in Australia . EAT LESS OF THESE

1. Processed meat eg pie, sausage roll, ham, bacon, deli meats, hot dogs

2. Bread

3. Sauces and dressings

4. Cheese

5. Processed veg eg canned, pickled, frozen, potato based

6. Biscuits & cookies

7. Milk products

8. Chips, crisps, popcorn

9. Margarine & butter

10. Spreads & dips, vegemite

3. EAT 2 SERVES FRUIT AND 5 SERVES VEGIES EACH DAY

4. DON’T OVERDO CAFFEINE, ALCOHOL, SOFTDRINK

5.SEE A RENAL DIETITIAN FOR MORE INDIVIDUALISED ADVICE

6.TRACK YOUR USUAL INTAKE FOR A FEW DAYS eg see Easy Diet Diary and enable renal options

Easy Diet Diary

Download and enable

renal options

More information

https://pkdcure.org/living-with-pkd/nutrition/

https://pkdcure.org/living-with-pkd/nutrition/

You can find me at: klambert@uow.edu.au

Twitter: @drkellylambert

Any questions?

Thanks!

mailto:klambert@uow.edu.au