Perawatan Kesehatan untuk Pasien CKD

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Medicines and herbal products that should be avoided in kidney patients

Maintaining water and minerals balance as well as excreting waste products out of the body are two main functions of the kidney. Patients with impaired kidney functions are prone to have certain drug toxicity. Therefore, kidney patients should use medicines cautiously especially OTC (over-the-counter-drugs) that can be found typically in drugstores (e.g. cough and cold medicines, painkillers, laxatives, vitamins, dietary supplements, herbal medicines and etc.)

Patients may think that these available medicines are general safe, but some of these medicines should be avoided in patients with known kidney impairment.

  • NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, mefenamic acid, naproxen, piroxicam, meloxicam, diclofenac, celecoxib, etoricoxib, etc. are widely used as painkillers. One of the effects of these medicines is reducing blood flow to the kidney resulting in reduction in kidney function.
  • Medicines containing sodium or effervescent tablet form like aspirin effervescent tablet, water soluble vitamin causes sodium, water and mineral retention.
  • Cough syrup often contains some herbs which may cause high potassium blood level (which may be harmful to your heart).
  • Laxatives or antacids containing aluminium and magnesium can have effect on nervous system if highly accumulated in blood circulation.
  • Laxatives or suppositories may result in water dehydration and high phosphate blood level.
  • Certain dietary supplements contain potassium and magnesium that can be built up in the body.
  • Herbs for examples, laxatives containing Isphagula Husk cause high blood potassium levels. Gingo Biloba, ginseng or garlic effect on blood clotting system causing fistula or graft bleeding in patients on dialysis.
 Patients with decreased kidney function should avoid taking any kind of herb/Chinese herb products (e.g. capsule, solution). Those may cause high blood potassium levels which may be harmful to your heart and kidney.  

Kidney patients guide

  • Always share the information of all your medications (including vitamins, dietary supplements, herbs & OTC products) with your doctors
  • If feeling sick or unwell, consult with a physician
  • Always notify your physician if you experience any abnormal sign or symptom such as nausea, vomiting, loss of appetite, weight gain, swelling in the legs, shortness of breath, muscle pain or cramps, numbness in arms or legs, skin irritation, or uncontrolled, frequent, painful urination.

The importance of diet for chronic kidney disease patients

Diet control is crucial for CKD patients because it helps:
  • delay kidney deterioration
  • postpone the stage that dialysis is necessary
  • alleviate the burden of kidneys in getting rid of waste products
  • mitigate the workload of kidneys
  • reduce the buildup of waste products from food
  • prevent malnutrition
  • improve patient's health and quality of life

Nutrients that have an impact on kidney disease

When renal patients are at the stages in which kidneys do not function efficiently, or when blood test results come out abnormal, patients should be advised about foods that they need to avoid or restrict. Certain nutrients cause health problems when consumed excessively because they leave too much waste products in the body. Important nutrients in food that normally have negative impacts on kidney disease are:
  • Sodium Our body needs sodium in small amounts to control blood pressure. In renal patients, kidneys cannot remove excessive sodium, resulting in fluid retention and swelling. This condition leads to hypertension, pleural effusion and may cause heart failure.
Food to avoid or limit: sodium-rich food; for example, salted fish, ham, bacon, sausages, pickled food, salted snacks and cheese. In addition, foods that are not salty but contain sodium should also be avoided, such as bread that contains sodium bicarbonate.
  • Potassium is a mineral that makes muscles and nerves work properly. When kidney function reduces, the ability to remove potassium through urine is decreased, leading to potassium accumulation. When the potassium level is too high, muscles get weak or cramp, and patients may experience irregular heartbeat. Patients in early stages of kidney disease (eGFR >90 mL/min/1.73m2) and middle stages (eGFR 30-59 mL/min/1.73m2), whose kidneys still remove waste and whose potassium level in the blood is considered moderate or at 3.5-5.0 milligrams/deciliter, may continue to consume fruits and vegetables. However, renal patients whose level of potassium in the blood is nearly or over 5.0 milligrams/deciliter need to control fruits and vegetables consumption. Patients in this group can eat fruits and vegetables that are low in potassium once or twice per day. Vegetables and fruits low in potassium include cabbage, cauliflower, cucumber, lettuce, sprouts, grape and pineapple.
Food to avoid or limit: potassium-rich food; for example, all kind of dried fruits, durian, tamarind, cantaloupe, Tahitian noni juice, tomato, green leafy vegetables, turnip, bananas, oranges, papaya and jackfruit.
  • Phosphorus When the kidneys fail, our body is unable to absorb calcium and remove phosphorus. Therefore, the body receive only small amount of calcium but retain too much phosphorus in the blood.
Food to avoid or limit: bran, cheese, milk and dairy products, sweetened condensed milk, fish roe, egg yolk, shrimp, crab, products that contain sodium bicarbonate, nuts, dried beans and dark-color soda.
  • Protein is a nutrient that our body needs. Even renal patients must consume foods that provide protein, but in limited amount. When the body breaks down and absorbs protein from food, waste products are produced in the process and excreted through kidneys. Eating too much protein makes the kidneys work hard, which is why renal patients should limit amount of foods protein-rich foods, both from plant and animal.
Food to avoid or limit: meat and protein with fat and cholesterol such as yolk, entrails and giblets, pork skin, chicken and duck skin, pork and beef with fat, fatty spareribs, barbecued suckling pig, Peking duck, streaky pork, crackling pork, roasted duck, geese stewed in pa-lo gravy, fish roe and prawn roe. In addition, meat that lacks essential amino acids should also be avoided because it makes kidney work hard in getting rid of waste products. Meat in this group includes sinew of pig, cow and chicken, shark fins, feet of duck and chicken, skin, cartilage, nuts, dried beans and food stuffed with nuts. 

Dietary Recommendations

  • Eat a variety of food in each meal. Be certain to include rice, meat, vegetables and fruits.
  • Chronic kidney disease patients must refrain from artificial seasoning sauce, artificial salt, artificial soy sauce, and artificial fish sauce. Use spices to enhance the flavor instead.

Many chronic disease patients feel they are too weak or too sick to exercise. This does not mean that exercise should be avoided. It may be the very thing your body needs. Your muscles and heart become weak when you inactive and your joints get stiff. Exercise can reverse this and make you feel healthy again.

The importance of Exercise

  • Strengthens your heart and reduces the risk of heart attack.
  • Increases your hematocrit and hemoglobin levels which necessary for oxygenation all the organs in the body. Improves your glucose control.
  • Decreases your blood pressure
  • Decreases levels of cholesterol and triglycerides.
  • Reduces stress.

Exercise recommendations

**At first, consult doctor before start exercise**
Choose an activity that is both convenient and enjoyable to you, whether it is floor exercise, walking, swimming or bicycling.  Exercise should be a minimum of three days per week. During the first week, exercise five minutes each session, then adds one or two minutes per session each week until you gradually work up to one half hour. For weight control and increased benefits, try longer walks (at least 20-30minutes).

Do not exercise under any of these conditions
  • If you have a fever.
  • If the weather is very hot and humid.
  • If you have any orthopedic conditions

Stop exercising if you feel any of the following
  • Excessively fatigued
  • Short of breath
  • Chest pains
  • Irregular or rapid heart beats
  • Nausea
  • Leg cramps 

Smoking allows other toxins into the body and harms nearly every organ of the body. Smoking causes changes in the blood vessels, forming arteriosclerosis (thickening and hardening) of the arteries and leads to heart disease, stroke, bronchitis, lung cancer.

Some of the possible ways smoking is thought to harm kidneys are by:
  • Increasing blood pressure and heart rate
  • Reducing blood flow in the kidneys
  • Narrowing the blood vessels in the kidneys
  • Damaging arterioles (branches of arteries)
  • Forming arteriosclerosis (thickening and hardening) of the renal (kidney) arteries
The risks in CKD get even higher for patients who smoke. As the number of cigarettes smoked increases, so does the rate of end stage renal disease. Smoking raises blood pressure and increases the risk for proteinuria (an excessive amount of protein in the urine), which means kidneys may be failing. Smoking has also been shown to hasten the progression of other types of kidney disease. The effects of smoking in diabetic disease are well documented. For diabetics who smoke, there is a higher risk of getting kidney disease. For diabetics with kidney disease, who smoke, lose kidney function more quickly than diabetics who do not smoke, or who quit smoking. In addition, smoking increases high blood pressure and cardiovascular risks, two health problems that often occur along with kidney disease. Stopping smoking has been shown to be one of the most important things a person can do to help maintain kidney function.

Tips to stop smoking

Since the number of cigarettes smoked tend to increase the risks for end stage renal failure, cutting down may be helpful. Ideally, however, quitting would be the best option. While quitting is difficult due to nicotine addiction, cravings and temptations, there are steps to help you succeed in not smoking. Sometimes it takes a few tries to stop smoking completely, but it’s worth the effort to become smoke free.
  • Talk to doctor about nicotine-replacement therapies like gums and patches, as well as medicines to help you
  • Give yourself a quit date and throw out all tobacco products
  • Have a strategy for helping you overcome cravings, such as: chewing gum, sucking on hard candy, trying deep breathing or meditation until the urge passes, and doing something to reduce your stress
  • Join a quit-smoking program
  • Keep trying until you quit

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