Nutrition in Chronic Renal Failure

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Abstract
Chronic renal failure affecting chiefly the glomeruli produces problems of abnormal retention of substances, whereas chronic tubular disease produces deficits principally of cations. The latter is simpler to treat, although there is a lack of adaptability to either deficits or excesses. Water intake should be high unless water retention or edema is present. Forcing fluids in the presence of edema will cause deterioration of renal function. The salt intake should average about 4 or 5 g daily. The salt intake should be reduced with water retention, but few patients will tolerate rigid restriction. Massive amounts of salt may be required in unusual instances. Potassium abnormalities are treated as indicated by the blood level and excretion studies. Patients with plasma potassium levels above 5.5 meq/liter should either be watched very carefully or treated with a potassium-absorbing resin. Calcium deficiency without blood phosphorus elevation responds well to oral administration of calcium, vitamin D, and alkali administration (after milk-alkali administration, vitamin D intoxication, and hyperparathyroidism have been ruled out). If the blood phosphorus is high, these measures are futile and phosphorus has to be eliminated with aluminum hydroxide. The diet should commtain about 0.5 g per kilogram of body weight of animal protein daily, supplied by a protein of high biological value, about 3–4 g per kilogram of carbohydrate, and 1–1.5 g per kilogram of fat. (See Appendix, Table III.) [See table in the PDF file]