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Navigating a Chronic Kidney Disease Diet for Individuals With Cancer

Published:February 25, 2021DOI:https://doi.org/10.1053/j.jrn.2020.11.003
      Understanding and following a diet for chronic kidney disease (CKD) can be difficult, especially with both cancer and CKD. A CKD diet can often limit the intake of protein, sodium, potassium, and phosphorus.
      • Ko G.
      • Kalanter-Zaden K.
      • Goldstein-Fuchs J.
      • et al.
      Dietary approaches in the management of diabetic patients with kidney disease.
      A cancer diet is more nutrient-dense in calories and protein intake to prevent cachexia.
      • Uster A.
      • Ruehlin M.
      • Mey S.
      • et al.
      Effects of nutrition and physical exercise intervention in palliative cancer patients: a randomized controlled trial.
      Cachexia is caused by undernutrition due to the high calorie and protein needs of the cancerous tumor, which can lead to longer stays in the hospital, more complications, and can impair quality of life.
      • Uster A.
      • Ruefenacht U.
      • Ruehlin M.
      • et al.
      Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial.
      For this reason, adequate nutrition is essential during cancer treatment to prevent cachexia.
      Monitoring protein intake is already a challenge for those with CKD. With increased protein needs during cancer, it is essential for protein sources to be added to the diet. Intake of plant protein has been found supportive in limiting CKD progression.
      • Ko G.
      • Kalanter-Zaden K.
      • Goldstein-Fuchs J.
      • et al.
      Dietary approaches in the management of diabetic patients with kidney disease.
      Therefore, adding tofu, legumes, whole grains, and other plant-based protein to the diet is a good option for those with CKD and cancer. Limiting high-fat meat and red meat is important in maintaining cardiovascular health while increasing protein intake due to cancer with CKD. For those struggling to find a diet that is CKD friendly while also containing healthy plant-based foods, a Mediterranean diet has shown promise in those with CKD.
      • Ajjarapu A.
      • Hinkle S.
      • Li M.
      • et al.
      Dietary patterns and renal health outcomes in the general population: a review focusing on prospective studies.
      ,
      • Rysz J.
      • Franczyk B.
      • Cialkowska-Rysz A.
      • Gluba-Brzozka A.
      The effect of diet on the survival of patients with chronic kidney disease.
      This type of diet is rich in fruits, vegetables, whole grains, legumes, olive oil, nuts, and lean protein. The Mediterranean diet is also high in monounsaturated fatty acids, which can help increase overall caloric intake.
      For some with CKD and cancer, it can be impossible to consume enough calories and protein to prevent malnutrition and cachexia.
      • Uster A.
      • Ruefenacht U.
      • Ruehlin M.
      • et al.
      Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial.
      ,
      • Rysz J.
      • Franczyk B.
      • Cialkowska-Rysz A.
      • Gluba-Brzozka A.
      The effect of diet on the survival of patients with chronic kidney disease.
      Nutrition supplements may be necessary to help increase oral intake for maintenance of a healthy body weight. In a study conducted with cancer patients, those who consumed one nutritional supplement a day, in addition to their normal diet, were able to maintain their body weight.
      • Uster A.
      • Ruefenacht U.
      • Ruehlin M.
      • et al.
      Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial.
      In the same study, individuals with cancer who received medical nutrition therapy had a higher total calorie intake, as well as a higher protein intake.
      • Uster A.
      • Ruefenacht U.
      • Ruehlin M.
      • et al.
      Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial.
      Therefore, a registered dietitian should be consulted for those with cancer and CKD to help maintain adequate intake and prevent malnutrition. Maintaining weight is extremely important to reduce negative outcomes, such as health complications while undergoing cancer treatment.
      Overall, maintaining adequate nutrition is a necessary goal for those with cancer and CKD. A healthy diet is the key to managing both cancer symptoms and CKD. Plenty of fruits and vegetables every day, 5-10 servings, is important to get vitamins and minerals and can be part of a renal diet. Whole grains are also important and can help increase calorie and protein intake. Protein intake needs to be monitored to ensure the proper amount of protein is being consumed. This is when working with a registered dietitian plays a key part in balancing a CKD and cancer diet. If calorie goals cannot be met orally, then diet modifications and nutrition support should be considered. A registered dietitian should be consulted to help balance the complexity of nutrition for CKD and cancer to help maintain proper caloric intake, a healthy weight, and optimal quality of life. The attached handout provides an overview of diet modifications and tips to help improve oral intake in the individual struggling with CKD and cancer.

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