Starchy vegetables Each serving contains approximately 15 grams of carbohydrate. Crackers and snacks Each serving contains approximately 15 grams of carbohydrate. Dairy and dairy substitute products Each serving contains approximately grams of carbohydrate. Sweets and desserts Each serving contains approximately 15 grams of carbohydrate.
If you have diabetes, understanding which foods contain carbohydrates and how much you can eat is important for blood sugar control. Taking diabetes medication prescribed by your doctor is not enough to manage blood sugar levels. Controlling diabetes includes:. Not all carbohydrates fit into a kidney diet because they contain high amounts of phosphorus , potassium , sodium or fluid , such as:. Some of the above foods may be worked into a healthy kidney diet depending on your lab results for potassium and phosphorus.
Work with your dietitian to individualize your meal plan when including these foods. If you do in-center hemodialysis or home hemodialysis HHD , you may have different carbohydrate needs for your dialysis diet. Your individual need for foods containing carbohydrate is typically half of your diet. For example, if you need 2, calories to meet your daily needs, then , calories should come from carbohydrate foods.
This equals grams of carbohydrate a day. For people on peritoneal dialysis PD , the need for carbohydrates is less than for people on hemodialysis. In PD, a dialysate containing dextrose — a form of sugar — is used to pull waste and fluid out of the blood. Because dextrose is a carbohydrate like glucose, your body absorbs these calories, decreasing your need to consume carbohydrates in food. These excess calories can affect weight control and blood sugar management.
The rest of your calories should come from protein foods and fat. For example, if you need 2, calories per day, calories should come from carbohydrate foods. Approximately calories are provided from the dialysate throughout the day. The percentage of dextrose in your dialysate and the type of PD you choose — continuous ambulatory peritoneal dialysis CAPD or automated peritoneal dialysis APD — may affect how many calories your body absorbs.
This table shows how many calories you may absorb per liter:. Consider which type of dextrose you use for treatment and how many bags you use each day. You may gain weight if you use too much of the more concentrated solution.
Data for the cross-sectional analyses were obtained from participants at BMES Of these, participants had fasting blood collected and also had complete dietary data available.
Among these participants, We compared the baseline characteristics of the study sample across dietary GI quartiles Supplemental Table 1. Male sex, smoking status, alcohol consumption, serum total homocysteine, serum total TG, hemoglobin, hematocrit, dietary intake of total fiber, carbohydrate, sugar, and starch differed across the GI quartiles.
We examined the association between carbohydrate nutrition and prevalence of CKD in older adults Table 1. Additionally, a trend was observed with increasing dietary intake of GI, i.
Additional adjustment for BMI, smoking, alcohol consumption, physical activity, serum total homocysteine, serum total cholesterol, serum TG, hypertension, and history of diagnosed diabetes. The association between dietary intake of fiber from various sources and the prevalence of moderate CKD was also assessed Table 2.
However, this trend became nonsignificant after further adjustment for other confounders. Additional adjustment for body mass index, smoking, alcohol consumption, physical activity, serum total homocysteine, serum total cholesterol, serum triglycerides, hypertension, and history of diagnosed diabetes. Includes soft drinks, cordials, cookies, cakes, buns, scones, pastries, confectionary, sugar, honey, jams and syrups.
We also examined the association between components of carbohydrate nutrition and fiber as a continuous variable and prevalence of moderate CKD. At the 5-y follow-up, BMES-1 survivors with fasting blood collected and who also had complete dietary data available were reexamined. Of these, did not have moderate CKD at baseline and hence were included for incidence analyses. There were 67 7. Additional adjustment for serum total homocysteine, hemoglobin, and hematocrit.
A higher baseline intake of foods rich in refined sugars or refined starches yielded a 3-fold higher risk of having incident moderate CKD Table 5. After multivariable adjustment, consumption of breads and cereals at baseline was not associated with the 5-y incidence of CKD Table 5. Includes soft drinks, cordials, cookies, cakes, buns, scones, pastries, confectionary, sugar, honey, jams, and syrups.
To our best knowledge, this report provides novel epidemiological evidence about the association between carbohydrate nutrition and reduced eGFR in a cohort of older adults. This minor inconsistency between the prevalence and incidence findings could be related to statistical power issues.
Over a 5-y follow-up, a diet high in cereal fiber had a protective influence on kidney function. In contrast, high consumption of energy-dense, nutrient-poor sources of carbohydrates at baseline had an adverse influence on renal function 5 y later. This suggests that the effects of dietary fiber on kidney health could vary depending on the food sources, which is consistent with prior reports that have shown varying effects of fiber from different food sources on cardiovascular outcomes Several mechanisms could underlie the temporal association with cereal fiber.
First, there is clear evidence to suggest that a harmful proinflammatory state exists in CKD and that this state is heightened in end-stage kidney disease 3. The protective influence of cereal fiber on kidney function could be due in part to the avoidance of postprandial hyperglycemic spikes 27 , because recurrent postprandial hyperglycemia results in overproduction of reactive free radicals and greater release of inflammatory cytokines 12 , 15 , Also, among women with type 2 diabetes, adiponectin, which has been shown to have pronounced antiinflammatory effects, was positively associated with cereal fiber intake Second, the presence of albuminuria is associated with CKD 29 and it has been demonstrated that the presence of albuminuria predicts progressive CKD independent of the level of eGFR Hence, a high intake of dietary fiber could reduce the risk of albuminuria, and thus the development of CKD.
Other mechanisms may include the alkalinizing effects of fiber supplementation previously observed in rat models This alkalinizing effect of dietary fiber could help maintain an optimum acid-base status and prevent metabolic acidosis, which has been associated with worsening renal function Third, cereal fiber intake could reduce known risk factors for moderate CKD.
A key risk factor for declining renal function is diabetes, and dietary intake of cereal fiber has been previously associated with reduced incidence of diabetes in a U. Another risk factor for CKD is hypertension and a recent meta-analysis demonstrated the blood pressure-lowering effects of dietary fiber 34 , Cereal fiber intake could also reduce the risk of hyperlipidemia, because it has previously been shown to lower total and LDL cholesterol concentrations Fourth, cereal fiber consumption could replace the intake of other foods with potentially adverse effects on kidney function e.
Moreover, increasing the dietary intake of fiber could help reduce the ratio of dietary protein:carbohydrate and thus attenuate the production of bacterial metabolites e. Also, certain constituents of dietary cereal fiber, such as trace elements, could reduce the risk of CKD in a manner similar to that observed for cardiovascular disease risk 26 , Alternatively, microvascular abnormalities in the kidney are common histopathologic findings in patients with CKD or renal failure High dietary fiber intake was previously shown to be linked to wider retinal arteriolar caliber and narrower venular caliber i.
Hence, dietary intake of cereal fiber could also have direct beneficial effects on kidney function by the prevention of microvascular abnormalities in older adults.
Nevertheless, we need to highlight that the BMES is an observational study and hence we need to be cautious, because we cannot confer a cause and effect relationship between dietary fiber intake and incident CKD. Further, longitudinal studies are needed to confirm our study findings.
In our older cohort, high consumption of energy-dense, nutrient-poor sources of carbohydrates e. Large quantities of such foods could be associated with higher blood glucose levels and insulin levels and could elevate FFA levels Acute hyperglycemia in healthy humans impairs endothelium-dependent vasodilation 41 and reduces NO availability Hence, hyperglycemia-induced oxidative stress contributing to a state of chronic low-grade inflammation may be the primary mechanism underlying this observed association in our study 27 , Obesity, another risk factor for CKD, may also be an additional consequence of high intake of energy-dense, nutrient-poor sources of carbohydrates Further, fructose could itself cause kidney damage, perhaps by raising serum uric acid levels 44 , and has also been shown to induce a proinflammatory response in the kidney that could contribute to the progression of CKD Finally, ingredients in, e.
However, we did not find a temporal link between dietary GI and CKD, and this could be due to the small numbers of incident cases of CKD, with a resultant lack of study power. Other reasons could include the short follow-up duration 5 y and the relatively high average age of the cohort, so that many of the adverse effects resulting from the consumption of high-GI foods could have already been exerted before the cohort was followed.
Also, survival bias could have played a role in the nonsignificant association. BMES participants, who had not yet developed CKD at the time of the first examination, could have some unidentified protective factor making them less likely to be at risk of reduced renal function in later years.
Further, we have attempted to adjust for a large number of confounders in the analyses; however, as with all observational studies, we cannot rule out the possibility that residual confounding e. The strengths of our study include its representative population-based sample with relatively high participation, minimizing selection bias, and use of a validated food questionnaire to collect dietary information and detailed questionnaires that permitted careful assessment of potential confounding variables.
However, there are limitations to consider. There is potential for misclassification, because information on dietary intake was collected by self-report. Although random within-person variation could attenuate any true association, the FFQ was designed to minimize this error by assessing average long-term dietary intake during the successive follow-up period These repeated measurements take into account possible changes in diet with time and reduce random variation in reporting.
Although the total effects of carbohydrate intake may not be fully depicted by the questionnaire, any measurement errors should be unrelated to the endpoints due to the prospective study design Finally, the BMES was not designed to examine issues of kidney function per se but rather to examine issues of sensory loss.
As such, we do not have urinalysis results, although we have estimated renal function in our participants using a widely accepted method. However, limitations of such estimated measures of kidney function exist and therefore should not be accepted unconditionally as a reliable substitute for direct renal function measurement In summary, a diet high in cereal fiber was protective against the development of moderate CKD among older adults.
The potential protective influence of cereal fiber on kidney function may be secondary to its effects of lowering postprandial glycemia. In contrast, higher consumption of energy-dense, nutrient-poor sources of carbohydrates at baseline increased the risk of moderate CKD 5 y later. Given the considerable health burden from CKD, recommendations to consume diets high in cereal fiber and low in energy-dense, nutrient-poor sources of carbohydrates could help maintain kidney function.
All authors read and approved the final manuscript. Oxidative stress in renal dysfunction: mechanisms, clinical sequelae and therapeutic options. J Hum Hypertens. Google Scholar. Omega-3 and renal function in older adults. Curr Pharm Des. The role of oxidative stress in chronic kidney disease.
Semin Dial. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int Suppl. Carbohydrate Counting with Chronic Kidney Disease. Jump to page content What is carbohydrate counting? What is a carbohydrate? Where are carbohydrates found?
What is a serving size of carbohydrate? Carbohydrate Counting and Meal Planning Ask your dietitian to help with your carbohydrate counting plan. What is carbohydrate counting? There are two types of carbohydrates: complex carbohydrates or starches, which usually raise blood sugar more slowly it takes your body longer to digest and absorb these simple carbohydrates or sugars, which usually raise your blood sugar more quickly than complex carbohydrates.
Carbohydrates are naturally found in many different foods. Carbohydrate Counting and Meal Planning. Important things to remember when carbohydrate counting: Eat at about the same time every day to keep blood sugars stable throughout the day. Eat the same amounts of carbohydrate at each meal and snack. Eat a meal or snack every hours to keep blood sugars even.
Do not skip meals.
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