Lifestyle and disease management

Recommendations for drinking water

Drink water regularly - Our body can't store water, so you should drink it regularly, in small portions throughout the day, even when you don't feel thirsty.

Adjust the amount of water according to your needs - It is recommended to drink 1.5 to 2 liters of water per day for adults, depending on gender, ambient temperature and physical activity, and up to 4-5 liters in intense exercise or hot weather.

Monitor hydration - It's a good idea to set goals for the amount of water you consume, such as dividing your day into glasses or labeling your bottle to control the amount you drink.

Start and end the day with water - It is a good habit to drink a glass of water right after waking up and before bed to stay hydrated throughout the day.

Carry water with you - Remember to always have water on hand, especially when traveling, at work, walking or working out, to make it easier to drink regularly.

Make your water taste more varied - To encourage yourself to drink more water, you can add fresh fruit, mint or other natural ingredients to make it more appealing.

Include other fluids and products - In addition to water, your diet should include other sources of fluids, such as teas, herbal infusions, soups, and fruits and vegetables with high water content.

Make water easy to access - Keep water in sight, such as on your desk, in your purse or in a bottle, as a reminder to drink regularly.

Be mindful of special groups - The elderly may feel thirst more acutely, so they should pay special attention to hydration to avoid dehydration.

Set a good example for children - Develop the habit of drinking water in your children by showing them that it is a daily routine and drinking water together with them.

Physical activity in different stages of MS

Physical activity is an important part of a healthy lifestyle, including for patients with chronic kidney disease (CKD). A well-chosen exercise program can improve quality of life, physical condition and benefit the course of the disease. Below are recommendations for physical activity, tailored to the different stages of renal failure and the presence of comorbidities. Before starting any exercise program, consult your doctor or physiotherapist. They will help you select the appropriate type and intensity of exercise.

Stage 1 and 2 PChN (mild kidney damage):

In these stages, regular, moderate physical activity is recommended, at least 150 minutes a week. You can engage in aerobic exercises such as brisk walking, cycling, swimming or dancing. Strength training twice a week, involving all muscle groups, is also advisable.

Stage 3 PChN (moderate kidney damage):

In stage 3, you can still lead an active lifestyle, but more caution may be necessary. Moderate aerobic exercise, such as walking or cycling, for 30 minutes a day, five times a week is recommended. Weight-bearing exercises can be continued, but with a lighter load adapted to your condition.

Stage 4 PChN (advanced kidney damage):

In stage 4, it is important that physical activity is tailored to your abilities. Shorter exercise sessions, such as 15-20 minutes a day, five times a week, are recommended. Choose gentle exercises, such as walking or biking. Avoid intense workouts, which can lead to overloading the body.

Stage 5 PChN (end-stage renal failure):

In end-stage renal failure, physical activity should be minimal and always consulted with a doctor. Light exercise, such as walking around the house or gentle stretching, is recommended. If you are undergoing hemodialysis, you can do simple exercises during the procedure if your doctor recommends it.

Physical activity can help control blood glucose levels. Regular low- to moderate-intensity exercise, such as walking, is recommended to promote control of these diseases. Avoid high-impact exercise, which can lead to hypoglycemia.

Physical activity can help control blood pressure. Regular low- to moderate-intensity exercise, such as walking, is recommended to promote control of these diseases. Avoid high-impact exercises that can lead to sudden spikes in blood pressure

If you have heart disease, it is important to have your physical activity monitored by your doctor. Moderate exercise, such as walking, is recommended, but the intensity should be low to avoid excessive strain on the heart.

In all stages of PChN and in patients with comorbidities, breathing exercises are particularly beneficial. They help improve lung capacity and oxygenate the body. Perform them daily for 10-15 minutes.

The key element is regularity. Even short sessions of exercise, but done daily, can bring significant benefits to your health.

Don't forget about adequate rest and recovery after exercise. In stage 3-5 of PChN, recovery time should be longer so as not to overload the body.

When exercising, pay attention to your well-being. If you experience pain, shortness of breath, dizziness or other worrisome symptoms, stop exercising immediately and consult your doctor.

Remember that physical activity, even in a limited way, is beneficial to your health. However, it is important to adjust the intensity and type of exercise to your health condition and stage of illness. Regular exercise can improve your well-being, increase your muscle strength and have a positive effect on cardiovascular function.

Monitoring of the liquid balance

Fluid balance refers to the balance between the amount of fluids taken in by the body and the amount of fluids excreted. The purpose of monitoring fluid balance is to maintain adequate fluid levels in the body to prevent health problems.

Noting fluid intake:
Record and log all fluid intake, including drinks, soups and liquid foods, to assess total fluid supply. Follow your doctor's recommendations for the recommended daily intake limit for fluids and salt. You can use a measuring cup to accurately measure the amount of fluids in your diet.
Record fluid excretion:
Monitor and record the amount of fluid excretion, including urine, to assess daily fluid balance
Weight control:
Regularly measure and record your body weight at a consistent time. Any significant changes in weight may indicate an abnormal fluid balance.
Monitor clinical signs:
Regularly check for the presence of edema, accelerated heart rate or headaches, which may suggest a fluid balance disorder
Blood pressure monitoring:
Regularly measure blood pressure and record measurements. Fluctuations in blood pressure can be an indicator of an abnormal fluid balance.
Systematic reviews:
Conduct regular systematic reviews of your fluid balance with your doctor to ensure that the methods you use are effective and tailored to your health needs.
Monitor laboratory parameters:
Regularly monitor laboratory results, such as electrolyte levels, creatinine and urea, which can help assess fluid balance.

Diet in stage 3 and 4 PChN

The diet for a patient with stage 3 and 4 chronic kidney disease should be carefully planned to support kidney function and prevent further progression of the disease:

Limit sodium intake:
Consuming too much salt can raise blood pressure and stress the kidneys. It is recommended to limit salt to 1,500-2,300 mg per day (about half a flat teaspoon). Instead of salt, use herbs and spices to improve flavor.
Limit potassium in your diet:
Although potassium is important, excess can be dangerous. Determine with your doctor whether you should limit it. If so, avoid potassium-rich foods such as bananas, tomatoes, potatoes, orange juice and ketchup. Choose vegetables low in potassium, such as cabbage, cucumber, onions and peppers, which can provide essential vitamins and minerals.
Pay attention to phosphorus:
Phosphorus is present in many foods. It is excreted by the kidneys. If kidney function is impaired, excess of this element can accumulate in the body and cause bone and heart problems. Avoid products such as sodas, cheese, nuts and whole grain cereal products. Read labels and avoid products containing additives with phosphates. Give up cured meats, which are high in salt and phosphorus.
Control your protein intake:
protein is essential, but excess protein can stress the kidneys. Choose protein sources with high biological value, such as lean turkey, chicken, fish, eggs, low-fat dairy products. Limit your intake of milk, cheese and yogurt. Milk is high in potassium and phosphorus, so its consumption should be controlled.
Limit the amount of meat, fast food and processed food you consume:
Choose fresh, unprocessed products. Red meat consumption should be limited, as it can be high in protein and phosphorus. Avoid fast food and processed foods, which are often high in salt, saturated fat and phosphorus.
Choose healthy fats:
Unsaturated fats such as olive oil, avocados and oily fish rich in omega-3 are healthier for the heart and kidneys. Avoid saturated and trans fats.
Limit your alcohol intake:
Alcohol can increase blood pressure. It is recommended to limit its consumption or avoid it altogether.
Consume small, regular meals and maintain a healthy body weight:
Small, frequent meals help maintain stable energy levels and avoid stress on the kidneys.
Limit sugar intake:
Excessive sugar intake can lead to obesity and diabetes, which is an additional burden on the kidneys. A diet rich in fiber can help regulate blood glucose levels and improve digestion
Avoid potassium and phosphorus supplements :
Do not take supplements containing potassium or phosphorus without consulting your doctor.
Drink enough water:
Proper hydration is key, but excess fluids can be harmful. Consult your doctor about determining the proper amount of fluids. Remember that water is found in many of the foods you eat, such as soup, fruits and vegetables. Avoid sodas, which can be high in phosphorus and sugar.
Regularly check your lab results:
Based on your test results, adjust your diet to support kidney health and prevent further progression of the disease. Be sure to consult your doctor and nutritionist regularly to help you make appropriate changes and monitor their effectiveness.

Diet in diabetes

Diet plays a key role in diabetes management, helping to control blood glucose levels and prevent complications such as heart or kidney disease. Changing your diet can also help treat comorbid conditions such as obesity, high blood pressure and elevated cholesterol, which increase the risk of heart attack and stroke.

Your doctor or nurse will develop a nutrition plan tailored to your health needs. They may also recommend a consultation with a nutritionist to help you make appropriate changes to your daily menu.

When to eat depends on the medications used. Those taking fixed-dose insulin should eat at regular times to avoid hypoglycemia. Those who adjust insulin doses with meals have more flexibility. For medications such as metformin, which rarely cause hypoglycemia, meal regularity is not necessary.

People with diabetes need to pay attention to:

Carbohydrates: They raise blood glucose levels, so it's important to control the amount. Avoid drinks with added sugar.
Protein: It is best to choose lean meat, fish, eggs, legumes, avoiding processed meat.
Fats: Saturated and trans fats increase the risk of heart disease, so it makes sense to reach for healthier fats, such as those from fish, olive oil or nuts.
Fiber: Helps control glucose levels; found in fruits, vegetables, whole grains.
Salt: Limit products rich in salt, especially if you have high blood pressure.
Alcohol and sweetened drinks: May raise glucose levels, so moderate consumption is recommended.

To lose weight, regular physical activity (at least 30 minutes a day) and calorie restriction are recommended. Your doctor, nurse or dietician will help you determine your daily caloric intake. If you are concerned about your weight, consult with your medical team to help make healthy changes.

Yes, you don't have to eat special foods. You and your family can eat the same healthy meals by focusing on healthy habits and portion control.

In addition to dietary changes, treatment includes regular exercise and medication. Some people need to adjust their medication doses with their diet and physical activity to avoid blood glucose levels that are too low or too high.

Dash diet

The DASH diet, or "Dietary Approaches to Stop Hypertension," is a nutritional plan that can help lower blood pressure and thereby reduce the progression of MS. It is also an effective tool in the prevention of hypertension. To follow the DASH diet, you don't need to look for special products or recipes; the key is to eat certain types of food in the right amounts.

The DASH diet is rich in fruits, vegetables, whole grains, lean meats, healthy fats and low-fat or fat-free dairy products. It is low in saturated fats, trans fats, cholesterol, added sugars and sodium (salt).

The standard DASH diet recommends limiting sodium intake to a maximum of 2,300 mg per day. Your doctor or nurse can help determine your individual health goals.

The DASH diet can provide benefits in the form of:

Lose weight or maintain a healthy weight.
Lower blood pressure and cholesterol levels.
Reduce the risk of cancer, heart attack, heart failure, other heart diseases, stroke, kidney stones and diabetes.

The following are guidelines and examples for daily and weekly dietary goals, based on a 2,000 calorie per day eating plan.

Cereals: aim to eat 6 to 8 servings of whole-grain, fiber-rich products each day. Examples of servings: 1 slice of bread, 30 g of dry breakfast cereal or 1/2 cup (120 g) of cooked cereal, pasta or brown rice.

Fruit: Try to eat 4 to 5 servings of fruit each day. Examples of servings: 1 medium fruit or 1/2 cup (75 g) of fresh, frozen or canned fruit. Choose a variety of species and colors. Frozen or canned fruit should not contain added sugar; look for fruit in 100% fruit juice or water.

Vegetables: aim to eat 4 to 5 servings of vegetables per day. Examples of servings: 1 cup (40 g) of leafy vegetables or 1/2 cup (75 g) of fresh or cooked vegetables. Choose a variety of types and colors. If you buy canned vegetables, choose those labeled "low-sodium" or "salt-free." Prefer frozen vegetables without added fat or sodium.

Dairy products: try to consume 2 to 3 servings of low- or no-fat dairy products. Examples of servings: 1 glass (240 ml) of milk or yogurt, or 50 g of cheese.

Lean meats, poultry and fish: Try to eat 6 or fewer servings of lean meats, poultry and fish each day. Examples of servings: 1 egg or 30 g of cooked meat, poultry or fish. Choose leaner meats such as chicken, fish or turkey, limiting your consumption of red meat.

Fats and oils: Try to consume 2 to 3 servings of fats and oils per day. Examples of servings: 1 teaspoon (5 ml) of soft margarine or vegetable oil, or 1 tablespoon (18 g) of mayonnaise. Prefer healthy fats, such as those found in fish, nuts and avocados. You can use olive oil or vegetable oils such as canola, corn, sunflower or soybean oil. Choose low-sodium and low-fat salad dressings and mayonnaise.

Nuts, seeds and legumes: Try to eat 4 to 5 servings each week. Examples of servings: 1/3 cup (45 g) of nuts, 2 tablespoons (50 g) of peanut butter or seeds, or 1/2 cup (75 g) of cooked legumes. Choose almonds, walnuts, sunflower seeds, peanut butter, soybeans, lentils, shelled peas.

Sweets: Try to limit consumption to less than 5 servings per week. Examples of servings: 1 tablespoon (14 g) of sugar or jam, or 1/2 cup (120 g) of jelly. Choose desserts that are low in fat and have no trans fats, such as fruit jellies, sorbets, jellies, graham crackers, low-fat fig and ginger bars. Fruits can satisfy the craving for sweet.

Use pepper, herbs, spices, lemon or lime juice to add flavor. Try to choose low-sodium or salt-free products whenever possible, which is especially important for broths, soups or soy sauce.

Cereals to avoid: Salty breads, rolls, crackers, quick breads, self-rising flours, cake mixes, traditional rolls, instant breakfast cereals, commercially prepared rice, pasta, stuffing mixes.

Fruits and vegetables to avoid: Prepared potatoes and mixed vegetables, traditional canned vegetables and juices, frozen vegetables in sauce, pickled vegetables, processed fruits with salt or sodium.

Dairy products to avoid: Full-fat milk, chocolate milk, buttermilk, full-fat cheese, ice cream.

Meats to avoid: Smoked, salted or canned fish, such as sardines or anchovies. Fatty cuts of meat, such as beef, lamb, pork, bacon and sausages, and chicken with skin.

Fats and oils to avoid: Consume fewer solid fats, such as butter, lard and hard margarine. Limit your intake of saturated fats, trans fats and total fat.

Sauces and snacks to avoid: Salty and canned peas, beans and olives, salty snacks, fried foods, sodas and other sweetened beverages.

Sweets to avoid: High-fat baked goods such as muffins, doughnuts, cookies and commercially baked sweets, chocolate bars.

Low-sodium diet

Sodium is the main component of table salt, also found in many foods. Your body needs it in small amounts to function properly. However, most people consume far more sodium than they actually need.

Most people eat too much sodium. The average daily intake of Americans is 3,400 milligrams, and experts recommend not exceeding 2,300 milligrams per day. If you have certain health problems, your doctor may recommend a low-sodium diet. It is worth asking how much sodium you should be consuming.

Reducing sodium intake can bring a number of health benefits:

It will help maintain strong bones.
It can lower blood pressure, reducing the risk of stroke, heart attack, kidney damage and other health problems.
It can reduce fluid retention in the body, relieving stress on the heart.
It will facilitate kidney function, which is especially important if you have kidney problems.
It will help reduce swelling in the ankles and abdomen, which can be uncomfortable and impede movement.
It can reduce the risk of kidney stones.

Most sodium is found in processed foods sold in cans, boxes, jars or bags. These products can have a lot of sodium, even if they don't taste salty. Sodium is also often found in sweet products. To find out how much sodium a product contains, check the label.

Here are examples of products with high sodium content:

Restaurant meals
Canned soups
Rice and noodle mixes
Sauces, dressings and condiments (e.g. ketchup, mustard)
Prepared frozen meals
Sausages, hot dogs and cheeses
Smoked, cured or pickled foods
Salted snacks and nuts

Here are some tips to help you reduce your sodium intake:

Avoid processed foods. This is the most important thing you can do to reduce the amount of sodium in your diet.
Instead of processed foods, choose fresh or freshly frozen fruits and vegetables.
Buy fresh meat, fish, chicken or turkey instead of processed products from the deli section.
Limit eating in restaurants.
Try to cook on your own, using fresh ingredients.
If you must buy canned products, choose those labeled "sodium-free" or "low sodium." Products with less than 400 milligrams of sodium per serving are a better choice.

In the table you can find examples of products to avoid and their substitutes.

Make changes gradually. Pick one thing you want to change, and stick with it for a while. If you manage to make that change easily, move on to the next one. For example, instead of canned beans, try buying fresh or frozen, cooking them without adding salt. If this change works, continue and then introduce another one.

If you encounter difficulties, don't be discouraged. Try another method to reduce your sodium intake. The most important thing is to make changes gradually and aim for health benefits.

Limiting food at restaurants is one of the best ways to reduce sodium intake. However, when you choose to eat out, try to choose places that offer fresh, healthy ingredients.

It is worth remembering a few rules:

If the portion is large, consider saving half of it for another meal.
Ask the waiter if the dish can be prepared without salt.
Avoid sauces and dips.
Choose grilled meat or fish and steamed vegetables.
Instead of salad dressing, ask for olive oil and vinegar.

It may take some time to get used to less salt, but your taste will eventually adjust. Try other ways to add flavor to your food, such as herbs, spices, lemon juice or vinegar.

Salt substitutes can be helpful in reducing sodium intake, but before you try them, consult your doctor. Some salt substitutes can be dangerous if you have certain health problems or are taking certain medications.

Yes, some medications may contain sodium. When buying over-the-counter medications, check how much sodium they contain. Avoid products that contain "sodium carbonate" or "sodium bicarbonate" unless directed by your doctor.

Low-potassium diet

Potassium is a mineral present in most foods. It is essential for the proper functioning of the body, as it regulates heart rhythm, supports nerve and muscle function. However, the body only needs a certain amount of potassium. Both too high and too low levels of potassium in the blood can lead to serious health problems.

Hyperkalemia is a condition in which the concentration of potassium in the blood is too high. It can cause serious heart rhythm disturbances and muscle weakness. Hyperkalemia most often occurs in people with kidney disease or those taking certain medications that can raise potassium levels.

A low-potassium diet is recommended for people who tend to have elevated blood potassium levels, or hyperkalemia. This most often applies to:

People with kidney disease who are unable to remove excess potassium from the body
Patients undergoing dialysis in whom renal function is significantly reduced
People taking medications for high blood pressure or heart disease, which can raise potassium levels

A low-potassium diet involves choosing foods low in potassium and avoiding or limiting potassium-rich foods. Your doctor may recommend working with a dietitian to help plan appropriate meals. It is also important to monitor the amount of potassium in the foods you eat, paying attention to nutrition labels.