I would suggest you talk to your physician about this. Most of the phosphorus in the body is stored in the bones; the phosphorus in the blood is only a small amount and not a good reflection of your body’s phosphorus stores. The K/DOQI recommendation for phosphorus is 800 – 1,000 mg per day for stages 3 and 4 of CKD.
I would suggest she asks her physician about this. Since you mentioned she is elderly, she may also have a heart condition which would affect her fluid needs. Itchy skin can occur in dialysis patients from uremia, which is a high BUN level - blood waste products building up in the blood, or a high blood phosphorus level – however I am not sure if these would occur in stage 3 CKD. Dry skin could be related to dehydration, however her physician should assess this for the causes and best treatment to alleviate the discomfort.
A diet which is too low in protein can increase the risk for malnutrition. The current recommendation is 0.8 gm. of protein per kg of body weight, which is the same as the RDA for adults (although typically Americans eat much more protein than this).
Congratulations, that is wonderful. I can provide some general guidelines. Often people feel so much better after a kidney transplant, and their appetite improves. It is important to maintain a healthy weight and also be physically active (according to your transplant surgeon’s guidelines). Developing diabetes after a kidney transplant (post transplant diabetes mellitus) occurs in 15% of transplant recipients after one year according to this NKF patient booklet, which will provide more information: http://www.kidney.org/atoz/pdf/new_onset_diabetes.pdf .
Good nutrition and activity can help to prevent this. Some medications to help prevent rejection also may increase blood sugars and blood lipids such as cholesterol and triglyceride levels. Limiting foods with saturated fats, such as whole milk, cheese, cream, fatty meats, and ice cream is recommended: choose fat free, reduced fat, or lean versions of these foods instead. Limiting desserts and avoiding sweetened beverages can help to control weight. You should have access to a registered dietitian at your transplant center, and he or she can help you with your calories needs and recommendations tailored to your medication regimen and past medical history.
If your husband is advised to limit potassium intake it is best to avoid or limit whole grain foods. To help with blood sugar control, measure portions and also you can try pasta with less digestible carbohydrates such as Dreamfields or Fiber Gourmet. There are many beneficial aspect of the Mediterranean diet which can be beneficial, such as limiting red meats and cheeses, and having a diet with more plant foods. Just choose lower potassium fruits and vegetables. Here is a list of some high and low potassium foods on the NKF web site which may help: http://www.kidney.org/atoz/content/potassium.cfm
Protein foods do contain potassium. Typically milk is limited, and high protein foods within his nutritional needs are included. Please consult with a registered dietitian for more specifics for his needs.
If you have one kidney and it is functioning well, you want to make sure to have regular checkups with your physician, and have your blood pressure monitored and lab work drawn to check your kidney function tests. You may be at risk for hypertension: try to keep your weight in a normal range and be active based on your ability. The D.A.S.H. dietary plan is a good plan for more fruits, vegetables, low fat dairy products, and limited lean meats and sweets – which can help prevent hypertension. This article from the National Kidney Foundation might be of use to you as well: http://www.kidney.org/atoz/content/nephrectomy.cfm
Information Clearinghouse: http://kidney.niddk.nih.gov/KUDiseases/pubs/kidneystonediet/index.aspx