My New Job: End Stage Renal Disease

My new job is in renal dietetics and I will be working as a dietitian in dialysis facilities caring for those with End Stage Renal (Kidney) Disease (ESRD). Chronic Kidney Disease (CKD) is the declining function of the kidneys and affects more than 26 million Americans, or 1 out of ever 9 adults. As kidney function declines, CKD progresses and when the kidneys perform at about 10% capacity, a patients is considered to have ESRD, which requires transplantation or dialysis to stay alive.

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What is dialysis?

There are two types of dialysis: hemodialysis and peritoneal dialysis. I will be working in hemodialysis and will expand on that type, but you can read all about peritoneal dialysis. Hemodialysis is traditionally performed in a dialysis clinic where patients come 3x a week (either Monday, Wednesday, Friday or Tuesday, Thursday, Saturday) and are dialyzied (blood filtered) for 3-4 hours through an access site, typically on their arm.

What do the kidneys do?

The kidneys perform a lot of vital functions of the body including filtering the blood to remove waste (e.g. urine) and the release of hormones which regulate blood pressure and bone health. When the kidneys lose filtering capacity, vitamins and minerals build-up in the blood at toxic levels. Micronutrients such as potassium, sodium, phosphorous, and calcium can cause fatalities in renal patients if not controlled in the diet. The diet is hugely important to follow for renal patients.

Why do the kidneys fail?

Chronic uncontrolled blood pressure, chronic uncontrolled diabetes, glomerular disease, and other complications such as polycystic kidney disease, drug abuse (prescription and illicit), poisons, and trauma. The rate of ESRD is increasing due to the increase of obesity and associated co-morbidities such as diabetes and hypertension.

What diet do dialysis patients have to follow?

Foods that are commonly omitted or limited from the renal diet include: beans, peanut butter, nuts, many cereals and grains, all dairy products, colas, processed meats, orange juice, oranges, bananas, tomatoes, tomato products, kiwi, pears, melon, dried fruits, potatoes, squash, avocado, mushrooms, pumpkin, chocolate, and WATER and all other fluids.

However, the renal diet is highly personalized to a patient’s needs based on their labs and may be changed on a frequent basis.

Renal diets need to be very high in protein — about 95 grams (for a 150 pound adult) or 140 grams (for a 220 pound adult). And because processed meats, beans, and nuts are discouraged in the renal population, fresh meat and eggs are the only sources of high biological value protein (HBV). A renal patient requires significant amounts of protein due to protein loss during dialysis, as well as a decline in the body’s ability to make amino acids (protein in the body) due to CKD.

What if a patient doesn’t eat enough protein?

Albumin is a protein made by the liver. This lab value has the strongest correlation to morbidity (illness) and mortality (death) in the renal population. In addition to drug therapies, the diet is the best way to elevate albumin levels.

This is a perfect example of why I support all food groups. A vegetarian/vegan would not fare well on dialysis based on their food preferences. Simply, there are NO methods available to achieve neither adequate intake, nor intake from high biological value proteins.

I hope this gives an idea of what my new job entails. Today I meet the entire patient care team: nephrologist, charge nurse, social worker, and me, the dietitian. We have rounds starting…soon! Better jet! 😀

But first a quick Lily picture. On our way to the dog park yesterday…

Question: Knowing what a renal diet aims to limit or eliminate, what would you have the most trouble omitting?

I think limiting fluids, tomato products, and bananas would be the hardest for me!

P.S. I am a writer for the Examiner in Columbus! I cover cooking! It’s been a slow start simply because I haven’t had time or Internet, but I look to put out a lot more articles soon! 😀

Happy Monday,

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39 Comments

  1. August 9, 2010 / 6:08 am

    Great post. It’s always a good refresher to read how the body parts work and what their purpose is. Other than processed meats, cola, and for the most part, dairy products, dried fruits, and pumpkin, all of those items are a huge part of my diet. I think the simple fact of having to limit water intake would be quite difficult though. It’s something I take for granite because I’m always told to keep drinking.

  2. August 9, 2010 / 6:29 am

    Great post. I know lots of people out there have no idea about this. I worked on the other side in a transplant clinic. While some of my patients were on dialysis, I mostly worked post transplant, and then pre-dialysis. For me, the hardest to eliminate would be beans and peanut butter. But I know once the itching kicked in from elevated phos, I would put the PB away. I actually had a patient whose phos was so high and I finally found out it was because she ate tons of PB. So I asked her if she was itchy and she said yes, so I asked if she wanted the itching to stop, and she said yes, so I told her it would if she stopped eating the damn PB. She complied at that point. The itching was no match for the taste.

  3. August 9, 2010 / 6:39 am

    Thanks for this review Nicole. I needed it BAD! I’m working with diabetes patients now and many of them have kidney problems. I do have a question for you. If someone has kidney disease but is NOT on dialysis, they should DECREASE their protein….right? Or is that acute renal failure that I am thinking about? When would the kidney’s filtering system let out TOO MUCH protein?

  4. August 9, 2010 / 6:40 am

    Ok wait, I meant to ask, when would the kidney’s filtering system NOT let out ENOUGH protein? I know we aren’t supposed to let protein out via the kidney, but I swear I learned that kidney patients need to be on a low protein diet. When is this?

    Sorry, long question, even though it’s really quite a simple one!

  5. August 9, 2010 / 6:45 am

    Wow that would be so tough. I don’t really love eggs or meat so I can’t even imagine eating that way.

  6. August 9, 2010 / 6:50 am

    Thanks for all the great info! Your new job sounds interesting – and busy! Good luck!

  7. August 9, 2010 / 7:20 am

    wow, interesting job. I used to work with a man who was on dialysis every week. He wasn’t allowed any water or fluids and said he never naturally went to the bathroom. I’m glad you are now going to be helping people like him! I always wished I could do something to help

  8. August 9, 2010 / 7:42 am

    This is a very timely post, at least for me. Just ten days ago my brother went into a mild diabetic coma, and his kidneys have quit functioning since then. He has been on continuous dialysis, but he is starting traditional dialysis today. They are hoping his kidneys start back up, but it is too early to tell.

  9. August 9, 2010 / 8:01 am

    I think it would be so hard to give up all dairy products. I love my cheese too much!

    Sounds like your new job is exciting.

  10. August 9, 2010 / 8:10 am

    I found your explanation of the diet for these patients fascinating. It seems that some of the components that need to be avoided are certain forms of gluten, casein, sulfates, nitrates and members of the nightshade family – or at least that is what it sounds like. What a challenge to find meals for such restrictions !

  11. August 9, 2010 / 8:56 am

    I would have the WORST time limiting fluids. I hardly ever stray far from my water bottle…

    Goodluck with the new job! It sounds like it’d be fascinating…

  12. August 9, 2010 / 9:16 am

    Your job sounds very interesting!
    I would have a hard time eliminating fruit and water..and probably chocolate who am I kidding 🙂

  13. August 9, 2010 / 9:38 am

    This is a great post! Your new job sounds so interesting and so challenging! I hope it’s going great!

  14. August 9, 2010 / 10:24 am

    Wait, am I reading this right?? They have limit their water??!! I like pretty much everything on that elimination list. That would be a very tough diet for me to follow. Your job sure does sound interesting and I know you’ll do so great!! 🙂

  15. August 9, 2010 / 10:56 am

    Hardest…dairy products…almost skipped right over that one. Definitely the hardest for me. Super cute pic of Lily!!

  16. August 9, 2010 / 10:56 am

    I would have a serious problem if I had to be on that diet! Hope the meeting goes well 🙂

  17. August 9, 2010 / 11:04 am

    Wow your new job sounds so interesting. What a challenging diet so many of the patients have to follow! Limiting water… that would be so tough for me.

  18. August 9, 2010 / 11:32 am

    A renal diet, I thought, was one of the most difficult when going through my internship.
    During my internship, I shadowed a renal RD at a dialysis center. It was very interesting. I hope you enjoy it!

  19. August 9, 2010 / 11:39 am

    Oh my gosh – it would be so hard to give up all of those things!

    I think I would have the hardest time with the tomatoes and tomato products. Cheese would be my second hardest.

    Good luck with the new job!

  20. August 9, 2010 / 11:44 am

    Great post and what a fun refresher! I miss clinical dietetics! The renal diet is so challenging and I would definitely have the most difficulty with fluids (I drink like crazy!) and dairy (love me some yogurt!). Hope you have a wonderful day!

  21. August 9, 2010 / 12:37 pm

    Reading this post make me wanna take care of body and my family better- especially the kidneys…
    Oh God! I’m so sad for the person with this problem.
    If I have to give up all these food… fluid and grains would be hard on me.
    Nicole, Lily is such a sweet heart 🙂 seeing her picture to day just make me think of when we rolled the car window down for my kid when we went to the lake this weekend 🙂

  22. August 9, 2010 / 1:48 pm

    I think all those things would be hard for me! I hate being told I can’t have something because I want it more.

    And the fluid thing would be horrible…

    Best of luck on your new job!!

  23. August 9, 2010 / 1:54 pm

    Well, if I could still have almond butter — that would be cool.

    Sounds like your job will be “emotionally” challenging or maybe I’m projecting.

    Love the composition of the Lily picture and kudos on your gig with the Examiner.

  24. August 9, 2010 / 6:01 pm

    Giving up all dairy products would be so hard for me. I love dairy.

    Good luck with your new job! You are my kidney/food related expert already and now your job is all about kidney stuff. Very cool!

  25. August 9, 2010 / 6:18 pm

    Wonderfully informative post, Nicole! I’ve seen many people with renal disease in my internship so far, and they almost always have trouble sticking with a renal diet because it tends to be very restrictive, whether the patient is on dialysis or not. It’s so hard to write a renal diet! Either the protein needs to be really high or really low and that’s not easy! I have a huge amount of respect for what you’re doing, Nicole. I can only hope I can be half as awesome a dietitian someday 🙂

    P.S. PB would be hardest for me to give up, I think.

  26. August 9, 2010 / 6:55 pm

    Yay for the Examiner gig! You know I will support a fellow Examiner writer. After all, its how we get paid the big bucks (or cents more aptly haha).

    All that information about dialysis and renal diets is so interesting to read. I had no idea that fluids had to be limited so severely. I wouldn’t handle that part well at all!

  27. August 9, 2010 / 11:37 pm

    Wow! Thats scary. I think for me, avoiding water would be the hardest. I have a glass of water either in my hand, or beside me at all times. Trying to limit the liquids would be so hard for me!

  28. August 10, 2010 / 8:47 am

    All of those things would be hard to eliminate..minus the processed meat. I hate the thought of having any food limitations..I am thankful I don’t thus far!

  29. August 10, 2010 / 8:51 pm

    Thanks for the informative article, as always. I have a relative with kidney failure and sadly, don’t know too much about it. I would have a hard time eliminating dairy, potatoes, tomatoes, and avocado! I practically live off those!

  30. Veronica
    August 12, 2010 / 6:38 pm

    What a great and informative post! My father-in-law suffers from ESRD so this was very helpful for my husband to understand his situation better. I’m starting MNT 1 in a couple of weeks and am excited to begin learning the clinical side of dietetics. And, I think the hardest things for me to restrict would be fluids & fruits.

  31. Shirley
    April 21, 2011 / 1:50 pm

    Thank you for the post. My brother is only 51 and on dialysis for four months now. He is pretty weak most of the time and has diabetes, congestive heart failure, liver disease, a blood clot in his heart following a stent that was placed a few weeks ago, and Hepatitis, which he contracted while volunteering for the Hurricane Katrina cleanup. He will be coming to live with my husband and I in 2 weeks. I love my brother and it breaks my heart to see him so sick. There is so much to learn. A meal plan for renal, cardiac and now also a Coumadin restrictive diet is overwhelming from all aspects, planning, shopping and preparing. So many things you never think about that my brother lives with daily just to stay alive. He doesn’t urinate anymore, is limited on ONE liter of fluid per day, whether that includes a cup of coffee or a cup of ice or the liquid in his soup. There are no more days of sitting around the table having a few cups of coffee, grabbing a handful of nuts, or a peanut butter sandwich. I know our lives will change as a result of our decision to care for my brother and I’m a little scared of that. But then I think about all the ways his life has changed since January and I’m sure my selfish fear doesn’t compare. When my anxiety about being a caregiver for a chronically ill person feels overwhelming, it is my husband who calms me and reminds me that we are doing the right thing. He encourages me with simple truths and understanding that we are all in this together, that because we are here my brother will not have to face any of this alone. There is comfort in that, not just for my brother, but for all of us.

    • Nicole
      Author
      April 21, 2011 / 2:50 pm

      Bless your heart. You are lucky to have one another. It sounds like he has the best sister a guy could ask for 🙂 Please let me know if I can help in any way. Thank you for your comment and I wish you all nothing but the best!

      • Shirley
        April 26, 2011 / 11:28 pm

        Thank you. Your website has a lot of helpful information. I have looked through some of the recipes and they look Yummy. Our schedule won’t allow for cooking meals at breakfast and lunch so I am clueless as to what types of foods to give him for those meals. Any suggestions you could offer would be appreciated.

        • Nicole
          Author
          April 27, 2011 / 2:50 pm

          What about hard boiled eggs at breakfast with some toast? Breakfast is tough to get in protein if no cooking is involved. I am a fan of making quiches ahead of time and reheating individual slices at a time. A protein drink (Nepro or High Protein Boost) or bar (I recommend the Zone Bars a lot) would also be an option.

          Lunch is a bit easier. I make the suggestion of egg salad, tuna salad, chicken salad, etc. It’s great on crackers, bread, tortillas, salads…so versatile and all renal-friendly 🙂 I hope that helps!

          • Shirley
            April 28, 2011 / 1:23 pm

            That helps tremendously. Hadn’t really thought of boiled eggs and toast but that’s pretty quick and can easily fit into our schedules. Quiche is also a great idea.He isn’t big on protein shakes and has tried most brands. He may have issues with “drinking” his meal also since his fluid intake is so limited. I love the idea of chicken, tuna, egg salad for lunch though. We could prepare it and have it in the fridge for him. It would go a long way in allowing him to feel helpful by getting his own lunch together. Thanks so much for your help and I would love to hear other suggestions for breakfast meals.

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