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.
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! 😀