I have worked as a renal dietitian for the past 2 years. If you’re thinking, “Wait, didn’t you just change jobs in January?”, the answer is yes, but I simply switched companies. Not much about my job duties changed, just location, patient load, and salary.
To start, the word “renal” refers to the kidneys. The kidneys are an organ in the excretory system and perform many vital roles in the body, including: blood pressure regulation, activation of vitamin D, red blood cell production, urine production and fluid removal, the excretion of waste, and so much more! These bean-shaped organs are on the back side of the body and lie just above the waistline.
My work was performed in dialysis units. Dialysis refers to the artificial process of cleaning the blood when the kidneys have failed (most often due to uncontrolled hypertension and complications of diabetes, though there are other causes for kidney failure). Dialysis can be done in-center by exchanging one’s blood through an artificial kidney and large machine, or by way of inserting a sugary fluid into the peritoneum (the space in between all of your organs in your belly) and draining it out. There are benefits and drawbacks to the different types of dialysis and it is up to the interdisciplinary team to help a patient receive the treatment regimen that best fits their needs.
I covered 2 dialysis units (and always have), and in my 24-26 hour work week, I generally cared for about 70-75 patients. The renal dietitian is responsible for completing nutrition assessments on each patient (initial, after 90 days, semi-annually, and annually), assessing each patient’s labs every month and making changes to their diet and recommendations to their prescriptions, dosing their vitamin D, performing nutrition education on the renal diet, monitoring weight status, conferring with hospitals and extended care facilities to meet patient’s needs, referring patients for IV nutrition, charting, and collaborating with the interdisciplinary team by way of physician rounds and attending quality control monthly meetings. My typical work hours were 7-8am to 3:30-4:30pm, though this can vary significantly and is extremely flexible.
Would I recommend renal nutrition to other dietitians? Absolutely…for a period of time. Working as a renal dietitian is such a specialized area of nutrition and it’s not for everyone!
- I got to see the same patients over-and-over. I knew my patients REALLY well. While this can come with plenty of disadvantages, I feel that having that rapport and relationship with patients was invaluable. I knew about their health history, social history, habits, preferences, personalities…I knew them! This made my job more fun and more successful in helping them meet their nutrition goals.
- Historically, renal dietitians are part-time employees because most dialysis units can only offer treatment to so many patients (patients run dialysis 3-5 hours, 3 times a week). Again, this comes with positives and drawbacks, but I was able to be very flexible in my schedule. I didn’t have a specific “start time” or “end time”. Some weeks are much busier than others and I could easily adjust my schedule to maximize my time and efforts. I absolutely loved having this flexibility.
- I thoroughly enjoyed being a part of a small interdisciplinary team and at the same time, being the only dietitian. If my job didn’t get done or didn’t get done right – I was to blame. Conversely, I didn’t rely on others to get my job done. I enjoyed being able to interact with my coworkers without “sharing” the workload, if that makes sense. I was a one-woman show and I liked it that way. Similarly, the physicians and I built rapport and my suggestions were generally well-accepted.
- Nutrition is valued in renal care. Fortunately and unfortunately, lab work that is monitored in dialysis patients is STRONGLY linked to their diet — everything from potassium to calcium to protein to phosphorus to fluid. The role of the dietitian is INTEGRAL to the outcomes of the patients and that is rewarding.
- Health care is changing and the way physicians approach health care is changing. Because I would see the same patients 2-3 times a week, I would hear about each and every one of their health concerns. While I understand the need to draw lines in the sand as to which health care professional should be “treating” which issue, so many issues affect dialysis outcomes. Due to the changes in reimbursement and thus health care, it is becoming difficult to treat patients as a “whole”. It’s concerning and a disservice to the patient.
- It’s hard to see patients so ill and have patients pass away. By the time patients are to the point of requiring dialysis, many of them only live a few short years. It is a blessing that you can live on dialysis a very long time and the kidneys are an organ that can fail and there is treatment other than transplant, but most patients live 5 years or less once starting dialysis. That said, patients who take care of themselves after beginning dialysis can live very fulfilling lives. In the older dialysis population, it is usually a situation of MULTIPLE health complications and conditions that result in death, not the dialysis itself. Sorry so morbid, but it’s a reality.
- My job could be very repetitive at times. Draw labs, do assessments, discuss labs and diet changes, chart, calculate dose changes, chart, educate, chart…again, and again. My months all mapped out the same which was nice for planning my schedule, but the work was very predictable and cyclical. I like a bit more variety!
- I won’t beat around the bush with this one – 9 out of ever 10 dialysis patients (if not more!) are non-compliant. They are non-compliant with their diet, fluid restriction, coming to treatment, taking medications…you name it. The population can be very trying. Seeing as dietitians are in the business of “change”, non-compliance is a major barrier and hardship to face. As much as you want something for your patients, it always came down to their motivation and follow-through. I think this was the #1 challenge of working in dialysis.
I can honestly say I learned a ton (if you ever want to chat about secondary hyperparathyroidism, I’m your gal!), but my passion is in disease prevention. I want to help diabetics never, ever end up on dialysis. I can speak to the reality of dialysis and outcomes if people don’t change their lifestyle.
I met some AMAZING people – patients and coworkers, and I did enjoy my job. I can’t say I loved it by the end, but I love working with people. I am very excited to open up my next career chapter and bring with me so much of what I learned working in dialysis.