RENAL DIET

Lecture by: M.K. Sastry

Program Director,
Post Graduate Studies and PhD Program
 Objectives
 Nursing staff will understand the basic premise of a
renal diet.
 Understand the nutritional needs Hemo and
Peritoneal Dialysis patients .
 Chronic Kidney Disease
 One in nine Americans has Chronic
Kidney Disease.
 Early detection can help prevent the
progression of kidney disease to kidney
failure.
 Chronic Kidney Disease
 High risk groups for CKD include those
with diabetes, hypertension and family
history of kidney disease.
 Chronic Kidney Disease
 Groups with increased risk include
African Americans, Hispanics, Pacific
Islanders, Native Americans and the
elderly.
 Chronic Renal Failure
 Progressive and irreversible loss of
function that occurs over many months
or years.
 Causes include diabetes, hypertension
and glomerular diseases.
 Chronic Renal Failure
 Some form of renal replacement
therapy is needed for life.
Stages Of Chronic Kidney Disease
STAGE GFR (mL/min/1.73m2) EFFECT ON HOMEOSTASIS
1 ≥ 90 Minimal; excretory and secretory functions
intact.
2 60 - 89 Usually no symptoms, but may have high BP,
anemia & disturbance in Ca+ & Phos+
metabolism.
3 30 - 59 May have fatigue, anemia, swelling, high BP &/or
Ca+ & Phos+ disturbance.
4 15 - 29 Usually symptomatic. Prepare for renal
replacement therapy.
5 < 15 Unable to maintain homeostasis without dialysis
or transplant.
 Goals of the
Patient Specific Renal Diet
 Improve / preserve nutritional status.
 Optimize functional status.

 Maintain patient safety.

 Prepare for transplant.

 Goals of the
Patient Specific Renal Diet
 Compensate / adjust diet for illness, catabolic
events.
 Subjective Global Assessment
Recognized by KDOQI as a useful measure of
PEM.
 Provides a nutritional score based on 2
components .
 Medical history: history of wt. loss (6
months), eating habits, GI symptoms,
physiological functions and metabolic
stress.
 Subjective Global Assessment
Recognized by KDOQI as a useful measure of
PEM.
 Provides a nutritional score based on 2
components .
 Physical assessment: visual assessment
of loss of subcutaneous fat and muscle
mass.
 Subjective Global Assessment
Recognized by KDOQI as a useful measure of
PEM.
 Patient is scored on a 7–point scale (1) .
 6-7 well nourished.

 3,4,5 mild to moderately nourished.

 1 or 2 severely malnourished.
Renal diet for Dialysis patients consists
of individualized modifications
 Calories
 Protein
 Sodium

 Potassium
Renal diet for Dialysis patients consists
of individualized modifications
 Phosphorus

 Calcium
 Fluid

 Carbohydrates
 Fat/Cholesterol
 CALORIES
 Adults on Hemo Dialysis and Peritoneal Dialysis.

 < 60 years old 30-35Kcals / Kg SBW.

 > 60 years old or obese 30 Kcals / Kg SBW.

 Protein
• 1.2 grams of protein per Kg SBW for
Hemo Dialysis.

• 1.2 - 1.3 grams of protein per Kg SBW

with for PD.
 Protein
 Important for growth and maintenance of body
tissue.
 Provides energy and fights infection.
 Keep fluid balance in the blood.
 Protein
 2 types of Protein.
 High Biological Value (HBV) or animal protein-meat, fish,
poultry, eggs, tofu, soy milk, and dairy .
 Protein
 2 types of Protein.
 Low Biological Value (LBV) or plant protein – breads, gains,
vegetables, dried beans and peas and fruits.
 Protein
The following list contains foods and their
protein content:
 1 egg=7 g protein.
 1-2 ounce (oz) chicken thigh=14 g protein.

 8 oz skim milk=8 g protein.

 1 slice of bread=2 g protein.

 Protein
The following list contains foods and their
protein content:
 1 cup (C) cooked rice=4 g protein
 ½ C corn=2 g protein
 Phosphorus
• A mineral found in almost all foods.

• Normal kidneys will balance the

amount of phosphorus in our bodies.
When the kidneys fail the
phosphorus increases in the blood.
 Phosphorus
• It is necessary to limit and/or avoid
high-phosphorus foods.
• Control of phosphorus is often
difficult for kidney failure patients.
 Phosphorus
• Dietary goal is 1-1.5gms/day.

• Normal range <5.5.

 Phosphorus
Foods high in phosphorus include:
 Dairy products.
 Dried beans and peas.

 Nuts.

 Peanut butter.
 Phosphorus
Foods high in phosphorus include:
 Bran cereals.
 Whole wheat bread.

 Meats.

 Food Additives.
 Potassium
• Dietary Goal is usually 2 - 3 gms /day.

• Potassium is a mineral , plays a role in

regulating your heartbeat; so, too
much can result in heart problems.
 Potassium
• Explore with patient high or low serum
potassium levels.
• Monitor residual renal function,
changes in appetite for dietary
adjustments.
 Low Potassium foods
 Apples.

 Grapes.
 Berries.

 Pineapple.

 Tangerine.
 Low Potassium foods
 Cabbage.

 Green Beans.
 Cauliflower.

 Eggplant.
 Potassium
 Common high K+ foods include many
fruits and vegetables:
 Prunes and Prune juice.

 Orange and Orange juice.

 Bananas.

 Dried fruits.
 Potassium
 Common high K+ foods include many
fruits and vegetables:
 Potatoes.

 Tomatoes.

 Brussels sprouts.
 Potassium
 Common high K+ foods include many
fruits and vegetables:
 Spinach.

 Beets

 Milk
 Sodium
 HD 2-4 gm/d.

 PD usually more liberal.

 Too much sodium in the blood is
related to high blood pressure and
congestive heart failure.
 Sodium
 Foods high in sodium include:

 Processed meats
 Canned soups

 Salty snack foods

 Deli meats
 Sodium
 1 Tsp salt = 2000mg sodium.

 Most of us eat 3,000-6,000mg of

sodium /day.
 Low sodium = ≤140mg/serving.
 Do not buy a food that has 150-350mg
sodium/serving.
 Fluids
 Hemo Dialysis: Fluid individualized to
accommodate fluid gains, blood
pressure control, residual renal function.
 Fluids
 Peritoneal Dialysis: Fluid individualized
to patient tolerance. Strive for minimal
use of hypertonic solution to maintain
fluid balance.
 Fluids
 Everything that is liquid at room
temperature.
 1500ml-2000ml.

 ~6 c-8 c /day .

 4 cups=32 oz=1 qt=1000ml=1 liter.

 Fluids
 Choices include all drinks and foods that are liquid
at room temperature.
 Water.

 Coffee.
 Tea.
 Sodas.
 Fluids
 Choices include all drinks and foods that are liquid
at room temperature.
 Soups

 Juices
 Jell-O
 Fluids
Thirst Quenching Ideas :
 Suck on sour candies or chew gum.
 Eat chilled fruit, frozen grapes and berries.

 Add lemon or Lime juice to water.

 Fluids
Thirst Quenching Ideas :
 Take pills with apple sauce instead of liquids.
 Use smaller cups or glasses .

 Keep track of all liquids.

 Fluids
Thirst Quenching Ideas :
 Limit salty foods.
 If diabetic, control blood sugars.
 Calcium
Hemo Dialysis Patients Balance is determined by:
 Dietary Calcium Intake.

 Calcium Supplements and Calcium Based Binders.

 Calcium
Hemo Dialysis Patients Balance is determined by:
 Dialysate Calcium Levels.

 Vitamin D Therapy.
 Physician Monitoring of PTH .
Carbohydrate

 Carbohydrate intake
may need to be
modified for Patients
with Diabetes to
achieve the goal of
HgAIC < 7 %.

Caution !
Fat / Cholesterol

• Cardiovascular
Disease is the most
frequent cause of
death among patients
with Renal Disease
regardless of
treatment modality.
Fat / Cholesterol

• Nutrition therapy for

Dyslipidemia is based
on pt’s metabolic
profile and
individualized
treatment goals.
• Consider nutritional
 Supplements
 Multi Vitamins.

 Water soluble.

 Vitamin C .

 Supplementation may improve Iron

availability from stores.
 Supplements
 Vitamin C .

 Limit to 60-100mg/d to avoid

oxalate formation.
 Iron and Zinc supplementation must
be determined individually based on
labs.
 Monitoring
 Monthly QAPI report to review the labs
and discuss plan of action to correct the
problem.
 Monthly interdisciplinary Care plan
meeting to review the patient
performance.
 Monitoring
 Albumin to monitor intake.
 (Goal >3.5mg/dl).

 Potassium to determine dietary

restriction.
 (Goal 3.5-5.5mg/dl).
 Monitoring
 Phosphorus to adjust binders &
compliance.
 (Goal <5.5 mg/dl).
 Summary
 When a patient has a diagnosis of renal
failure, their nutritional needs are complex—
Levels of Protein, Calories, Fluid, Sodium,
Potassium, Calcium Phosphors need to be
regularly monitored and make changes based
on pt’s needs.
 Summary
 It is important to continuously monitor their labs ,
PO intake , provide or offer nutritional supplements,
encourage dietary and medication compliance .
 Question and Answers
Which food is highest in Potassium?
 Apple
 Pineapple
 Broccoli
 Banana
 Potato
 Q&A
Correct answer…
 Apple -1 medium(62 mg)
 Pineapple -1/2c(150mg)
 Broccoli -1/2c(127mg)
 Banana -medium(451mg)
 Potato- medium (926 mg)
 Q&A
What are the foods high in Phosphorus?
 Pizza (Cheese and meat)
 Chicken
 American Cheese
 Yogurt
 Cream Cheese
 Cottage Cheese
 Oatmeal
 Q &A
 Pizza (1-1/8 slice -131mg Po4, 1780mg K+, 382mg
Na).
 Chicken (1oz-60mg po4).
 American Cheese (1oz- 211 mg Po4, 46 mg K+,
405 mg Na).
 Q &A
 Yogurt (fruit 6 oz - 150 mg Po4, 310 mg K+, 100
mg Na).
 Cream Cheese (1tbsp- 15 mg PO4, 17mg K+, 43
mg Na)
 Q &A
 Cottage Cheese (4 oz- 152 mg Po4, 97 mg K+, 459
mg Na)
 Oatmeal (instant, 1 cup - 176 mg PO4, 131 mg K+,
377 mg Na)
Q &A

 Why do dialysis
patients need to limit
dairy and high
phosphorus foods?
 Q &A
 Healthy kidneys get rid of Phosphorus from the
body, but when kidneys fail, phosphorus builds in
the blood.
 Q &A
 High levels cause calcium to come out of the
bones and make them brittle, weak and painful. It
also gets deposited in soft tissues like blood
vessels and heart, causing damage to them.
 Q&A
 How does the diet for someone on peritoneal
dialysis differ from the one for hemodialysis?
A. It requires more calories
B. It requires more calcium
C. It requires less protein
D. None of the above
Q&A

A. It requires more
calories

B. It requires more
calcium
C. It requires less
protein
D. None of the above
 Q&A
 If you are on a renal diet, you most need to limit
your intake of what three things? 
A. Apples, oranges, grapes.
B. Carrot cake, ice cream, Coke.
C. Sodium, phosphorus, potassium
D. Seafood, surf-and-turf Red Lobster entrees,
macaroni and cheese.
 Q&A
A. Apples, oranges, grapes.

B. Carrot cake, ice cream, Coke.

C. Sodium, phosphorus, potassium

D. Seafood, surf-and-turf Red Lobster entrees,
macaroni and cheese.
Thank You