Renal Diet Question.

The amount of protein allowed in the dialysis diet is determined by checking the amount of protein (and protein waste byproducts) in the person’s blood, as well checking the urea clearances before and after dialysis. This is usually monitored on a monthly basis. Laboratory tests may include chem-20, creatinine, albumin, and pre and post dialysis blood urea nitrogen.


I know that doesn't give you an exact amount, but this is usually how it's determined on a pt to pt basis since no two are the same.

Most RF pts don't get such specific dietary info. They are told to avoid high protein (limit meat intake) and if diabetic, avoid sugar. Getting a dialysis pt to comply with a diet restriction is a miraculous feat.

And that my friends is the most honest answer I've read in a while!

While that is most probably true, I respectfully ask, have you ever tried to follow a renal (dialysis)/diabetic diet? My brother did for three years, and let me tell you, it is a logistical nightmare.

He managed to stay within guidelines, his dry weight was always good, and his labs were always WNL. However, it was almost impossible to order in a restaurant or eat at a friend's house. He ate with us about half the week, and we had to plan meals the day before to allow time to leach potatoes, review ingredients, etc. He basically had ONE thing he could order at any restaurant, and even that was special-ordered to the hilt. He made fast friends with restaurants that were willing to tweak the menu for him.

It was not impossible but it was definitely hard. He has since had a kidney/pancreas transplant and is doing well, but is having trouble getting over the food issues he developed during those three years. By issues I mean losing any joy or happpiness related to eating because it had been such a looming issue for so long. He now cannot relate food with celebrations or fun the way most of us do. It is only a tool to stay alive and healthy to him now.

CST wannabe, you are correct about the diet being hard to follow. What I meant in my comment though was not to be meanspirited, but true in many cases. My daughter is a diabetic and I feel like banging my head against the wall with her sometimes. She tries to follow her diet mostly, but you have to help yourself some. The medication and treatments can't completely do it alone. There are some that try to follow a diet as best they can, I know it's difficulty and nobody is perfect. You have to live a little sometimes. But there are many frequent fliers on a renal floor I work frequently that think that because they faithfully go to dialysis, that's all the effort they have to make. Thus, that is why they are frequent fliers. I commend your brother for realizing that the machines can't do it alone and giving it his best effort!

I'm an advanced practice nurse in a nephrology practice. I work with an indigent, poor, homeless, psych population. My issue with the diet is that my patients can't afford the quality protein needed to maintain an albumin of 4.0 which is what KDoqi guidelines now state is the goal.

That's the sad state for patients with many health problems now. It hurts when you know that they are in the health that they are in because they don't have the financial means for the proper food, medicine, tx's to take care of themselves properly. The ones that seem to be falling through the cracks the most are the working poor.

Most of the diabetic Pt.s and dialysis Pt.s lose the battle with their cravings. In my opinion, diabetic hunger is equal to most drug addictions, and thirst is said to be the most compelling desire we have. My dad would go to dialysis swearing he had not had more than a pint of fluid per day to drink, but he would show a 20 lb.+ weight gain. He would not be swayed the least by the reading on the scale. My Mother-in-law was as honest as the day is long, but every few minutes she would make a trip by the cookie jar and steal a cookie, all the while swearing she was totally compliant with her diabetic diet. I have been a nurse 17 years and observed hoarding by diabetics and others. They usually have friends supporting their behavior to the point they have a night stand full of sweets or other "forbiddens" stashed away.

I am working with a diabetic Pt. now who has lost one leg, and the other one is in danger. Often he will not take his insulin. Often his BS runs near 500. It is almost never under 200. He does not comply with a diabetic diet. When I have talked to him about his diet, he has told me every time that he cannot afford a healthy diet. He spends $150.00/Month on cable TV with internet access. I have to ask myself whether he cannot afford a healthy diet or whether he does not like a healthy diet. Thursday I saw him and he told me that he was eating strawberry preserves on cereal for breakfast. I asked about the milk, and he told me he was using water. While I was there, the microwave alarm went off. I asked what he was cooking. It was a baked potato. That AM his BS had been 392 and the AM before it had been 357. The night before I was there he had eaten pizza. A long time ago I reached the conclusion that all we can or should do is thoroughly educate the Pt. as to health, actions and consequences and let the Pt. do the choosing while we CYA. I do not try to intimidate Pt.s or "force" Pt.s. I just educate them and let them choose, but I do document, document, document.

The guidelines we follow at work are:
Renal insufficiency/pre-HD: as you said, 0.6-0.8 gm/kg
Intermittent HD: 1.2-1.5 gm/kg
Peritoneal dialysis: 1.4-1.8 gm/kg (I believe, this is one we don't see very often so I always look it up)
Continuous renal replacement therapy: 1.5-2 gm/kg

At this point we use actual body weight for underweight or <125% of ideal body weight and an adjusted body weight (IBW + 25% of weight over IBW) for those >125% of IBW, although the literature seems to point toward using IBW for overweight rather than adjusted.

And it's a difficult diet to stick to, especially if you throw in an altered consistency (dysphagia, thickened liquids). Sometimes when we are trying to get patients to transition from tube feeding or TPN to eating and they are on a renal diet, we liberalize it some, if the nephrologist will allow us, to encourage PO.

Also, the restrictions are individualized, some people need more or less Na+, K+, PO4- and fluid restriction than others.