Renal diet and label reading?

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Okay, I'm a newer nurse working LTC/skilled rehab and in my short career I have already had this come up 3 times and each time I promised I was going to read more on this. Today is that day. 3 times I've had a different nurse ask me if I knew whether a snack was okay/or not okay for a dialysis or resident on a renal diet. I have a diabetic child and a celiac child so I do great with diabetic diets and am fairly good at reading nutrition labels, but I get a little frustrated with renal diets because honestly I'm just never sure how much I'm supposed be limiting of what. I got the idea that I'm looking at potassium, phosphorous, sodium, and protein, but not sure how much I should be restricting and what amounts I should be looking for snacks to be under. I do better with label reading because this means I'm not limited to choices on my snacks I can give them - I can just read the label and say hey this should be okay. I got that they should have no OJ, bananas, tomatoes, dark sodas, or prunes, raisins, nuts. I'm a little confused about milk? I'm also confused about protein. I found this great link here Renal Diet and that was very helpful, but left me confused a little on protein and milk. It looks like milk really is a no-go, but I don't see a lot of milk substitutes available at the facilities I go to. Maybe I should look harder to see if they are available. How much milk should people have on a renal diet because that came up recently as well. I think the resident returned the milk saying she wasn't supposed to have it, but reading up on this she sounds right. I'm also not sure about protein. Not thinking I should be giving snacks with protein outside of their meals, but unsure on that as well.

I would love to get a list of good snack ideas as well. The usual snacks I see available are rice crispy treats, cereal bars, animal cracker, rice puff type snacks, sometimes pretzels, yogurt, puddings. I need some good ideas on foods that they can eat. I have no problem waltzing myself down to the kitchen and looking through what I can find at night, but I'd like to have some options of snacks to give my residents when they ask for something to eat.

So to simplify my questions.

How much milk?

How do I know whether to give/not give protein for snacks?

Snack idea list?

Acceptable amounts in grams of potassium, phosphorous, and sodium when reading labels for snacks?

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There are a few things you need to know first contact the dialysis unit where they treat for a copy of blood work and also contact the dietitian to see what the levels these include potassium calcium and phosphorus. The dietitian can give you exactly how large or how small the portion should be. They can also tell you exactly what foods and snacks and what you can substitute

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There are a few things you need to know first contact the dialysis unit where they treat for a copy of blood work and also contact the dietitian to see what the levels these include potassium calcium and phosphorus. The dietitian can give you exactly how large or how small the portion should be. They can also tell you exactly what foods and snacks and what you can substitute

I work 6p-6a so this is not always practical. I can work on finding this info, but at night when there is nobody to call are there any free foods or safe options that I can give for snacks without having specific details? I can just avoid milk and protein if I don't know. Often times what I am told in report is just "resident is on renal diet". I get it that the diet can be somewhat complicated, but there have to be a handful of safe foods that I can give without too much worry.

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Thanks for taking the time to research this. I'm surprised the diet is just 'Renal Diet', look in the orders and see if K, Phos, Protein and fluid restrictions are specified. I have never worked in LTC so maybe that's the norm. I would think peanut butter and ghram crackers with apple juice would be a fairly safe snack. If they have a snack time binder order be sure to provide that also. But, as calroann mentioned, the best resource (by far) will be the dietition at the pts dialysis clinic.

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The best would be graham crackers or breadsticks and apple or cranberry juice to drink. I would avoid any protein because you don't know any levels.

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Thanks for taking the time to research this. I'm surprised the diet is just 'Renal Diet', look in the orders and see if K, Phos, Protein and fluid restrictions are specified. I have never worked in LTC so maybe that's the norm. I would think peanut butter and ghram crackers with apple juice would be a fairly safe snack. If they have a snack time binder order be sure to provide that also. But, as calroann mentioned, the best resource (by far) will be the dietition at the pts dialysis clinic.

I'm going to go digging in the chart tomorrow to see what I can find. I know fluid restrictions are specified. I'm going to see about K, phos, & protein restrictions as well. I know I had 3 dialysis patients last time I was in so I'll go digging through their charts to see what I can find. In the mean time I will not give extra protein unless I can find info stating other wise and stick with snacks that are low in potassium, phosphorous, and sodium.

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Specializes in Public Health, TB.

Usually, once patients need dialysis protein is not restricted. Animal protein, however is a source of phosphorus. When I worked acute care evening snack was usually skim milk and graham crackers. The majority of our ESRD patients were diabetic, so we rarely gave juice.

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Dialysis patients actually need protein to keep their immune systems intact and aid in wound healing. In fact most chronic dialysis clinics give out protein supplements to patients to consume during their treatment.

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In chronic dialysis clinics supplements are only given out if the patients albumin is 4 and lower to much protein is not good

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In the clinics I've worked in few patients have albumins 4 or over.

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Specializes in RN, BSN, CHDN.

First of all thank you for caring so much that you are asking for advice on the renal diet, two things you need to know are your patients on dialysis or are they on a renal diet to slow down their kidney deterioration? By this i mean are they stage 3 or 4 pre dialysis patients?

The reason I ask this is because the Renal Diet is different for pre dialysis patients-my suggestion is call or send a note to the dietitian at the renal centre where they get their dialysis. Each patient has their own specific diet prescribed for them and the dietitian at the dialysis facility would be more than happy to send you information on each of your patients.

Dietitian love it when nursing home staff contact them about this as they have a deep frustration when it appears NH patients eat just what ever they want, plus drink what ever they want and their lab results suffer as a consequence.

Call the facility before you leave-staff in renal units start very early and leave a message on the dietitians voice mail or speak with an RN who can get you all the information you would ever need.

If the pt is in end stage renal failure but not yet requiring dialysis then you need to speak with a dietitian at the doctors office or you can fax the dietitian and ask for them to provide you with a diet for that specific patient

I hope this helps

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First of all thank you for caring so much that you are asking for advice on the renal diet, two things you need to know are your patients on dialysis or are they on a renal diet to slow down their kidney deterioration? By this i mean are they stage 3 or 4 pre dialysis patients?

The reason I ask this is because the Renal Diet is different for pre dialysis patients-my suggestion is call or send a note to the dietitian at the renal centre where they get their dialysis. Each patient has their own specific diet prescribed for them and the dietitian at the dialysis facility would be more than happy to send you information on each of your patients.

Dietitian love it when nursing home staff contact them about this as they have a deep frustration when it appears NH patients eat just what ever they want, plus drink what ever they want and their lab results suffer as a consequence.

Call the facility before you leave-staff in renal units start very early and leave a message on the dietitians voice mail or speak with an RN who can get you all the information you would ever need.

If the pt is in end stage renal failure but not yet requiring dialysis then you need to speak with a dietitian at the doctors office or you can fax the dietitian and ask for them to provide you with a diet for that specific patient

I hope this helps

Tonight's project was scouring her chart to see if I could actually find any specific info. I could find a dietary consult nowhere in her chart. I could find no specifications on potassium, sodium, or phosphorous amounts. What I did find was that it said high protein renal diet so that was helpful to me. She didn't actually ask for any snacks or food. I will look and see where the dialysis center she goes phone number is and if food requests become an issue I know who to call. My other two dialysis patients were actually in the hospital right now so I didn't look at their charts last night. (Plus it was kind of a crazy shift to be looking up extra stuff :)) Thanks for all your (and the other posters) help!

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