By Joyce L. Hornick
My first thoughts about being an RD who works in a dialysis center are completely wrong. I thought that specializing in renal nutrition would be pretty much the same as any RD working in the clinical setting of a hospital. The only difference would be that you only deal with people who have End Stage Renal Disease (ESRD) and not many other issues. There would be the occasional help with diabetes and blood sugar control, but not much else.
Four days of working with an RD at a dialysis center with approximately 140 patients showed me how wrong I was. Renal dietitians work in a very clinical atmosphere and are very clinically oriented. Patients with ESRD are on many medications. Most of these medications are directly related to their nutritional status, especially with their phosphorus, potassium, sodium, calcium, and vitamin D levels. They need to take phosphate binders to prevent phosphorus from building up in their tissues and blood. If a patient takes them incorrectly, they may not work efficiently. They can also cause upset stomach, vomiting, and constipation. All of their medications depend on their diet and the dosing of other medications. Dosing needs to be fine tuned on a regular basis. The RD is in charge of these dosing recommendations.
The renal dietitian works very closely with their patients. They know who is good at following their diet and who is not. They know who likes a lot of technical information about food and who doesn’t. One question by a patient about hidden phosphates in salad dressings created an investigative and educational project for all of the patients in the center, complete with a handout, a brief education, and a taste test of ranch dressings with pretzels.
If you think being a dietitian at a dialysis center would be too technical or clinical for you, think again. Even though it does involve these aspects, it involves so much more. You get a lot of personal interaction with patients and get the opportunity to help them over a long period of time.