Three years ago while visiting my family in Argentina, I had the opportunity to shadow a renal dietitian at a dialysis center. At that time, I knew little to nothing about the nutritional implications of renal disease or the role the kidney played in maintaining a balance of fluid and chemicals in the body. I learned a little about what a renal dietitian does during that visit, but perhaps more importantly, the exposure piqued my interest. A few weeks ago, I completed a highly anticipated renal rotation where I learned so much about managing renal disease with nutrition and dialysis. Nutritional therapy is critical to manage and slow the progression of renal disease from Chronic Kidney disease (CKD) to end-stage-renal disease (ESRD). Once the disease has progressed to ESRD, dialysis or kidney transplantation is required to stay alive. A dietitian can provide nutrition education critical for successful management of ESRD. Two key nutrients of concern in ESRD patients are phosphorus and albumin. These nutrients are the hardest laboratory values to keep within range.
Dialysis does a great job in removing the extra potassium and sodium from the body, but it is less effective with phosphorus or “Phos.” It is very important patients know how to control their dietary phosphorus intake.
So, why is phosphorus hard to control for people in dialysis? During my rotation I became aware that phosphorus is ubiquitous in foods. There are natural sources of phosphorus, such as from dairy products, fish and meat; additionally phosphorus is added to most processed foods, such as Gatorade, twinkies, chocolate pudding, etc. I was able to teach patients how to read food labels to help them recognize and avoid foods that are either naturally high in phos or contain phosphorus additives. They should check the label for long words that contain “phos,” such as “monosodium phosphate,” “dicalcium phosphate,” etc.
Another important topic that I covered with patients was the importance of compliance with phosphate binders. Unfortunately, non-compliance was a common issue. Since keeping phosphate within normal range is so difficult for most people undergoing dialysis, it is vital that they remember to take phosphate binders with each meal. For that purpose, I had fun delivering key chains designed specifically to carry the phosphate binding pills for patients to use when they will be away from home during meal times.
Another potential problem with ESRD is low blood levels of albumin. It was very unusual to see a patient with a normal level of this protein.
Albumin is the most abundant protein in our body. Our body needs protein to help build muscle, repair itself, and fight infections. Since so many patients on dialysis need to eat a good amount of quality protein, I made sure to discuss how to make good protein choices with the patients. It was very challenging, but critically important to tailor a diet specifically for their underlying disease; the diet typically needed to be high in protein but lower in sodium, potassium, and phosphorus.
After having this experience, I have a clearer understanding of the role the kidneys play in normal bodily function. Additionally, I realize the importance of regulating key nutrients such as sodium, potassium, phosphorus, and protein when the kidneys are not functioning properly. I was taken aback with renal nutrition three years ago because of the major impact diet plays in the outcome of this terrible disease. Now, after completing my renal rotation, I understand the complex, but fascinating world of renal nutrition a bit more. I am not only convinced that my true passion lies in renal nutrition, but also about the importance of leading a healthy lifestyle to help keep our kidneys healthy.