Renal Diet In-service for Nursing Staff
Use
A nutrition staff member should deliver this in-service to nursing staff.
Introduction
Residents often are sent to long-term care facilities with an order for a renal diet.
However, recommendations for nutrition care of a renal patient vary depending on the
stage of kidney disease. A renal diet is not always the best diet order for a patient
undergoing dialysis. The facility’s registered dietitian can recommend a diet order to best
meet the nutritional needs of patients with chronic kidney disease.
Quick readings
 Academy of Nutrition and Dietetics. Nutrition Care Manual®. Available to subscribers
at: www.nutritioncaremanual.org.
 National Kidney Foundation™. Nutrition and chronic kidney disease. Available at:
http://www.kidney.org/atoz/content/nutrickd.cfm.
 National Kidney Foundation. Nutrition and hemodialysis. Available at:
http://www.kidney.org/atoz/content/nutrihemo.cfm.
Objectives
 Nursing staff will understand the basic premise of a renal diet.
 Nursing staff will understand the differences between the nutritional needs of a patient
with chronic renal insufficiency/chronic kidney disease and those undergoing dialysis.
Outline
1. Renal diets are ordered for those with chronic renal failure, not acute renal
failure.
 Stage of chronic renal failure is defined by a lab value called the glomerular
filtration rate (GFR).
 Stages 1–4 patients have impaired kidney function based on GFR.
 Stage 5 patients require dialysis.
2. A renal diet calls for a number of dietary restrictions.
 Restrictions are based on:
– Lab values
– Medical condition
– Weight
– Skin condition
3. A traditional renal diet menu in most medical facilities is lower in phosphorus,
potassium, protein, and sodium than the regular diet.
 Potassium often is restricted.
– Common foods high in potassium include many fruits and vegetables:
 Bananas
 Beets
 Brussels sprouts
 Dried fruits
 Orange juice
 Oranges
 Potatoes
 Prune juice
 Prunes
 Spinach
 Tomato juice
 Tomato sauce
 Tomatoes
– Too much potassium in the blood can cause heart problems.
 Phosphorus is sometimes restricted.
– Foods high in phosphorus include:
 Bran cereals
 Cheese
 Dried beans and peas
 Milk
 Nuts
 Peanut butter
 Whole-wheat bread
 Yogurt
– Too much phosphorus in the blood pulls calcium from the bones.
 Sodium sometimes is restricted.
– Foods high in sodium include:
 Canned soups
 Deli meats
 Processed meats, such as bacon, sausage, hot dogs, and bologna
 Salty snack foods
– Too much sodium in the blood is related to high blood pressure and congestive
heart failure.
 Protein sometimes is restricted, but not always:
– Patients undergoing dialysis usually need more protein than the average person.
– Patients with Stages 1, 2, 3, or 4 kidney disease may need a protein restriction.
– A registered dietitian can look at a patient’s overall medical condition and meal
intake and decide if protein restriction is needed.
4. Lab values are reviewed to determine if dietary restrictions are needed.
 GFR determines the stage of kidney disease and need for protein restriction.
 Albumin and prealbumin are not always good indicators of protein stores:
– Do not increase protein based on a low albumin alone.
 Potassium—above-normal values may require potassium restriction.
 Phosphorus—usually PhosLo® or other medications are recommended, rather than a
phosphorus restriction.
5. Is a renal diet really needed?
 Many older adults in long-term care have poor meal intake or skin breakdown, or
have experienced significant weight loss.
 Providing a regular diet may increase intake, improve nutritional status, and improve
quality of life.
 As a rule, with the input of a registered dietitian, many long-term care patients on
dialysis can receive a regular diet, if certain foods, such as high-potassium or highsodium foods, are placed on the patient’s tray card as a food dislike.
6. Summary
 When a patient has a diagnosis of renal failure, their nutritional needs are complex.
 Often a renal diet is not necessary or appropriate.
 Nutrition assessment by the facility’s registered dietitian and/or consultation with a
dietitian at the patient’s dialysis center can help a facility determine what the best
diet prescription is for a patient with renal failure.
Renal Diet
Pretest and Posttest
Name:
____________________________________
Date:
____________________________________
Department:
____________________________________
1. True or False: All patients with renal disease should receive a renal diet.
2. Which of the following is true about patients receiving kidney dialysis:
a. They need less protein than a healthy older adult
b. They need more protein than a healthy older adult
c. They need to watch their sugar intake
d. They need to watch their magnesium intake
3. Changing a patient from a renal diet to a regular diet is possibly a good idea when:
a. The patient’s intake is poor
b. The patient has skin breakdown
c. The patient has lost weight
d. All of the above
4. True or False: High phosphorus levels usually are treated with medications rather than
dietary changes.
5. Low-protein renal diets sometimes are necessary for:
a. Individuals with Stage 5 chronic kidney disease
b. Individuals who are on dialysis
c. Individuals who have chronic kidney disease, but are not on dialysis
d. Individuals with acute renal failure
Renal Diet
Pretest and Posttest Answers
1.
2.
3.
4.
5.
False
b. They need more protein than a healthy older adult
d. All of the above
True
c. Individuals who have chronic kidney disease, but are not on dialysis
References and recommended readings
Academy of Nutrition and Dietetics. Nutrition Care Manual. Available to subscribers at:
www.nutritioncaremanual.org. Accessed January 8, 2013.
National Kidney Foundation. Nutrition and chronic kidney disease. Available at:
http://www.kidney.org/atoz/content/nutrickd.cfm. Accessed January 8, 2013.
National Kidney Foundation. Nutrition and hemodialysis. Available at:
http://www.kidney.org/atoz/content/nutrihemo.cfm. Accessed January 8, 2013.
Review Date 1/13
R-0570