Renal Failure                                    Return to the Beginning

The kidneys are the filtering system of the body. Waste products are filtered and then eliminated from the blood into the urine.  The kidneys also regulate necessary substances such as water, sodium, and potassium. An excess of any of these substances can be harmful. Certain diseases, including diabetes and hypertension, can lead to a decrease in kidney function or renal failure. Depending on the type of renal failure one has, nutrition treatment will be different. Patients will look to the nursing professional to answer questions about the diet, especially if the dietitian is not included in the patient’s care prior to discharge. Awareness of the difference between pre-dialysis renal failure and end-stage renal disease with dialysis and their diet implications is necessary.

Renal failure can happen suddenly (acute renal failure), but more commonly happens gradually over the years (chronic renal failure). Acute renal failure (ARF) happens most often as a complication from a serious illness and does not require long-term dialysis. ARF is often a temporary condition and with proper treatment can often be reversed with no permanent or serious damage to the kidneys. Chronic renal failure (CRF) is a progressive loss of the kidney’s ability to excrete waste products. CRF slowly gets worse and most often is a result of any disease that causes gradual loss of kidney function. Unlike acute renal failure, CRF is not reversible. This gradual progression leads to end-stage renal disease, which requires long-term dialysis treatments. 

The therapeutic nutrition provided will depend on the type of renal failure the patient develops. In acute renal failure (pre-dialysis) nutrition guidelines are very strict. The protein content of the patient’s diet is restricted severely until the renal labs return to normal. Sodium, fluids, potassium and phosphorus are also restricted in the diet during the duration of the acute renal failure. Hopefully, by the time the patient is ready to be discharged, the nutrition restrictions won’t be as severe. 

Chronic renal failure nutrition therapy will be the same until it progresses to end-stage renal disease and the patient starts long term dialysis treatments. Once dialysis starts, protein is no longer restricted as with ARF or CRF. Patients receive dialysis three times per week for at least three hours each time, and their blood is being cleansed repeatedly. It is crucial to make sure that the patient is receiving adequate protein during dialysis to make up for protein losses during the process. Sodium and fluids are still restricted to limit weight gain between dialysis treatments. Phosphorus is limited to avoid increased phosphorus blood levels which may interact with calcium to weaken bones. Phosphorus also has negative effects on the tissue of your heart, blood vessels, and lungs. Patients take phosphorus binders with meals to help rid the body of excess phosphorus. Potassium is also restricted in the diet. Excess serum potassium can negatively affect heart rhythms. Patients have blood taken monthly to check renal laboratory values. The outpatient dialysis dietitian will review labs with the patient and make any necessary nutrition treatment changes at that time.

Once the patient is able to see the dietitian after discharge during an outpatient appointment, food records from the patient will be reviewed and the dietitian can answer further questions in more detail. The following is a list of nutrition guidelines to give patients before they are discharged to help them feel comfortable with their home diet:

 

Pre-dialysis Renal Failure Survival Skills

• Protein needs to be restricted to two ounces of meat at lunch and supper.
• Restrict milk to one-half cup per day.
• Limit sodium and high-sodium foods – get rid of the saltshaker.
• Limit the amount of fluids consumed daily. The physician may order a fluid restriction to be followed. This could range from 1200-2000 ml (40-60 ounces) per day.
• Reduce the amount of fruits and vegetables eaten daily due to potassium content. Items in particular include: tomato, vegetable juice cocktails, sweet potatoes, bananas, melons, and oranges. 
• Reduce whole grains and bran, cheese, and beans to decrease phosphorus consumption.

 

End-stage Renal Disease with Dialysis Survival Skills

• Increase the amount of protein eaten – make sure you have meat with every meal.
• Limit sodium and high-sodium foods – get rid of the saltshaker.
• Fluids need to be limited to the amount ordered by the physician.
• Limit high-phosphorus foods (see above). Take phosphorus binders as ordered.
• Limit high-potassium foods (see above).