Renal Diet Delight

To be completely honest with you, when I work as a tech  correcting menus renal diet orders are my least favorite.  However when the census gets high and there can be up to ten patients with renal diet orders I let out an inward sigh, roll up my sleeves, and turn on my calculator.  If have studied nutrition, you know the key players in a renal diet: phosphorous, sodium, and potassium.  Here's a refresher on why:

• Phosphorous: stays balanced with its buddy calcium to make sure bones and teeth stay strong.  When kidneys start failing, phosphorous can accumulate becoming higher than calcium.  The balance is thrown off with more phosphorous than calcium causing the body to steal calcium from the bones to make up for the deficit which makes the bones weak.   
• Sodium: can build up if kidneys aren't working...too much can cause the body to hold onto fluid and increase blood pressure
• Potassium: in charge of nerves, muscles, and the heart...can build up if kidneys aren't working causing heart problems

The most basic diet order will be called "Renal Standard" designed for 60 g protein and monitors potassium, phosphorous, and sodium.  I will see what a patient orders and modify to follow a pattern for the amount of fats, starches, proteins, fruits, vegetables, and beverages at each meal. Following the pattern give the right amount of phosphorous and sodium.  After I do that, I calculate total potassium to make sure it is at least 2000 mg and not over 2099 mg.  

It is very common to see renal carbohydrate control diets as high blood sugar can overwork the kidneys.  The pattern I follow for a carb control renal is slightly similar to the renal standard, however sugar and concentrated sweets are restricted.  There is a renal standard carb control diet which is 1800 kcal and 60 g protein.  However there are also patterns for 1500 kcal 40/50/60/70/80/90/100 g protein - 2400 kcal with varying protein levels.  Having preset patterns makes it easy for me to somewhat quickly correct diets to ensure the patient receives the correct amount of kcals and protein prescribed by the physician or dietitian.

There are also nightmare-ish renal diets...for example renal, carb control, 40 g protein, 1.5 g potassium, cardiac diet (this would be low fat and lower protein making it difficult to balance carbs).  I've also had a 2000 kcal renal carb diet which makes it difficult to stay below 2 g potassium.  Diets higher in protein (> 60 g) are also difficult when it comes to staying at 2 g potassium because 1 g of protein contains 100 mg potassium.

There are certain foods I would never ever allow on a renal diet because of their high potassium.  For example...
-bananas
-oranges or orange juice...or grape juice
-potatoes
-tomatoes
-very very very limited dairy (4 oz of milk has 185 mg)
-peanut butter
-mushrooms
-cantaloupe
...there are many many more, however these are foods available where I work.

Foods I use in renal diets (I know the potassium/K+ amounts by memory now):
-mocha mix (milk substitute that is higher in fat but low protein and has 80 mg potassium per serving)
-green beans (90 mg per 1/2 c), peas (90 mg), carrots (180 mg), zucchini (220 mg, this is as high as I would go)
-1 c lettuce (100 mg)
-canned peaches/pears (120 mg per 4 oz), applesauce (90 mg), fruit cocktail (115 mg), watermelon (100 mg), honeydew (200 mg, this is as high as I would go)
-1 serving of carbs is 35 mg (i.e. 5 vanilla wafers, slice of angel food cake, 1 roll, 1 slice bread, 4 oz oatmeal/cream of wheat, 1/2 c rice or pasta)
-1 oz eggs (100 g), 2 oz chicken (200 g)
-renal sandwich (270 g) has 2 pieces of bread (70 mg) and 2 oz meat (200 mg)
-tea, if allowed (65 mg per 8 oz)
-coffee, if allowed (90 mg per 8 oz)
-3 creamers or 1 pat margarine (10 mg)
-cranberry juice cocktail (20 mg), apple juice (150 mg, pretty high for a beverage)

Sample day (roughly, I don't have a pattern in front of me) to give you a vague idea:

Breakfast: 4 oz mocha mix, 4 oz reduced fat milk, 1 oz eggs, 4 oz canned peaches, 1 slice of toast, 4 oz oatmeal, 8 oz coffee, 2 pats margarine (675 mg K+)

Lunch: renal turkey sandwich, 1 c green beans, 4 oz applesauce, 3 pat margarine, 5 vanilla wafers, cranberry cocktail (625 mg K+)

Dinner: 2 oz chicken, 1/2 c rice, 1 dinner roll, 1/2 c zucchini, 4 oz canned pears, slice of angel food cake, 3 pats margarine, 8 oz tea (735 mg K+)

Total: 2,035 mg K+ (this falls in between the 2000-2099 mg range)

Sometimes I am too high and have to remove things such as tea, coffee, juices, or fruits/veg higher in K+
Sometimes I am too low and have to add a beverage or fruit/veg higher in K+

Image from Edinburgh Renal Education Pages