Slowing down the spiral toward kidney failure

Editor’s note: This article is based on excerpts from the upcoming second edition of, “Healthy Eating for Chronic Kidney Disease Patients,” written by NN&I editorial advisory board member Peggy Harum, RD, LD.The book will soon be available on Amazon and through Barnes and Noble as an eBook. Peggy can be reached at peggyharum@yahoo.com for more information.

“If you have been told…”

My childhood friend called me about a year ago saying she had found a doctor’s report on her husband’s desk saying he had a GFR of 40 and was in Stage 4 kidney disease. She asked, “What is a GFR?” and “What is stage 4 kidney disease?” Apparently the nephrologist had handed him the report with little explanation, other than, “Watch high potassium foods.” This fellow is a lawyer and an aeronautical engineer formerly with NASA.

So I quickly wrote something that I thought would peak his interest. It took about six months before he caught on that this was serious, despite that fact his urine output was normal and he had no symptoms. His wife was frantic when she realized this is no small problem – “What should I feed him?” “What should I do?”

I arranged for him to make an appointment with an old friend – probably one of the most well known renal dietitians I know. (Coincidentally, she also works with his nephrologist in research.) In the meantime, I offered them a number of materials to tide them over until they saw her. For example, answers to, “Is there anything you can do to prevent the progression,” “What caused your kidney disease,” plus, information on the function of kidneys, what is GFR, what are the stages of chronic kidney disease, and where is protein found. I wrote a week of menus for him with 70 grams of protein and a potassium restriction. His lab work showed potassium of 6.1 mEq/l.

He is now working with this expert renal dietitian I recommended hopefully to stave off progression of his disease.

Frequently I receive phone calls or emails from hospital dietitians or those in private practice. Since hospital dietitians must be savvy in all areas of nutrition, they don’t usually specialize in renal care. Hospitalized patients, or those patients coming for counseling sessions, have a myriad of problems that require nutritional guidance. It is almost impossible to have current educational materials for such a vast group of patients.

Training to become a dietitian does not prepare one for the problems associated with a dialysis clinic, even though one may have rotated through for some weeks. New renal dietitians can be befuddled when faced with a room full of needy new patients or old-timers already hardened in their ways.

Because registered dietitians often receive referrals for Stage 3 and 4 chronic kidney disease patients, this second edition includes one week of menus for 50-gram protein, 60-gram protein, and 70-gram protein with a potassium restriction as well as one week without a potassium restriction (six weeks of menus).

Hemodialysis and peritoneal dialysis clinic patients seem to enjoy getting menus specific to their individual needs. Confusing and complicated subjects like PTH, EDW, URR and KtV, take time to explain, so simple explanations are helpful with this patient population. There are multiple one-page handouts in the book on albumin and appetite, potassium, phosphorus, diabetes, and calories in peritoneal dialysis solutions. Blood test analysis can be daunting to understand. Hopefully the “Monthly Nutrition Lab Report” for HD patients and PD patients is easy to comprehend. I owe this idea to Susan Childress MS, RD, my clever colleague in North Carolina.

“Eat This Not That” is a section in the book where patients can make good choices as opposed to poor choices. This includes:

Potassium and phosphorus––what is the difference?

Some breakfast ideas for early morning risers (1st shift hemodialysis patients)

What to eat for breakfast

Restaurant dining out for lunch

How about dinner?

Desserts and snacks

Good seasonings to taste

Something to drink

How much fluid can I drink?

The book also includes a variety of new recipes with a nutrient analysis. -by Peggy Harum, RD, LDN