Dietary prescriptions vary by patient based on numerous variables, including the extent of renal disease, the current nutritional state of the patient, and the applied renal therapy.

This module will review basic dietary requirements for patients with chronic kidney disease and will explore the nutritional impact of three dialysis therapies and transplant.

Planners, content specialists and feedback personnel have declared that there is no conflict of interest in the preparation and content of this module. There is no commercial support for or endorsement of products in this module.

• Discuss the need for a dietary prescription.
• Explain the role of dietary nutrients in maintaining health and well being.
• List the major nutrients associated with the renal diet.
• Discuss the recommended nutrient intake for each treatment modality.
• Describe the role of the renal dietician.
• Identify at least three evaluations performed by the dietician as part of the nutritional assessment.
• Describe the role of the multidisciplinary team in the nutrition of a dialysis patient.

Bibliography
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Curtis J. Daily short and nightly nocturnal home hemodialysis: State of the art. Dialysis & Transplantation. 2004; 33: 64-73; 100.

Ehrilich J, Rumberger J. Detection and clinical management of cardiovascular calcification in ESRD: A review. Dialysis & Transplantation. 2004; 33: 306-314.

Foque D. Nutritional requirements in maintenance hemodialysis. Advances in Renal Replacement Therapy. 2003; 10:183-193.

Galland R, Traeger J, Arkouche A, Cleaud C, Delaware E, Fouque, D. Short daily hemodialysis rapidly improves nutritional status in hemodialysis patients. Kidney International. 2001; 60: 1555-1560.

Herselman M, Moosa M, Kotze T, Kritzinger M, Wuister S, Mostert D. Protein-Energy malnutrition as a risk factor for increased morbidity and mortality in long-term hemodialysis patients. Journal of Renal Nutrition. 2000; 10: 7-1.

Kopple J. Focused Review: Introduction. In Advances in Renal Replacement Therapy. 2003;10:153 -154.

Lore G. NKF releases Its K/DOQI nutrition clinical practice guidelines. Contemporary Dialysis & Nephrology, 2000; 21: 8.

Ludlow M. Renal handling of potassium. Nephrology Nursing Journal. 2003; 30: 493–498

McCann L. Total calcium load in dialysis patients: An issue of concern for dieticians. Dialysis & Transplantation. 2004; 33: 282-290.

McPhatter L, Lockridge RS. Daily dialysis: Nutritional implications and advantages for a state-of-the-art treatment option. Nephrology Nursing Journal. 2004; 31: 223.

Mehrotra R, Kopple J. Protein and energy nutrition among adult patients treated with chronic peritoneal dialysis. Advances in Renal Replacement Therapy. 2003; 10:194–212.

National Institutes of Health. The DASH Eating Plan. 2003 NIH Publication No. 03-4082.

National Kidney Foundation. NKF-K/DOQI Clinical practice guidelines for nutrition in chronic renal failure. New York: National Kidney Foundation. 2001.

Paskalev D, Ikonomov V, Hristosov, K, Dechiva, L. Some medical aspects of nutritional therapy in elderly chronic renal failure patients. Dialysis & Transplantation. 2002; 31: 607-614.

Pupim L, Cuppari L. Malnutrition in end-stage renal disease: Beyond inadequate nutrient intake. Nephrology News & Issues. 2003; June: 70.

Reyes F, Fedje L. Therapeutic renal nutrition. In Curtis J, Varughese, P ed. Dialysis Technology: A Manual for Dialysis Technicians 3rd ed. Ohio: NANT; 2003: 88–91.

Wells C. Optimizing nutrition in patients with chronic kidney disease. Nephrology Nursing Journal. 2003; 30:637-648.

Webliography
American Association for Clinical Chemistry. Lab tests online: Vitamin B12 and folate deficiency. Aug 10, 2004. Available at: http://www.labtestsonline.org/understanding/conditions/vitaminb12-3.html. Accessed June 6, 2006.

American Association of Kidney Patients. AAKP Nutrition Counter: A Reference For the Kidney Patient. 1999-2006. Available at: http://www.aakp.org/AAKP/nakphos.htm. Accessed June 6, 2005.

Feinburg School, Northwestern University Department of Preventive Medicine. Nutrition Fact Sheet: Sodium. Sept 21, 2005. Available at: http://www.feinberg.northwestern.edu/nutrition/factsheets/sodium.html. Accessed June 5, 2006.

Institute of Medicine, Committee on Use of Dietary Reference Intakes in Nutrition Labeling. Appendix C: Acceptable macronutrient distribution ranges. In: Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification. Washington: National Acadamies Press. 2003. Available at: http://darwin.nap.edu/books/0309091438/html/180.html. Accessed June 6, 2006.

Kidney School. Module 9: Nutrition and Fluids for People on Hemodialysis. 2004. Available at: http://www.kidneyschool.org/pdfs/Module9HD.pdf. Accessed January 26, 2007.

King M. Introduction to Vitamins. Vitamins and Coenzymes. Mar 28, 2006. Available at: http://web.indstate.edu/thcme/mwking/vitamins.html. Accessed June 6, 2006.

National Heart, Blood, and Lung Institute. The DASH Eating Plan. 2006. NIH Publication No. 06-4082. Available at: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm.

National Kidney and Urologic Diseases Information Clearinghouse. Eat Right to Feel Right On Hemodialysis. NIH Publication No. 03–4274. April 2003. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/eatright/index.htm. Accessed June 5, 2006.

National Kidney Foundation, Kidney Dialysis Outcomes Quality Initiative (K/DOQI). Guidelines 2000: Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. 2000. Available at: http://www.kidney.org/professionals/kdoqi/guidelines_updates/doqi_nut.html. Accessed June 6, 2006.

National Kidney Foundation. Kidney Disease A-to-Z Guide: Nutrition, diet. 2006. Available at: http://www.kidney.org/atoz/atozTopic.cfm?topic=4. Accessed June 6, 2006.