Dietitians at the Dialysis Center

“We're not the food police!” exclaims one DaVita dietitian. Okay, then: what exactly is a renal dietitian, what do renal dietitians do and why would they have a law enforcement-type reputation?

What is a renal dietitian?

A renal dietitian is highly educated in food and nutrition and specializes in the dietary needs of people with chronic kidney disease. After earning a bachelor's degree, a dietitian needs to complete an internship and pass a national exam to become a Registered Dietitian (RD). Many dietitians also have a master's degree. Several states require that dietitians also get a license from the state where they work. All dietitians must continue their education each year to maintain their status as a registered dietitian.

A dietitian enjoys food sciences, understanding the relationship between food and nutrition and how it affects the body as well as teaching people what to eat to be healthier and feel better. Because renal dietitians specialize in the care of patients with chronic kidney disease, dietitians have thorough knowledge of what types and amounts of foods should be eaten by people who have high blood pressure, heart disease, diabetes, early kidney disease or are on dialysis.

What do renal dietitians do?

Whether the patient does in-center hemodialysis, at-home hemodialysis or peritoneal dialysis, a dietitian is an important member of their health care team.

When a person with chronic kidney disease begins dialysis they will meet with a renal dietitian. At that initial meeting, the dietitian will:

• Introduce herself or himself to the patient
• Assess the patient's current physical condition and nutritional status
• Develop a rapport and get to know the patient, the patient's family and caregiver
• Discover what the patient likes to eat as well as their past and current eating habits
• Examine current lab work
• Determine and prioritize the patient's nutritional needs
• Determine if the patient has a support system to help with the shopping and cooking
• Develop an individualized meal plan
• Provide education related to diet, nutrition, medical conditions and the state of the patient's health
• Provide menus and a grocery list to help with purchasing items and preparing meals

Since many people are overwhelmed when starting dialysis treatments, the dietitian is careful not to overload the patient with information. The dietitian will focus on the patient's immediate needs first, then provide more information as it is needed.

What does the renal dietitian do for dialysis patients on an ongoing basis?

The most important responsibility of the dietitian is to educate patients on what to eat based on the results of their lab work. The dietitian will provide valuable information to help the patient stay as healthy as possible. The dietitian's goal is to help patients understand that what they eat directly affects where their lab levels are. Dietitians also try to make patients aware of what can happen over time when those lab levels are not where they should be.

At least once each month the dietitian will give the patient a “nutrition report” with lab values from their blood test results. At this time the dietitian will:

• Educate the patient on what the lab values mean and how the patient is doing
• Educate and provide advice on what and how much to eat to improve lab results and patient health
• Explain the relationship of the lab values to the food the patient has been eating
• Review food and fluid intake and make recommendations, if necessary
• Review vitamin supplements and medications such as phosphorus binders and active vitamin D
• Consult with the physician regarding adjustments that may be needed
• Provide advice on protein and/or calorie supplements, if necessary
• Analyze trends over time to determine how the patient is responding
• Motivate patients to follow the prescribed eating plan
• Provide educational materials including, handouts, recipes and where to obtain specialized cookbooks

The dietitian will assist in the management of bone disease (renal osteodystrophy), which can occur when phosphorus levels are too high for too long. By looking at phosphorus and calcium lab values, the dietitian will adjust the patient's diet, and work with the physician regarding medications, such as phosphate binders and active vitamin D doses.

Patients can also turn to their dietitians for advice when experiencing digestive problems such as trouble swallowing, loss of appetite, feeling full, constipation or other elimination problems.

“We're not the food police!”

Food has evolved into something more than what we need to eat to survive. People have developed a relationship with food. We have favorite foods, foods that tempt us and foods we hate. Dietitians realize people have emotional attachments to food and encourage patients to talk about these issues. The dietitian is available to offer support in addition to educating patients.

Far from policing what patients eat, the dietitian is a resource for living better on dialysis. Many times dietitians seem all knowing because lab values are giving them clues as to what the patient has been eating. A patient who has not been following the renal diet may feel a little guilt. This may be one of the reasons dietitians have the food police reputation. The dietitian isn't there to judge, but to help the patient be as healthy as possible.

Dietitians want to keep their patients healthy, plus they want to help them enjoy their foods. While a renal diet can seem restrictive, there is flexibility. A dietitian can show patients how to enjoy—in limited portions—their favorite foods and still have good lab results. Patients can also enjoy going to parties and dining at restaurants after learning how to plan ahead and make wise menu choices.

With a vast understanding of food science and how intake and nutrients affect the body, a dietitian creates an individualized eating plan for each and every dialysis patient. When a patient gives the dietitian a realistic assessment of their lifestyle, food preferences and health concerns, they can receive the best advice from this knowledgeable professional.

There can be many reasons a patient finds it difficult to stick to the renal diet. Some obstacles include phosphorus, albumin, weight loss, fluid gain, financial problems, not understanding their lab work, not knowing what to eat, lack of a support system, forgetting to take binders and many more. Whatever the challenge, the dietitian can provide patients with the tools to overcome obstacles and succeed.