Running head: RENAL NUTRITIONAL ASSESSMENT 1

Renal Nutritional Assessment and Discharge

Olivia M. Taylor

University of South Florida

RENAL NUTRITIONAL ASSESSMENT 2

Renal Nutritional Assessment

Mr. Jabba The-Hutt has recently been diagnosed with chronic renal failure and is

scheduled for a dialysis consult. Before discharge, it is important that JH receives teaching

concerning dietary habits that aid in the management of chronic renal failure.

Disease Process of Chronic Renal Failure

Chronic renal failure (CRF) is characterized by a consistent decline of kidney function

over a period of months or years. Causes of renal failure include diseases such as diabetes

mellitus and hypertension, as well as diseases specific to the kidneys, such as glomerulonephritis.

The inflammation and injury to the nephrons cause decreased glomerular filtration rate (GFR)

and the body becomes unable to properly excrete waste or maintain fluid and electrolyte balances

(Heuther & McCance, 2015, p. 763). Preventing the worsening of electrolyte imbalances, waste

accumulation, and fluid overload are the main priorities of the renal diet.

Restricted Nutritional Items and Rational

Patients with CRF need to limit consumption of sodium, phosphate, and potassium.

Sodium intake above the recommended amount of 1,500 mg / day can lead to increased blood

pressure and fluid overload, further complicating CRF. Adhering to recommended daily limits

has been shown to reduce edema and hypertension medication doses (McMahon, Campbell,

Bauer & Mudge, 2015, Main Results section, para. 2). High serum phosphate levels due to

decreased GFR can cause hyperparathyroidism and, consequently, osteomalacia (Center for

Clinical Practice at NICE, 2013, Introduction section, para. 6). Therefore, foods with added

phosphates, such as premade baking mixes, should be avoided. Many animal based proteins also

have a high phosphorous content. In the same manner, the kidneys are unable to efficiently

excrete potassium. If a patient becomes hyperkalemic, potentially life threatening cardiac

RENAL NUTRITIONAL ASSESSMENT 3

arrhythmias can occur. Close monitoring of serum potassium levels is required, and a potassium

level above above 5.0 mEq/ L will warrant potassium restriction (National Institute of Diabetes

and Digestive and Kidney Diseases [NIDDK], 2015, Hyperkalemia section para. 5).

Patients with CKD should also lower the total amount of fats consumed and substitute

unsaturated, plant based fats for saturated fats whenever possible. Increased blood pressure due

to a high fat diet both exacerbates CKD and further increases the patients risk of cardiac

complications (NIDDK, 2015, Blood Pressure section, para. 4).

Required Dietary Inclusions and Rational

Although JH will need to adjust to new dietary restrictions, there are many nutrients that

a renal diet requires. Protein sources that are low in phosphate, such as egg whites, are needed to

prevent malnutrition while keeping serum phosphate levels within desirable limits. A CKD

patient may need to consume refined grains instead of whole, as they are lower in phosphorous.

Many fruits can be incorporated into the diet, as they are naturally low in sodium, phosphorous

and, depending on the fruit, potassium (NIDDK, 2015, Food Groups Section, para. 7).

Patient Education Regarding Proper Nutrition

Before discharge, JH should receive teaching on how to read nutrition labels, including

how to identify low sodium foods, added phosphates as words that begin with the prefix phos-

and salt substitutes. Salt substitutes are composed of potassium chloride and should be avoided

to prevent hyperkalemia (NIDDK, 2015, Potassium section, para. 7).

Conclusion

It is important that JH restricts intake of sodium, phosphate, potassium, and fats while

consuming adequate levels of necessary nutrients, such as grains and low-phosphate proteins.

Doing so will aid the treatment of his chronic renal failure and promote maximum well-being.
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References

Centre for Clinical Practice at NICE. (2013). Hyperphosphataemia in Chronic Kidney Disease

National Library of Medicine - PubMed Health. Retrieved November 17, 2016, from

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0080142/

Huether, S. E., & McCance, K. L. (2015). Understanding pathophysiology (6th ed.). St. Louis,

MO: Elsevier Health Sciences.

McMahon, E. J., Campbell, K. L., Bauer, J. D., & Mudge, D. W. (2015, January 13). Altered

dietary salt intake for people with chronic kidney disease - National Library of Medicine

- PubMed Health. Retrieved November 17, 2016, from

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072284/

National Institute of Diabetes and Digestive and Kidney Diseases. (2015, June 22). Chronic

Kidney Disease (CKD) Nutrition Management Training Program. Retrieved November

17, 2016, from https://www.niddk.nih.gov/health-information/health-communication-

programs/nkdep/identify-manage/professional-education/ckd-nutrition/training-

modules/Pages/training-modules.aspx