Question

Case Study - Planning a renal diet for dialysis

Beth is a 51-year-old white female, 5’ 5” tall weighing 130 pounds with a sedentary activity level. She has chronic renal failure and has recently begun hemodialysis three times per week. She has been referred to you for help with her diet.

Help Beth to plan a diet with adequate protein, 2000-3000 mg potassium/day, and no added salt (approximately 2000-3000 mg sodium/day). Her usual urine output is 8 ounces (250 ml) per day. She will need a daily diet pattern and a sample day of meals.

Using Appendix 29 (Renal diet for dialysis) complete the following:

Beth’s daily diet pattern:

Food Group	Number of Servings
Protein Foods	X
Potassium Foods – High                                - Medium                                - Low	X X X
Sodium Foods     – High                                - Medium                                - Low	X X X
Fluid Total	X

Sample Day of Meals:

Food Group	Food	Serving Size
Protein Foods	X	X
Potassium Foods – High                              - Medium                              - Low	X X X	X X X
Sodium Foods      - High                              - Medium                              - Low	X X X	X X X
Fluid totals	X	X

What other information will help Beth follow her diet?

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As you follow Beth’s progress, what laboratory or anthropometric biomarker will evaluate the sufficiency or excess of the following nutrients in her diet:

protein? _____________________________________________________________________

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Sodium _________________________________________________________________

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Potassium ________________________________________________________________

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Fluid _____________________________________________________________________

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Answer 1

Food Group	Number of servings
Protein foods	4 ounces of meat/poultry/fish at both lunch and dinner
Potassium foods-High	No
Potassium foods-Medium	1-2 servings per day
Potassium foods-Low	4 servings per day
Sodium foods-High	No
Sodium foods-Medium	No
Sodium foods-Low	2-3 serving per day
Fluid total	4 cups per day

Food Group	Food	Serving size
Protein foods	egg,fish ,meat	1 chicken breast or medium fish fillet or medium pork chop
High potassium foods	Milk,chocolate,peanut butter	Best to avoid
Medium potassium foods	Apple,lettuce,corn	1/2 apple
Low potassium foods	Cucumber,carrot,cabbage,onion	1 small fruit or 1 ounce of juice or 1/2 cup of vegetable cooked or raw
High sodium foods	Processed foods,salad dressing,table salt	Best to avoid
Medium sodium foods	Fresh leafy vegetables	1/2 cup
Low sodium foods	fresh poultry,meat,fruits	1/2 cup
Fluid totals	Water,juice,smoothie	1/2 cup

Other information that will help Beth follow her diet:
She should limit phosphorus intake in her diet and its better to avoid foods high in phosphorus.She should not add salt while cooking as this would help to keep the sodium level of her body in control.

The following laboratory or anthropometric biomarkers will evaluate the sufficiency or excess of the following nutrients in her diet:
PROTEIN: PEW(protein-energy wasting) where there is a loss of the protein mass and energy store of the body.Mid-arm circumference,biceps skinfold and triceps skinfold

SODIUM: Serum analysis for sodium
POTASSIUM: Serum analysis for potassium
FLUIDS: Swollen hands and feet,increase in blood pressure, fluid weight gain shows excess fluid intake.