By Maria Karalis, MBA, RD, LD & Julie Prinsen, RD, LD, CSR

There have been many changes in your life, and probably the most confusing and difficult adjustment is your new diet. Changing your diet now can make a difference. It can possibly slow down the progression of your kidney disease.

Your nephrologist may have told you to follow a low-protein or low-potassium diet. Perhaps even to avoid high-phosphorus foods. Limiting potassium or phosphorus, while still getting enough calories and limiting protein, is not easy. Luckily, there are nutrition experts who can help with your questions and ease the transition to this new way of eating. They are called registered dietitians (RD).

RDs are trained nutrition experts who completed training and education standards by the Commission on Dietetic Registration. An RD has been trained in all areas of nutrition and how it relates to disease, and has a bachelor’s degree in nutrition and medical dietetics. Some of the course work includes food and nutrition sciences, foodservice systems management, biochemistry, physiology, microbiology and chemistry. An RD has finished a six to 12 week internship and passed a national exam. After passing the exam, in order to maintain their credentials, RDs must complete continuing education each year. This helps them keep up with advances in their field. An RD may need to be licensed if this is required by the state in which they work (LD stands for licensed dietitian).

RDs work at hospitals, medical centers, private practices and other healthcare facilities. A renal dietitian is an RD who specializes in the nutrition care of patients with chronic kidney disease (CKD). These dietitians work in dialysis centers and see hemodialysis and peritoneal dialysis patients. Some work with kidney transplant patients. Many see patients before they start dialysis.

Some RDs have special board certifications in diabetes, pediatrics or renal nutrition. In addition to the RD credential, those with board certification in renal nutrition will have the credentials CSR after their name. These RDs have many years of experience in the renal field and have taken an extra exam providing proof they are familiar with all clinical problems related to renal nutrition.

An RD can translate complicated medical jargon into an understandable nutrition plan. RDs understand how kidneys work and how kidney disease relates to the bones, organs and anemia. They can also explain why you need to limit certain foods. When planning your new meal plan, the RD will include your favorite foods, including any ethnic foods.

The RD is also trained to fit your new meal plan to your schedule, whether it includes working, traveling, chauffeuring children to school activities or running with energetic toddlers. With education, the renal meal plan can fit into any schedule and the RD is the person to help you do this.

If you have been diagnosed with CKD and are not yet on dialysis, it is important to find a renal dietitian who can help with your new meal plan. Medicare will pay 80 percent of the cost of Medical Nutrition Therapy (MNT) with an RD trained to work with the renal diet. Ask your nephrologist for a referral to an RD. They often work closely with RDs and can provide names of MNT-certified dietitians in your area. You can find board certified renal dietitians in your area at www.cdrnet.org. Go to “Fellow and Specialty Online Directories Available,” then “Specialist Locator Search.” If you are not currently on Medicare, you can contact the outpatient dietitian at your local hospital. They are usually able to provide nutrition counseling for people with CKD.

Nutrition is an important part of your medical plan and following a complicated new meal plan does not happen by chance. Consulting an RD may be the most important thing you do to help you feel better and help your body become strong again. It can also make a difference in when you start dialysis.

Maria Karalis, MBA, RD, LD, is a Registered Dietitian who has worked in the nephrology field for 14 years. Maria is the Nutrition Consultant for iKidney.com and Assistant Editor of the Journal of Renal Nutrition. In 2001, she was the recipient of the National Kidney Foundation Council on Renal Nutrition Recognized Renal Dietitian Award.

Julie Prinsen, RD, LD, CSR, has been working in renal nutrition for 19 years. She is currently with FMC-Ohio Valley in Evansville, Ind. and Central City, Ky. She served on the MRB of The Renal Network and enjoys planning special educational projects and writing the patient newsletter for her unit.

This article originally appeared in the March/April 2005 issue of Kidney Beginnings: The Magazine, Vol. 4, No. 1.

Back