Eating right for end-stage renal disease (ESRD) or diabetes mellitus is complicated enough, so when both conditions are present patients may be very confused and frustrated as many nutritional recommendations are contradictory. Aside from focusing on types and quantities of carbohydrates, the typical diet for diabetes is the same as what any healthy consumer would be advised to follow. Whole grains, fruits and vegetables, nuts, beans, dairy products, and lean meats are encouraged, while refined white grains, sweets, and fats are among the “limit or avoid” list. Many of the nutritious foods recommended are restricted on the dialysis diet because of their potassium or phosphorus content, and sweets and fats are often used to fill calorie gaps. To further complicate the matter, dialysate contains glucose, potentially causing hyperglycemia during treatments!

We want to make recommendations as simple as possible for patients - they typically do not have much nutrition education. Estimating how many calories and grams of carbohydrates, protein, and fat they should aim to consume lays a great foundation. When provided with exchange lists of kidney-friendly foods and recommended servings of each type of food per meal and snack, patients can plan their own meals, aiming for consistency from meal to meal and day to day. We can also make specific suggestions for meals and have lists to choose from so patients don’t have to create food combinations or do calculations. For the individual who is not at all fussy about food, we can provide a complete meal plan to follow.

As with any chronic condition with which nutrition is an influencing factor, regular follow-ups with the physician for blood work and any other applicable testing is important to gauge how one is doing and to determine if modifications must be made. As registered dietitians, we are instrumental in explaining and implementing these changes.