The Renal Diet on the NCLEX
Potassium, phosphorus, sodium, protein rules in CKD, and how dialysis changes them.
Failing kidneys cannot excrete potassium, phosphorus, sodium, or fluid. The diet does the excreting for them.
Potassium: restrict
Hyperkalemia kills by arrhythmia. Avoid: bananas, oranges, potatoes, tomatoes, spinach, avocados, dried fruit, melons, beans. Salt substitutes are potassium chloride and are the single most-tested wrong answer on renal stems. Leaching helps: peel, cut, and boil potatoes in a large volume of water, then discard the water.
Phosphorus: restrict
High phosphorus pulls calcium from bone. Avoid: dairy, colas, processed foods, nuts, organ meats. Phosphate binders (calcium acetate, sevelamer) go with meals, not on an empty stomach. A binder taken between meals binds nothing.
Sodium and fluid: restrict
Sodium usually 2 g/day. Fluid restriction once urine output falls; on hemodialysis a common target is previous day's urine output + 500-700 mL. Interdialytic weight gain over 1-1.5 kg/day means the restriction is failing.
Protein: it depends on dialysis
This is the trap. Pre-dialysis CKD: restrict protein (about 0.6-0.8 g/kg/day) to slow uremia. On hemodialysis: increase protein (about 1.2 g/kg/day) because dialysis strips amino acids. Same disease, opposite protein rules. Read the stem for the word dialysis.
Frequently asked
Best snack for a hemodialysis patient?
Something low potassium, low phosphorus, higher protein. An egg white or a small apple beats a banana, yogurt, or trail mix.
Why no salt substitute?
It swaps sodium chloride for potassium chloride. In CKD that trades edema for a lethal arrhythmia.
Can renal patients drink orange juice?
No. OJ is a potassium load. Apple, grape, or cranberry juice fit the limits, counted against the fluid restriction.
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