We are in the home stretch…I am currently in my final rotation: Riderwood for Food Service!! Before I started Riderwood this past week, I spent time at a couple DaVita clinics, where patients receive hemodialysis treatments (and occasionally some peritoneal dialysis patients come in too). The dietitians are so well respected there because nutrition has such an important impact on dialysis patients’ health.
The thing I love about renal nutrition is the complexity of it. Phosphorous, protein (albumin), calcium, iron, vitamin D, parathyroid hormone (PTH), potassium, and sodium must be carefully monitored, and they often have an effect on each other. Because the kidney’s don’t work correctly, they cannot regulate these levels (such as getting rid of excess electrolytes in urine, or protein being taken out of the body during dialysis) like a healthy person can. This can be very dangerous! And at DaVita, dietitians work directly with correcting lab values through proper diet and even medication. Another great thing about working in dialysis? You get a clinical point of view, but develop long-term relationships with your patients. Getting to know the people I’m helping and seeing them improve over time would be so rewarding!
My partner Ala and I handed out samples of a protein drink and discussed the importance of adequate protein and albumin levels. We also conducted a few individual assessments and went over lab value “report cards” with patients during their treatments. Our preceptor Leah was very helpful in explaining all the ins and outs (pun intended 😉 ) of dialysis and its nutritional concerns.
For more information about all things kidney, see the National Kidney Foundation and DaVita webpages.
So although it’s been hard having more serious cases on my hand, I also had some more good interactions with patients last week. Take one patient who all of a sudden had kidney failure. Kidneys are responsible for regulating electrolytes (levels of sodium, phosphorus, potassium, etc in the body) and fluid (retaining/excreting water/urine). This person had no history of kidney problems, until his primary care provider did a routine blood test that showed abnormal kidney functioning. Sent to the ER, the patient was told that they had to go on dialysis! They also found that he had high levels of potassium in his body, a condition called hyperkalemia, because he was unable to get rid of enough of it due to his impaired kidneys. Too much potassium could potentially cause heart failure, so it’s pretty serious. I went to go talk to him about a “renal diet”, which is low in those electrolytes I mentioned previously. I even gave them a list of foods high in potassium that he should try to limit. The poor wife was shocked when she realized she had been feeding him potatoes, lunchmeat, soymilk, and spinach, which are all high sources of this micronutrient.
I had just printed out the list of high potassium foods when a doctor happened to need to get on the computer next to mine. He saw the list of foods and he said, “I had no idea all those foods had so much potassium in them! Usually I only tell them about bananas” (which are a more commonly known source). That’s when the other dietetic intern piped up “that’s why you should consult a DIETITIAN.” And it’s true. Doctors know so much about so many things, but nutrition is such an intricate, involved part of the medical field that is often overlooked and undertaught at medical schools. Which is why we have dietitians, who are health professionals that devote themselves to this specific part of medical knowledge. It felt good to make that impression on a doctor, even as just a measly intern, that we ARE an essential part to a patients plan of care!
Back to the little element that started it all: To find out more foods high in potassium, check out this list from the USDA. If you have normal kidney functioning, you don’t have to worry too much about it- potassium is important for a healthy body! It’s even supplemented to some people suffering from hypertension.