Sunday, March 27, 2011

the renal diet is [seriously] crazy

I’m working with a lot of patients with renal (kidney-related) disease at my new job, and the diet I have to recommend for many of these patients is one that would be very difficult to follow myself.


For being such small organs (approximately each the size of a fist), the kidneys do a whole lotta work!

  • filter waste from the blood
  • release erythropoeitin, which stimulates production of red blood cells
  • regulate electrolytes (sodium, potassium) and release renin, which regulates blood pressure
  • release calcitriol, the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body
  • regulate acid-base balance

When your kidneys aren’t working properly, this affects sodium, potassium, phosphorus, and protein regulation, which may require you to decrease consumption of foods that contain these items.

These would be some of the hardest ones for me to give up…

  • bananas
  • oranges
  • sweet potatoes
  • beans
  • peanut butter
  • chocolate

I’d really love to come up with some fun food ideas that fit into the kidney diet guidelines, a sort of cookbook to give to clients with creative recipes. Like cauliflower mac & cheese and faux chicken nuggets (because let’s face it…all children love these foods).


I made whole wheat apple muffins recently. If made a smidge smaller, they might just fit into the renal diet [**edited to add: Since I've received some comments about this, I wanted to say that in general, these muffins would not be acceptable as a regular part of a renal diet. I think that most foods can fit into the renal diet as special treats, but they should not be consumed occasionally. As always, consult your renal dietitian, who is familiar with your specific case, labs, meds, etc. before making any dietary changes].

My modifications: sub applesauce for the butter and leave out some of the sugar (or don’t…I won’t tell).


Yes, these are giant muffins because I have a Texas-sized muffin tin, which is incredibly fun to use and requires less filling of muffins cups, which I also appreciate.


Time for a run…it’s sunny but still cold here! Spring can come anytime…..anytime.

How would you do on the renal diet?!



  1. Can you imagine me giving up nut butter? OMG no!

  2. I would do so awful on the renal diet. I love pretty much everything on that list :( Unfortunately my brother in law only has one working kidney so he has to watch a lot of the things he eats. Him and his gf don't cook that much so I'd love to have recipes or suggestions that fit into the diet to share with them. I think that's an awesome idea!

  3. I was just learning about renal diseases and the complications of renal diets in my Diet in Disease class the other day! We have an assignment due in a few weeks to assess a clinical scenario with a patient that has renal disease and create a diet for them. My professor said it is a brutal process. :)

  4. Uhm, yeah, I agree ... where is spring??

    I think it would be very hard for me to give up sweet potatoes, and really everything on that list! Ha.

    Hope your weather gets nicer very soon!!

  5. Interesting! I like a lot of the things on that list, but I guess I could give them up.

    Is it just oranges or any citrus fruits?

  6. I could never give up any of those foods you mentioned! I eat all of those on a regular basis!

  7. Yes, the renal diet is hard and challenging to follow, due to the number of foods one is limited to eating as well as the constant leaching of most vegetable items. Whole wheat to a renal is generally a no no, so how are you going to work it into the renal diet ?

  8. @mica: grapefruit also has high potassium; lemons have a moderate amount of potassium.

    @seygra20: We generally caution whole wheat products, but you can work things in carefully through moderation. When we advise a phosphorus or potassium restriction, it doesn't mean that a patient cannot have foods containing these nutrients, they must simply eat within a specified level (i.e. 1500 mg K+/day, etc).

  9. when i was in physiology class the renal system just fascinated me. it does sooooooooooooooo much! i'd totally fail at the renal diet! although i suppose if my health was on the line then i'd be forced to do it well.

  10. I think this would be the most difficult diet for ANYONE. It makes diabetes look easy (but of course, most people on this diet are also diabetic, I know, yikes!).
    Thanks for the refresher. I always forget things about renals diets and I really think I need to take another clinical nutrition course one of these days. I hope the job is going well!!

  11. What!? No pb, chocolate, beans or bananas?! I could never do it..great work to anyone who can follow this crazzzay diet though!

  12. oh my, i've never heard of the renal diet until now! i can't believe ppl actually have to give up some healthy food?!!! like potassium! and fluids! and nut butter!

  13. wow the renal diet does not sound fun at all! this makes me appreciate my kidneys even more...and how important it is to take care of them!

  14. whoa. i would be a very very sad girl! very informative post that makes me count my blessings!

  15. It's a sad day when I don't eat a banana...I'm so glad I don't have renal disease! Also, being on dialysis is something I would never wish upon anyone.

    Kidneys are powerful little guys.

  16. Those muffins look awesome, I love subbing applesauce too! Omg, I. Had to do a case study on renal and we went to a dialysis center to spend the day with the rd! I would have some serious issues with bananas and chocolate and pb and the water balancing and the different dialysis steps. So complicated and what's crazy is that more centers are opening up all the time !

  17. WHOAA that is soooo weird!!! Im not sure about that.. I would be so sad to have to be on that diet :(

  18. my Granddad is on peritoneal dialysis i would struggle thanks for coming down under with me

  19. A few weeks ago I had to follow a renal diet for two days for a Medical Nutrition Therapy project. I could not wrap my brain around that diet. It's awful! Renal patients definitely need a creative mind like yours to come up with healthy recipes! I would be very sad without my whole grains and mounds of dark leafy greens. I will definitely be taking good care of my kidneys!

  20. hmmm, I am just learning the renal diet as my daughter's kidneys are failing and she just started dialysis. Am searching for renal friendly muffins but will check with her dietitan about this one. I'm not sure about the whole wheat flour and the high-phosphorus brown sugar. This is proving to be quite the challenge. Looking for muffin recipes with no baking powder is tough too!

  21. Hello,
    I am a Renal Dietitian and while the renal diet is the most difficult diet of all, most foods can be worked into a renal diet. The only absolutes when on dialysis are high protein, no added salt/very low sodium, and restrict fluid intake.
    Potassium foods should be adjusted per patient depending on their labs. Most patients find their 'sweet spot" as to just how much they can tolerate and keep within the normal range. Some dialysis actually need more potassium foods and can actually liberalize their diets. It all depends on their labs which are drawn at least monthly.
    Most patients have to monitor phosphorus intake but we are now learning that the phosphorus from whole grains, legumes, nut/seeds are less of a problem than we realized and the added phosphates which are continually increasing in our food supply are the big culprit (such as those in sliced deli meats/processed meats and brown colored colas/soda pop). Avoiding those usually leaves a little wiggle room to enjoy some peanut butter, nuts (unsalted: 1oz serving) and 1/2 cup beans (legumes) occasionally.

    Note: a renal diet for chronic kidney disease NOT on dialysis requires low protein and preferably more plant based protein options.

  22. @anonymous: thanks for the comment! i do think there is some flexibility, but for me it w difficult as i eat a lot of whole wheat products, pb, legumes and nuts. as always, the renal diet varies depending on each patient's status, but it is a pretty difficult diet especially for pediatric patients who love fast food/snack foods. :)


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