End-stage kidney disease (ESKD) or CKD manifestations include fatigue, decreased alertness, anemia,
decreased urination, headache, and weight loss.
ESKD or CKD occurs when the glomerular filtration rate (GFR) is less than 29 mL/min, the serum
creatinine level steadily rises, or dialysis or transplantation is necessary.
◯◯ Therapeutic Nutrition
■■ The goal of nutritional therapy is to maintain appropriate fluid status, blood pressure, and
☐☐ A high-protein, low-phosphorus, low-potassium, low-sodium (2 to 4 g/day), fluid-restricted
diet is recommended.
☐☐ Once dialysis begins, protein intake will be increased because some protein is lost during
dialysis. The amount of protein increase will depend on whether hemodialysis or peritoneal
dialysis is being performed.
☐☐ Vitamin D and calcium are nutrients of concern.
■■ Potassium intake is dependent upon the client's laboratory findings, which should be
■■ Sodium and fluid allowances are determined by blood pressure, weight, serum electrolyte
findings, and urine output.
■■ Achieving a well-balanced diet based on the above guidelines is difficult. The National Renal Diet
provides clients with a list of appropriate food choices.
■■ Protein needs increase once dialysis has begun as protein and amino acids are lost in the dialysate.
☐☐ Fifty percent of protein intake should come from biologic sources (eggs, milk, meat, fish,
☐☐ Adequate calories (35 kcal/kg of body weight) should be consumed to maintain body
■■ Phosphorus must be restricted.
☐☐ A high protein requirement leads to an increase in phosphorus intake.
☐☐ Foods high in phosphorus are milk products, beef liver, chocolate, nuts, and legumes.
☐☐ Phosphate binders (e.g., calcium carbonate, calcium acetate) must be taken with all meals
■■ Vitamin D deficiency occurs as the kidneys are unable to convert vitamin D to its active form.
☐☐ This alters the metabolism of calcium, phosphorus, and magnesium, leading to
hyperphosphatemia, hypocalcemia, and hypermagnesemia.
☐☐ Calcium supplements will likely be required because foods high in phosphorus (which are
restricted) are also high in calcium.