Following the renal diet helped staff at one dialysis clinic gain a better understanding of the obstacles patients living with end-stage renal disease face every day.

“The disease impacts nearly every part of a patient’s life,” said Katie Kwon MD, a nephrologist in Benton Harbor, Michigan. “But it’s easy to lose sight of that if you’re just sitting there rounding with a laptop in front of them and looking at numbers.”

Kwon said she and other staff members had been discussing ways to gain more empathy and understanding of what their patients have to live through, when Terry Mehigan, NP, developed the idea to follow the renal diet. “He wanted us to do some of the things we’re asking patients to do,” said Kwon.

Read also: No more ‘renal diet’ – tell me what I can eat! 

Mehigan gave the eight staff participants very little time to prepare so they could better replicate a crash into dialysis Each participant was given the same educational materials that go to new dialysis patients. They were not given any counseling with the dietitian.

“Our tendency with new patients is to give them a lot of paper work,” Kwon said. “So we tried to make sense out of that paper work.”

The team followed the diet for three days. They did not limit fluids, but Kwon said she did limit herself to only four ounces of fluid with a meal “just to give me an idea of what it’s like to eat meals with limited fluids.”

Kwon chronicled her experience on Twitter, using the hashtag #renaldietchallenge.

She said she found the diet frustrating almost immediately.

“I hated it,” she said. “It was frustrating that food I had always considered healthy is now suddenly forbidden.”


She said it was also difficult to determine serving sizes of certain foods, and some of the educational materials gave conflicting information.

On Twitter, she highlighted the difficulty of determining serving sizes based on limited information.

“The potassium was the most annoying part. But the part I had the most anxiety about was the phosphorous because it’s not on the labels,” she said.

All of the participants struggled to quickly incorporate the strict diet into their busy lives.


As a vegetarian, Marlena Crow, MS, RD, said the hardest thing for her was getting enough protein while still limiting potassium and phosphorous. “I actually ate a little meat,” she said.

Insights gained

Kwon said she now sees the diet, and the challenges it presents, in a more nuanced way.

“I learned that sometimes you don’t have a great choice in front of you, and you just have to do the best you can.”

Following a strict diet requires discipline and constant planning and preparation. It leaves little room for spontaneity. “One small choice cascades throughout the day,” she said.


Celebrating the patients’ successes, she said, is more important than criticizing transgressions.  “It dismisses the hard work they do every day.”

She said she encourages everyone who works in a dialysis clinic to try the diet, and wishes she had taken empty gel caps with every meal to mimic taking phosphate binders.

She was excited when the challenge ended. “It was really nice not having to worry about food being kidney friendly. And I missed avocado. But let’s be real. It was three days. My patients do this for years on end.”