Diet in Renal Disease – Quiz

One point for each answer for Qs 1-12; 13 and 14 as indicated.

Question 1 (a)

The average daily intake of NaCl in the UK is …
(choose one of these and then click to see if you are correct)

False

FALSE

TRUE – 9g/day (equivalent to 153mmol Na)

Question 1 (b)

And what is this in mmol of sodium?

1g of NaCl is 17mmol.
More about this on the diet info page

Question 2 (a)

What is the Department of Health’s recommendation for NaCl intake for the general population in the UK?
(choose one of these and then click to see if you are correct)

FALSE

TRUE – 6g/day. The physiological requirement is 3-20mmol/day!

FALSE

FALSE

Question 2 (b)

And what is this in mmol of sodium?

1g of NaCl is 17mmol.
More about this on the diet info page

Question 3

Renal patients are advised to follow a ‘No added salt’ (NAS) diet. This is equivalent to:
(choose one of these and then click to see if you are correct)

FALSE

TRUE – 80-100mmol/d: amazingly generous in some ways
More about this on the diet info page

Question 4

How much sodium is there in 1g sodium bicarbonate?:
(choose one of these and then click to see if you are correct)

FALSE

TRUE – 11mmol. Renal patients may be prescribed 3 g per day!
More about this on the diet info page

FALSE

Question 5

True or false? Salt substitutes (eg. Lo Salt) are suitable for use by renal patients? Explain your answer.

FALSE. They contain KCI, and are therefore a rich source of potassium.
More about this on the diet info page

Question 6

By reducing intake of which nutrient can help control itching?
(choose one of these and then click to see if you are correct)

FALSE

TRUE – Phosphate
More about this on the diet info page

Question 7

When should phosphate binders be taken?

With food. PO4 control is important. More about this on the diet info page

Question 8

By reducing which nutrient can prevent thirst?
(choose one of these and then click to see if you are correct)

FALSE

TRUE – Salt, duh. More about this on the diet info page

FALSE

Question 9

True or False? All renal patients must take a phosphate binder with every meal.

FALSE – depends on biochemistry and dietary intake; if PO4 only up a little, maybe with only some meals; no point in taking them in meals with negligible PO4 content such as toast with butter. More about this on the diet info page

Question 10

Acidosis can be a contributing factor in:
(choose one of these and then click to see if you are correct)

FALSE

TRUE – hyperkalaemia

FALSE

Question 11

Calcium Resonium is used to treat:
(choose one of these and then click to see if you are correct)

FALSE

TRUE – hyperkalaemia

FALSE

Question 12

True or False? Dietary potassium restrictions are usually less strict for patients on peritoneal dialysis than haemodialysis.

TRUE

Question 13

List 5 causes of malnutrition in the renal patient. (0.5 points per answer up to max 2.5)

There are lots – click to see these on the diet info page

Question 14

Case study: A 52 year old woman has renal failure secondary to APCKD and has been on haemodialysis for 4 years. Here is her diet diary:

Breakfast: Fruit and Fibre cereal with semi skimmed milk
Coffee with semi skimmed milk
Glass of fresh orange juice
Mid Morning: Coffee with semi skimmed milk
Banana
Lunch: Cheddar cheese/ham and tomato sandwich
Cup-a-soup
Yoghurt
Mid-afternoon: Packet of crisps
Small glass orange squash
Apple
Dinner: Chicken and mushroom casserole
Boiled potatoes
Steamed carrots and broccoli
Tinned fruit with cream
Evening: Cup of black tea
2 x chocolate digestives

Salt: Adds small amount in cooking and at the table.
Milk: Approx 1/3 pint /day.
Fluid restriction: 1L per day.
Relevant medications: Takes one calcium carbonate tablet per day with evening meal

Part A

She has a pre-dialysis potassium of 6.5mmol/l. What changes could be made to reduce the potassium content of this diet?
(up to 2 marks for the perfect answer)

Swap to cereal without nuts etc (eg cornflakes, rice krispies) Max of 1 x coffee/day. ?swap to tea? Small glass of orange juice only. Could swap to cranberry juice Limit fruit to ~2 portions daily. Swap banana to lower K+ fruit such as apple/pear. ?lettuce in sandwich rather than tomato. Choose corn based crisps rather than potato (still salty!) Swap mushroom for lower potassium veg in casserole. Boil vegetables Plain or jam/cream filled biscuits rather than chocolate. More about this on the diet info page

Part B

She is gaining approximately 3kg of fluid between HD sessions. On going through their current intake in detail, they realise that they are tending to exceed their fluid restriction, and are therefore given advice on this. Is there another aspect of their diet that could help? Could you suggest some changes? (up to 2 marks for the perfect answer)

Give advice on salt intake – Cheese and ham are high in salt. Choose lower salt sandwich fillings (e.g. Chicken mayo, turkey) – Cup-a-soup very high in salt. Suggest they stop this. Could try homemade soup? – swap packet of crisps. Could use salt and shake crisps (without salt) BUT high in K+. Stop adding salt at the table and use as little as poss in cooking (click to go to diet info) Swap packet of crisps. Could use salt and shake crisps (without salt) BUT high in K+ – Stop adding salt at the table. Use as little as possible in cooking. Swap packet of crisps. Could use salt and shake crisps (without salt) BUT high in K+ – Stop adding salt at the table. Use as little as possible in cooking. More about this on the diet info page

Part C

A few weeks later, her phosphate level is 2.2mmol/l. What could you suggest to decrease their dietary phosphate intake? Is their any alterations to their medications that may help? (up to 2 marks for the perfect answer)

Could decrease cheese consumption. Decrease yoghurt to ~3 per week,
not daily. Probably need to look at increasing phosphate binders. More about this on the diet info page