Dietitians and nephrologists

The whole time I’ve been on dialysis, it has been confusing to me what the role of the dietitian is vs the nephrologist. Can someone clarify?

Hi Folks

Hi Jane

Are you Kidding?

Thanks
BobObrien

Bob wish I was. Some nephs I have had defer to the dietitian, and some dietitians I have had defer to the neph on the various issues we need to know like anemia, pth, iron, EPO, renal vitamins, calcium, vit. D etc. Whose job is it to counsel patients on these issues?

Well, to generalize, most doctors get very little–if anything–in the way of nutrition training in medical school. But, in-center HD (which is used by 92% of U.S. dialysis patients) does so little in the way of blood cleansing that strict limits on diet and fluid are needed to sustain life along with the treatments. So, renal dietitians are trained to handle the complexity of helping folks figure out how to reduce potassium, sodium, phosphorus and fluids, increase good quality protein, plan meals based on all of that (good luck), and tie in blood test results with what level of which nutrient needs to be increased or decreased. In practice, renal dietitians also end up dealing with bone disease protocols and drugs. They may also deal with encouraging folks to exercise.

Nephrologists are medical doctors who specialize in the function of the kidneys. Depending on their training, they may have focused on renal physiology, transplant medicine, research, certain diseases (e.g., PKD, FSGS…)–only a tiny handful (from 10% of the schools that train nephrologists) are dialysis experts.

If you get a nephrologist who IS a dialysis expert, he or she is likely to know a lot of information that overlaps with the dietitian. If not, the dietitian is probably doing a lot of what a dialysis expert nephrologist might do.

With daily or nocturnal HD, fewer (or no) diet and fluid limits are needed. There is no such thing as a “renal diet”–just a heavily restricted diet meant to make up for what in-center HD can’t do. So, once you’re home, the dietitian would still probably go over your blood test results to see if you have too much or too little of any nutrient or drug, and help you understand how to change your diet if you travel and temporarily switch to in-center HD.

When you say that only 10% of nephrologists are dialysis experts, are you saying they get that specialty training atthe univ. that they went to, or do they get it from some other source?

And when it comes to dietitians, where exactly do they get the specialty training to be certified as a renal dietitian?

I haven’t found any of the numerous nephs and dietitians I have had to be very helpful when it comes to explaining what the body is doing and suggesting ways to compensate through meds, diet and exercise. As a patient, it didn’t take me long to see- phos. a little high, cut back on phos. foods, take an extra binder etc. I don’t need a neph or dietitian for that, but it seems like that’s about all they do. Strange that with all their education, they have little more than that to advise. Sad that they are not more excited about their chosen professions, up to date, and enthusiastic to motivate patients to more thoroughly achieve balance in their meal planning, vitamin intake and exercise.

Yes. Only about 10% of nephrology fellowship training programs focus on dialysis, which is the “orphan stepchild” of nephrology–it’s somewhat looked down upon by the academics. If fellows don’t get it during their postdoctoral training, it’s not too likely that they’ll get it later.

And when it comes to dietitians, where exactly do they get the specialty training to be certified as a renal dietitian?

The American Dietetic Association has a credentialing program for renal dietitians:
"Board Certified Specialist in Renal Nutrition - The Commission on Dietetic Registration defines the Board Certified Specialist in Renal Nutrition as an individual who (1) has maintained Registered Dietitian status for a minimum of two years (see above for definition of Registered Dietitian); (2) has completed 2,000 hours of practice as an RD in the specialty within the last five years; and (3) has successfully completed the Board Certification as a Specialist in Renal Nutrition examination."

I haven’t found any of the numerous nephs and dietitians I have had to be very helpful when it comes to explaining what the body is doing and suggesting ways to compensate through meds, diet and exercise.

That’s too bad, since, of course, that’s what they’re supposed to be able to do for you…

As a patient, it didn’t take me long to see- phos. a little high, cut back on phos. foods, take an extra binder etc.

I wish everyone were as smart about all this as you’ve been, Jane!

Watch a videoanswer to your question

HI folks

I keep wanting to reply ,but I’m at a lost at what or where to start.

Bob obrien