I finished up my Renal rotation a little over a week ago. For our rotation, we spend two days each week working with the VA’s renal RD and two days working with an RD at a private dialysis clinic. In our case, we work with the renal RD for Fresenius. Working in both the VA and the Fresenius dialysis clinics is a great experience. The populations served at each site are slightly different, so it challenges you to promote the same messages but in differently tailored ways.
A lot of my time was spent reviewing patient’s monthly lab results (if you’re on dialysis, you get labs drawn every month to keep a close eye on your kidney function and/or on effectiveness of dialysis.) I ended up spending a lot of time talking about sources of protein, potassium, and phosphorus. In fact, the board display I put together for the Fresenius clinic was focused on protein.
One of the most helpful things to have during the renal rotation was a color handout that had pictures of phosphorus binders medications. Renal patients are on a lot of medications (sometimes for things besides CKD) and can’t remember the names of everything they take. When counseling patients or reviewing labs, I frequently asked, “Are you taking your binders? Which ones? How many with each meal?” If a patient couldn’t remember the name of their binders, I asked them to pick it out of the picture. I know of an RD who has one of every pill in a little pill case and asks the patients to pick out the binders that way.
Renal dietetics is a little different than other clinical dietetic fields. In most clinical dietetic fields, you don’t see patients on a regular basis – you only get to see them when they’re in the hospital. Even with psychiatry and spinal cord injury, the patients are only with you for a few weeks to months. With renal dietetics, most of your patients are with you for years. If the patient is on hemodialysis, you have the opportunity to see your patient up to three times a week. If the patient is on peritoneal dialysis, you’ll see the patient at least once a month. Some of your patients might have had kidney transplants and you won’t see them all that often. Some of your patients may be experiencing acute kidney failure and only be your patient for a short period of time.
If you want to do clinical dietetics but you want to see the same patients long-term, renal dietetics might be the field for you. There’s a Renal DPG that’s really good. They regularly send out a newsletter with CPE opportunities. If you’re interested in pursuing renal dietetics, and you’re a student, I recommend joining the DPG.