Potassium, Phosphorus, Sodium, Oh My!

– by Kira Bursaw

Throughout my time as a dietetic student in university, professors would always brush over the topic of dialysis. Renal nutrition, they indicated, was something we would learn lots about during the dietetic internship. Given this, I was feeling trepidation the first time I walked into a Fresenius Kidney Center on a cold January morning for my renal rotation.

I was greeted in the front lobby by Jackie, the dietitian I would be working with for the week; she was waiting after seeing me pull into the parking lot. I was immediately struck by how observant and considerate that was of her, especially since I had no idea where I was going or who I was looking for. This first impression immediately reassured me that the rotation wasn’t going to be of the sink-or-swim variety.

Our first day together was spent reviewing what a dialysis dietitian does in a typical day. First, she ran through the schedule of the patients. Patients come in for one of three 4-hour shifts during the day starting before 7:00 am and finishing after 7:00 pm. The staff weighs patients before treatment begins, then the patient heads off to a treatment chair. I learned about the different healthcare team members patients’ meet with while in the treatment chair. The final step for the patient is the post-treatment weigh-in to determine the amount of fluid that was taken off. Before making rounds in the treatment area, Jackie reviewed the charts and most recent labs of each patient and made note of any changes that need to be addressed. Since many of the patients have been at the kidney center for years, Jackie has established a solid rapport with each of them and knows their social history well enough to inquire about family members by name and specific leisure activities.

For me, one of the most surprising aspects of Jackie’s role in the dialysis center was in regards to medications. She is very involved in the management and titration of each patient’s medication dose, often speaking to the doctor and the charge nurse about adjustments to make. We spent a lot of time each day reviewing patients’ lab results and comparing them to the corresponding medication trend. I hadn’t been expecting to have such an in-depth discussion of medications and the effects they have on patients, but it was very refreshing and a welcome challenge.

Since the dialysis center is only open to patients on Monday, Wednesday, and Friday, I spent the day Thursday creating a bulletin board for the treatment area. The board itself hangs over the floor scale by the door, and almost all of the patient chairs face it. My topic of choice was bone health, with an emphasis on phosphorus, due to the high number of patients that went above the target range for their phosphorus lab values during their last blood draw. The board I designed consisted of an explanation of end-stage renal disease, the dialysis process, high and low phosphorus foods with corresponding pictures, how to control phosphorus levels in the body, consequences of high phosphorus levels regarding calcium movement, and the target ranges for phosphorus, potassium, and calcium. I also included a great visual of the various medications patients are taking through FreseniusRX, the Fresenius Pharmacy. During our patient rounds on Friday morning, Jackie encouraged me to speak with each patient about the new information available to them. Many of the patients were excited to have a change in the treatment room and thanked me for taking the time to provide them with the material. They especially loved the purple background, which had been green for several years. It was nice to see my work noticed and appreciated, and to hear that it actually made a difference for the patients.

The renal rotation was a very valuable experience, and I hope to one day work in a dialysis center as a dietitian. There is a very close-knit, family-like relationship amongst the staff and patients, where everyone knows everyone. I greatly enjoyed my time with such a wonderful group of people. I can understand now why the work of renal dietitians wasn’t heavily emphasized during undergrad- it wouldn’t have done the role justice. The unique interpersonal environment is what makes the dialysis center stand out, more so than at any other rotation I have been in.