Medical Nutrition Therapy for Kidney Patients

Many people with chronic kidney disease (CKD) find that visiting a dietitian is a great source of help with diet and meal planning. I would like to tell you more about dietitians and the medical nutrition therapy (MNT) they provide.

About Registered Dietitians

A registered dietitian (RD) or registered dietitian nutritionist (RDN) is a food and nutrition expert who holds at least a bachelor’s degree and accredited by Accreditation Council for Education in Nutrition and Dietetics (ACEND). The college courses include food and nutrition sciences, foodservice systems management, biochemistry, physiology, microbiology, organic chemistry, business, economics, computer science, and sociology among other courses.

After completing the course work approved by the Academy of Nutrition and Dietetics (AND), dietitians complete an accredited, supervised practice program or an internship. They go to different health care facilities such as hospitals, nursing homes, dialysis units, community agencies such as Women, Infants and Children (WIC) programs, as well as school systems and food service corporations.

After training is complete, dietitians must pass a national examination administered by the Commission on Dietetic Registration. After passing the exam, a dietitian can add the RD/RDN credential after their name. In addition, they have to meet the continuing professional educational requirement to maintain their registration on an ongoing basis.

March is National Nutrition Month® and March 14th is Registered Dietitian Nutritionist Day. The theme this year is Go Further with Food.  It’s a great time to start seeing a dietitian or to contact your dietitian if it’s been a while since your last visit.

Dietitian Medical Nutrition Therapy Services for Kidney Patients Not on Dialysis

If your doctor has diagnosed you with CKD, make sure that you asked what stage is your CKD. There is a lot of information out there, especially now with access to the internet. But be careful with so much conflicting and confusing information about foods that are not good for you. I recommend for you to consult with a Registered Dietitian who is experienced in renal nutrition.

A renal dietitian is able to calculate the amount of protein, sodium, potassium, phosphorus and calories not only according to your size, but also according to your CKD stage. They will review your eating habits and work with you to develop an eating plan. This is called personalized dietary instruction.

If you already have Medicare part B, your doctor should be able to write a prescription for MNT. Here is an excerpt from Medicare.gov site:

Medicare Part B (Medical Insurance) covers medical nutrition therapy (MNT) services and certain related services. A Registered Dietitian or nutrition professional who meets certain requirements can provide these services, but only your doctor can refer you for these services. MNT services may include:

• An initial nutrition and lifestyle assessment
• One-on-one nutritional counseling
• Follow-up visits to check on your progress in managing your diet
• If you’re in a rural area, a Registered Dietitian or other nutritional professional in a different location may be able to provide MNT to you through telehealth.

Who is Eligible for MNT Covered by Medicare?

People with Medicare Part B who meet at least one of these conditions are eligible for MNT with a dietitian:

• Diabetes is a diagnosis
• Kidney disease is a diagnosis
• Have had a kidney transplant in the last 36 months
• People with Part B must get a referral from their doctor or qualified non-doctor practitioner for the service.

Medical nutrition therapy is also covered by a variety of insurance plans. It is very important that you ask your healthcare provider (MD, PA, NP) for a prescription just like you do for a new medication. Most private insurance companies cover what Medicare covers, but of course consult with your commercial insurance plan. In addition, DaVita offers services of a renal dietitian who provides counseling to CKD patients who are not on dialysis. Go to DaVita.com  and check out Eat Smart for more information.

Tips for Your First Dietitian Visit

Bring your most recent lab results. Write down a two day food/drink record and also bring your current list of medications you are taking. Provide information about changes in your weight and appetite. It is also helpful to write down a list of questions and things you would like to discuss during the session.

Together with a RD/RDN, you will set nutrition goals to improve your overall health and hopefully slow down progression of CKD. Checkout the video below to learn more about your kidneys.

Renal Dietitians and Dialysis Patients

Each dialysis center is required to employ a dietitian who provides nutrition care to the dialysis patients. For this reason, there is no need for outside MNT if a patient is on dialysis. DaVita employs over 2,000 renal dietitians.