Chronic kidney disease (CKD) involves the progressive loss of kidney function. Jen Hernandez, a registered dietitian board certified in renal nutrition, explains why working with a dietary expert is a great addition to a CKD management plan.
Chronic kidney disease (CKD) is a progressive loss of kidney function. It
While CKD treatment involves medications and medical management of underlying conditions, diet also plays an important role in slowing the disease process and reducing symptoms and complications.
Jen Hernandez, an award-winning registered dietitian (RD) who is board certified in renal nutrition, takes us through what RDs do in CKD and how they can help.
[An RD] is someone who has [typically] received their nutrition education through a college with a graduate degree and then completed a minimum of 1,000 supervised hours in clinical settings working with [people] in various health situations and conditions.
To gain the official title “registered dietitian,” they then must pass a formal exam. As of February 24, 2025, there are 113,266 RDs in the United States.
A renal dietitian may or may not have additional formal credentialing, as it is not required. For example, an RD working at a dialysis clinic may call themselves a renal dietitian.
However, renal dietitians can become a board certified specialist after 2 years of being an RD. This process includes logging an additional 2,000 hours of RD work, specifically with [people with kidney disease].
Next, they take a second dietitian exam focused solely on kidney nutrition. Passing the exam allows dietitians to use the letters “CSR” behind their name in addition to the RD/RDN, establishing them as a board certified renal nutrition specialist. As of February 24, 2025, there are 595 board certified specialists in renal nutrition.
An RD is professionally educated and trained to get a full diet recall while considering factors such as medical history, family history, medications, supplements, nutritional preferences, food knowledge, lifestyle, and more to create a comprehensive nutritional assessment.
They have the ability to provide nutritional diagnoses that can be billed to insurances or used for superbills and health insurance reimbursements.
RDs with experience and education in CKD can further assess a person’s diet history alongside their renal labs. Specific nutrients we look at include sodium, potassium, phosphorus, protein, fiber, vitamins, and others, depending on a person’s kidney function and other comorbidities or concerns.
We also support physicians by taking time to explain some medications more thoroughly to patients to help them better understand the benefits in the medication. For example, some kidney patients may be prescribed a phosphorus or potassium binder — we can provide more education around these nutrients and the medications.
We can also look at a diet history and highlight certain foods or meals to further demonstrate why the medication is prescribed.
In some cases, [people with] late stage CKD and dialysis may have a fluid restriction in place. Dietitians can spend the time reviewing a food journal and teaching different examples of how much fluid adds up throughout a day.
Both the
The great thing about the most recent renal diet guidelines is that there are truly no required foods to include.
The KDOQI released nutrition updates in 2020 to encourage more flexibility and reduce “food deserts” in the renal diet based on research and evidence.
The KDIGO Clinical Practice Guidelines published in April 2024 show support for a diet that is more inclusive of plant proteins and other foods once thought to be off-limits for [people with] CKD.
In fact, there have been more food freedoms over the recent years to encourage more fruits, vegetables, and whole grains that were once thought of as foods to avoid with kidney disease.
Even frozen and canned foods can be incorporated.
If you can find low sodium options, that’s great! Otherwise, drain and rinse canned foods to remove some of the salt.
For frozen foods, adding an extra bag of frozen veggies (often easy to find without added salt) can lower the sodium content of a meal simply by stretching out the number of servings with the extra veggies.
Remember that working with an RD means a partnership. You want to work with someone who you feel comfortable with — comfortable enough to have in-depth discussions about your bowel movements. If you’re using your insurance to see a dietitian, your time may be limited, so you want to make the most of it.
Ask them what experience they have with people with kidney disease:
- What stages were their patients at?
- Did [those patients] see improvements in their kidney labs after working together?
- What kind of approach do they have regarding a renal diet?
You can also ask your doctor for a referral to a renal dietitian or ask your health insurance provider. Your health insurance provider can also give you information such as how many sessions with a dietitian you’re allowed per year and if there are any requirements to see a dietitian, such as a physician referral or certain health conditions.
Currently, Medicare Part B provides coverage for 3 hours per year with a dietitian in the first year, followed by 2 hours every year following. Therefore, use your time wisely and be sure to find a dietitian you want to work with for that time — it does not reset if you want to change dietitians.
Jen Hernandez is a registered dietitian and board certified specialist in renal nutrition with over a decade of expertise in kidney health. As the CEO of Plant-Powered Kidneys, Jen leads a virtual practice dedicated to empowering individuals with chronic kidney disease through practical, evidence-based nutrition education. Her insights have been featured at top conferences, including the National Kidney Foundation Spring Clinical Meetings, where she shares her knowledge on renal nutrition therapy, precision nutrition, and dispelling kidney diet myths. Jen’s work focuses on helping patients make sustainable, kidney-friendly dietary choices to improve their quality of life.
