A client with chronic renal failure is being discharged. Which dietary instruction is appropriate?

• A. Be sure to eat meat at every meal.
• B. Monitor your fruit intake, and eat plenty of bananas.
• C. Increase your carbohydrate intake.
• D. Drink plenty of fluids, and use a salt substitute.

Answer: (C)

In chronic renal failure, the kidneys struggle to clear nitrogenous wastes from protein, so dietary management emphasizes meeting energy needs with carbohydrates and fats while limiting protein. Providing adequate calories from carbs helps spare the body's protein stores, reducing protein breakdown and the buildup of waste products.

That’s why increasing carbohydrate intake is the best instruction: it supplies energy without adding to the nitrogenous load the kidneys must handle, supporting nutrition without worsening azotemia. Eating meat at every meal would raise protein and phosphorus intake, which the failing kidneys have trouble processing. Bananas and other high-potassium fruits add potassium, which is often restricted in renal disease to prevent dangerous hyperkalemia. Drinking plenty of fluids and using a salt substitute can also cause fluid or electrolyte imbalances; salt substitutes commonly contain potassium, making them inappropriate for someone with kidney failure.