Fluid allowances are 1,000-1,5000 milliliters per day and are based on urine output and type of dialysis.Protein: Protein requirements range from 1.1-1.5 grams per kilogram, depending on the type of dialysis used and the patients nutritional status. It is important to ensure sufficient protein to maintain visceral protein stores, but to avoid excesses that could lead the accumulation of nitrogenous waste products in the blood (uremia).Phosphorus: Kidney failure causes high levels of phosphorus to build up in the blood and disrupts calcium/phosphorus balance. Elevated phosphorus levels can lead to metastatic calcification (soft tissue calcification), secondary hyperparathyroidism, and renal osteodystrophy. Recommended intakes usually range from 800-1,000 milligrams per day with hemodialysis and less than 1,200 milligrams per day with periotoneal dialysis.Potassium: Potassium restrictions depend on serum potassium levels, the type of dialysis, medications, and residual renal function. Patients on hemodialysis are usually restricted to 2,000-3,000 milligrams per day to prevent hyperkalemia between treatments. Patients on peritoneal dialysis may follow a more liberal dietary potassium intake, as potassium is lost in the dialysate solution during daily exchanges.Kidney StonesAbout 12 percent of Americans develop a kidney stone at some point in their lives. Stones usually result from the crystallization of calcium (which originally came in foods or supplements) and oxalate, a part of many plant foods. Some people have a tendency to lose excessive amounts of calcium or oxalate through their kidneys, and they have a greater likelihood of a stone.7-10 Kidney stones can also form from uric acid, which is a breakdown product of protein, or from struvite (ammoniomagnesium phosphate) or cystine.The prevalence of kidney stones is three times higher in men than women, and is higher among Caucasians than Asians or African Americans, for reasons that are not clear. They are especially likely to strike between the ages of 40 and 60.Nutritional steps are important in preventing stones and can also help prevent recurrences, which is important given that 30-50 percent of people diagnosed with a renal stone have a recurrence within five years.Preventing stones is like keeping a salt crystal from forming in a glass of salty water. You can either reduce the concentration of salt or add more water. Epidemiologic studies have shown that certain parts of the diet help reduce the amount of calcium that filters into the urine. It is a simple matter to put these factors to work clinically.WHATS IN A STONE? 7Calcium oxalate72%Uric acid23%Ammoniomagnesium phosphate (struvite)5%Cystine<1%Protective FoodsCertain parts of the diet clearly help reduce the risk. The first is no surprise.Water. Water dilutes the urine and keeps calcium, oxalates, and uric acid in solution. In research studies, those subjects whose total fluid intake (from all sources) over 24 hours was roughly 2.5 liters, the risk of a stone was about one-third less than that of subjects drinking only half that much.7 (They do not need to drink 2.5 liters of water per day; rather this is the total fluid consumption, including juices, soups, etc.) Patients need to understand that their thirst sense can lag behind their hydration status, and they may need to develop a routine for