with acute renal failure. Clinicians should plan diets with an eye toward the possibility of uremia, metabolic acidosis, fluid and electrolyte imbalances, infection, and tissue destruction. Nutritional support of dialysis will be discussed below in the section on chronic renal failure.Protein: A low-protein diet (0.5-0.6 grams per kilogram) is recommended initially. Protein may be increased in the diet as the glomerular filtration rate increases to normal. If dialysis is initiated, the protein level may be increased to 1.0-1.5 grams per kilogram per day if necessary to compensate for protein losses in the dialysate.Calories: Calorie needs are generally elevated (35-50 kilocalories per kilogram) in order to provide positive nitrogen balance under stressful conditions. As protein is usually quite restricted, calorie needs may be met by providing greater amounts of carbohydrate and fat in the diet.Sodium and Fluid: Sodium is restricted depending on urinary excretion, edema, serum sodium levels, and dialysis needs. During the oliguric phase, sodium may be restricted to 500-1000 milligrams per day, and fluid requirements are based on replacing losses via urine, vomitus, and diarrhea, plus approximately 500 milliliters per day.Potassium: Potassium requirements vary depending on hemodynamic status and the degree of hypermetabolism due to stress, infection, or fever. High potassium levels are treated by dialysis or with kayexalate, an exchange resin which substitutes sodium for potassium in the gastrointestinal tract. During the oliguric phase, potassium may be restricted to 1,000 milligrams per day.3Chronic Renal FailureApproximately 90 percent of cases of end-stage renal disease are attributable to diabetes mellitus, glomerulonephritis, or hypertension. Kidney failure results in fluid and electrolyte imbalances, the build up of nitrogenous wastes, and reduced ability to produce renal hormones. The two treatment options are transplantation or dialysis.1Mild renal insufficiency is defined as 40-80 percent of renal function. Moderate insufficiency is defined as 15-40 percent, and severe renal insufficiency is below these figures.2Diet in Chronic Renal FailureLow-protein diets may slow the progression of mild and moderate renal insufficiency. Therapeutic diets using plant sources of protein are more effective in delaying the progression of renal insufficiency, compared to those using animal proteins.5Vegan (pure vegetarian) diets have been shown to provide adequate protein. A study of 22 patients with mild renal failure compared a vegan diet to a conventional low-protein diet. All patients were followed for at least six months. There was no sign of protein insufficiency and inorganic phosphorus levels remained normal.6Dialysis PatientsDialysis changes dietary needs. Patients undergoing typical hemodialysis, involving about three treatments per week, follow diets that are restricted in protein, sodium, potassium, phosphorus, and fluid. Patients on continuous ambulatory peritoneal dialysis, involving several dialysate exchanges per day, can be more liberal in protein, sodium, potassium, and fluid intake.Sodium: Sodium intake must be modified to prevent hypertension, congestive heart failure, and pulmonary edema. Limiting intake will help avoid thirst and maintain acceptable fluid balance. Restrictions range from 1,000-3,000 milligrams per day with hemodialysis and 2,000-4,000 milligrams per day for peritoneal dialysis. Major salt sources are described below.Fluid: Fluid consumption should be controlled to avoid congestive heart failure, pulmonary edema, hypertension, and swelling of the legs and feet.