patricia stremel

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Chronic Kidney Disease and Nutrition



          Good nutrition is the key to good health for everyone. It is especially important for people with chronic kidney disease. Even with the help of artificial kidney treatments (dialysis) , you  cannot get rid of all the wastes and fluids that build up in your body from what you eat and drink.

You can work closely with your renal dietitian to decide on a meal plan that is best for you and includes some of your favorite foods.

Your individual meal plan will be based on your age, your weights, foods you like your dialysis treatments and other medical conditions such as diabetes, heart disease and high blood pressure



Let’s learn a little more!





*Calories are needed to provide your body with energy to allow it to function properly.  Your renal dietitian can help you plan a meal plan containing the right balance of calories from different sources to keep your body healthy.

*Protein is used to build and repair tissue. Many of the foods you eat contain protein. The best sources of protein are dairy products, eggs, meat, poultry (chicken, turkey, etc.) and seafood. Bread, cereal, and vegetables are mostly carbohydrates but also contain a small amount of protein.

*Carbohydrates provide fuel or energy for your body in the form of starches and sugars. The major sources are bread, cereals, fruits, grains, and vegetables. If you have diabetes you may be watching your carbohydrate to help control your blood sugar.

*Fat concentrated energy source that adds flavor, moisture, and calories to food. It is often added to a meal plan for chronic kidney disease to provide much-needed calories to help gain or maintain weight and add flavor to food. If you are overweight and wish to lose weight, your dietitian or doctor may recommend limiting the fat in your diet. Certain kinds of fat may also be recommended for you to use if you are concerned about your blood lipid levels.

*Calcium and phosphorus are minerals that work together in the body to keep your bones strong and healthy. This balance is changed when they kidneys are unable to filter out enough phosphorus. Phosphorus levels are then increased in your blood. When this balance of calcium and phosphorus is upset it can cause bone disease and contribute to the calcification of arteries and organs including your heart. The consistent use of phosphorus binding medication and following a diet that limits food high in phosphorus may be needed. Almost all foods have some phosphorus, but the highest levels are found in dairy products (cheese, milk yogurt), dried beans, nuts, chocolate and cola drinks. Also, be aware of foods containing phosphate additives. Look for “phos” in the ingredient list. Your doctor and renal dietitian will help you balance your dietary intake and medications. Sodium helps regulate the fluid balance in your body. High -sodium foods may upset this balance in chronic kidney disease. Some foods that have the highest amounts of sodium are cured and processed.

Keep healthy !!


National Kidney Foundation. (1991). Living Well on Dialysis . New York , NY. DOI: 01-100420_DBC

Photo by Flo Dahm, pexels.
Photo by Trang Doan,pexels.
Photo by Pixabay, pexels.

Dialysis and Vacation.

Let’s take a vacation! South Florida has

beautiful places to visit.

Enjoy the day on the beach with clear water and sunshine, or visit other attractions around West Palm Beach and Boca Raton.

West Palm Beach has beautiful Downtown’s Clematis Street and City Place, where you can find restaurants, bars, shops, movie theater, and live music, Perfect atmosphere to a vacation.


For those appreciates the natural environment, Palm Beach Zoo or Gumbo Limbo Nature Center in Boca Raton is a great option to be close to nature. The Gumbo Limbo N. Center count with 20 acres coastal preserve area designated to preserve the nature, with Sea Turtle Rehabilitation facility, Butterfly Garden, native fish, sharks, and other natural marine animals.         


     Among many perfect beaches, the Spanish River Park            

display beautiful beaches and picnic area with access to the playground.


To support Dialysis Patients taking a vacation with family and friends,

Crown dialysis is committed to helping patients offering high-class dialysis, flexible schedule, transportation,  individuals rooms in the center for hemodialysis,

peritoneal dialysis support, assisted Home hemodialysis and much more to make your vacation unforgettable.

Crown Dialysis can make part of your vacation, call today 561-372-3700.


We accept most health insurances and private.


References:THE 10 BEST Parks & Nature Attractions in Boca Raton. (n.d.). Retrieved May 16, 2019, from

ULTIMATE GUIDE TO DIALYSIS: Rollercoaster Emotions



Living Well on Dialysis by American Psychological Association and DPC Education Center.




If you receive dialysis treatment for kidney disease, you probably spend a lot of time focused on your physical health. That’s important, but so, too, is your mental and emotional well-being. 

Rollercoaster Emotions: dialysis requires significant time and effort. In addition to the considerable time spent traveling to and from appointments and receiving treatment itself, people receiving dialysis must carefully monitor their diet and fluid intake. It’s a lot of work, and it takes time to adapt to the changes.

Anger, sadness, worry, and guilt are also common. But the emotions aren’t always negative. People who knew that dialysis was likely in their future might feel a kind of relief now that they have started. Some people, such as those awaiting a kidney transplant. might feel a strange mixture of emotions, including hopefulness, anxiety, and fear.

No matter what you’re feeling, it helps to know this emotional rollercoaster is common. As you adjust to the dialysis routine, you should start to feel more like yourself again. And as you continue on with your life, there are steps you can take to manage sadness, worry, and stress.

        Dialysis is life-saving, but it’s also life-changing. Still, by taking chance of your emotional health, and accepting help when you need it, you can live a rewarding life on dialysis.



For more information visit:,, and
Association, A. P., & Center, D. E. (n.d.). Living Well on dialysis.




Chronic Kidney Disease (CKD) and Nutrition

Learning about the CKD (Chronic Kidney Disease) and Nutrition

Chronic Kidney disease(also called renal disease) is when the kidney don’t filter enough waste from the blood.The most common causes of CKD are diabetes, high blood pressure, genetics, drug side effects, and blockage caused by kidney stones.

Some people don’t have any signs or symptoms or CKD but others may notice :

  • Nausea
  • Tiredness
  • Vomiting
  • Loss of appetite

When the kidneys can’t work on their own, dialysis – a treatment that removes the excess waste out of your body-is usually needed (CaglarK,2002).

Why does it matter what you eat?

When kidneys can’t remove wastes out of your body, they build up and act like toxins. To keep wastes from building up, you have to watch what you eat between dialysis treatments.

Choosing healthy foods, with the help of your dietitian, helps lower these wastes and may make you feel better between treatments.

CALORIES: Make sure you are getting enough calories every day because they are important to keep your energy level up.

PROTEIN: Your body needs protein to build muscle and lower your risk for infection. Now that you are on dialysis, you will need more high-quality proteins, such as lean meat.

Vitamins/Minerals: The kidneys are important in processing several vitamins and minerals. Some vitamins and minerals may need to be limited.

Fluids: Fluids can build up quickly between dialysis treatments and cause bloating and discomfort.The right amount of fluid intake can help you feel your best.

Blood Sugar: If you have diabetes, the carbohydrates you eat should be balanced with your medicines and activity level to keep your blood sugar under control

Caglar K, et al. Kidney int. 2002;62(3):1054-1059
Abbott, L. (2010, December). Retrieved July, 2018, from /76585/December 2010 LITHO IN USA



Kidney Transplant.

Crown Dialysis patients have 3 successful Kidney Transplants this year !

Lean more about Kidney Transplant below.

What is a kidney transplant?

 A kidney transplant allows a person whose own kidneys have failed to receive a new kidney from another person. A successful kidney transplant can improve many of the complications of kidney failure.

 A kidney may come from living donors or from individuals who have died (deceased donors). A living donor may be someone in your immediate or extended family, or it may be your spouse or a close friend. In some cases, a living donor may even be a stranger who wishes to donate a kidney to someone in need of a transplant. A deceased donor is someone who has consented to donate his or her organs upon death.  In situations where the wishes of the deceased donor are not known,  family members may consent to organ donation (N.K.Foundation,2009).


How do I start the process of getting a kidney transplant?

You Can find a transplant program by state or region using the website of The Organ Procurement and Transplantation Network   ( You may also ask your doctor about the transplant process. He or She can refer you to a transplant center for evaluation (N.K.Foundation,2009).


What are the chances that a transplanted kidney will continue to function normally?

A number of factors affect the success of kidney transplantation. Generally, the chances that a transplanted kidney will continue to work correctly are between 89-95 percent one year after the operation (N.K.Foundation,2009)


If I have diabetes, can I have a pancreas transplant?

Sometimes. It may be possible for a patient with type 1 diabetes to receive a pancreas transplant along with a kidney transplant. Your doctor can advise you about this possibility (N.K.Foundation,2009).


How can I pay for my transplant?

Medicare Part B will cover 80 percent of the cost of your antirejection medication. You will need to apply for Medicare Part B and also need a supplemental or secondary insurance policy. For medicines, Medicare Part D (prescriptions and Drug Plan benefits) can help. The financial counselor or social worker at your transplant center will be available to answer questions about coverage options(N.K.Foundation,2009).

Private or commercial health insurance policy, please contact your insurance company customer service or transplant coordinator, to obtain more information.


What is the financial cost to the living donor?

              The living donor should have no financial responsibility for the surgical cost of kidney donation. The living donor evaluation and surgery are covered by Medicare or recipient’s insurance. However, he or she is not covered for time off from work, travel, lodging expenses, and incidental expenses. Travel and lodging cost may be covered by the recipient, or the National Living Donor Assistance Program(,(N.K.Foundation,2009).

Cite/ National Kidney Foundation (2009). Kidney Transplant. Love Your Kidneys, 11-1-0304_JAJ


                Crown Dialysis patients have 3 successful Kidney Transplants this year already.

       Our team of Nephrologist, RN’s, Dietitian and Social Worker, maintain the dialysis facility -level referral for kidney transplant evaluation priority for our patients.


Morning French Toast

Portions: 9 Serving size



  • 3/4 cup brown sugar
  • 1/2 cup unsalted butter, melted
  • 3 teaspoons cinnamon, reserve half
  • 3 large tart apples, peeled, cored and thinly sliced
  • 1/2 cup dried sweetened cranberries
  • 1 loaf Italian bread, cut into 3/4″ slice
  • 6 eggs
  • 1-1/2 cups rice milk, unenriched
  • 1 tablespoon vanilla


Using a baking dish, combine brown sugar, butter and one teaspoon of cinnamon. Add apples and the cranberries; toss well to coat. Spread apple mixture evenly over bottom of the baking dish. Arrange the bread on the top. Mix the eggs, rice milk, vanilla and the remaining cinnamon into a blend well. Pour mixture over bread, soaking bread completely. Cover and refrigerate 4-24 hours. Preheat oven to 375ºF. Bake covered with foil for 30 minutes. Uncover dish and bake 15 minutes or into starts to brown. Remove dish from oven and let stand for 5 minutes before cutting.

This recipe contains/per serving: calories 428g, protein:19g, carbohydrates: 60g, fat:16g, Cholesterol: 170g, Sodium:363mg, calcium:81mg, fiber:2.8g and potassium 200mg. 


Recipe from ESRD Network13, Edition 4, November2013/

New Medicare Card

Medicare Card

Medicare Cards have a new face and unique ID numbers. The main idea is having new numbers for each member, removing Social Security Numbers from Medicare cards to prevent fraud, fight identity theft, and keep taxpayer dollars safe, said CMS at

The government has great intentions to protect member's information and is providing full support to who need help at and can sign up for emails about the status of card mailings in your area.

Let's look at Medicare Schedule to the card mailings:

All - Nationwide April 2018 - ongoing

                                                 Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,                                                      West Virginia..................................................Beginning May 2018

Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon..................................................Beginning May 2018
Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma,

South Dakota, Wisconsin....After June 2018

Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York,

 Rhode Island, Vermont ........After June 2018

Alabama, Florida, Georgia, North Carolina, South Carolina............................After June 2018

Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, 
Washington, Wyoming .......................After June 2018

Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, 

Tennessee, Virgin Islands ...........After June 2018

References: U.S. Centers for Medicare & Medicaid Services,

Please if need assistance visit one of CMS and HHS Websites

References: U.S. Centers for Medicare & Medicaid Services,

Peritoneal Dialysis at Home .

Peritoneal dialysis (per-ih-toe-NEE-ul die-Al-uh-sis) is a modality of Dialysis performed at home.

Is a way to remove waste products from the blood when your kidneys can no longer perform adequately.

Hemodialysis a more commonly used blood-filtering procedure performed at the Center by the RN and PCT, 3 or 4 times weekly and can take into 4 hours each treatment. Peritoneal dialysis the patient give your self a treatment at home, at work or while going for a vacation with use of small size machine called cycler and the duration can be at the time of sleeping.

Understanding  Peritoneal dialysis :

1: Can be done any time of the day or when the patient is sleeping.
2: Give the patient freedom to work, take care the family, travel or complete daily activities.
3: Peritoneal Dialysis is done 7 days a week, the peritoneal Nurse will training the patient to connect and disconnect from the Cycler without issues.
4:  A cleansing fluid flows through a tube called ” catheter”  inside of the abdomen and filters the waste products from your blood.
5: Nephrologist will prescribe the right period time for treatment, the fluid with all filtered waste products will flow out of the abdomen and will be discarded.

Renal Social worker and Dietitian will give support and orientations through your treatment and provide all the information to renal transplant enrollment.

Peritoneal Dialysis program will help the patient with educational material, responding questions and keep tracking the patient progress every month.  Contact your Dialysis Center for more information and check with your Nephrologist to see if Peritoneal dialysis will work for you.

Peritoneal Dialysis can provide the freedom through the day to work, travel, shopping, enjoy the time with kids, walk in the park with your pet or any other daily activity.

Crown Dialysis Center of Palm Beach offers an excellent Peritoneal dialysis program, contact 1(561)372-3700 for more information.

Top 25 Dialysis Blogs Winners

Dialysis Blogs

Crown Dialysis Center of Palm Beach received an award for being in the top 25 dialysis blogs.

These blogs are ranked based on following criteria

Google reputation and Google search ranking
Influence and popularity on Facebook, twitter and other social media sites
Quality and consistency of posts.
Feedspot’s editorial team and expert review

Is a pleasure continue with our blog to inform all the dialysis community!
Thank you for all the supporters that make this possible .

Patricia Stremel

Home Hemodialysis

'Have you thought about Dialysis at Home ?

” Getting Involved really Matters”.

You’ll feel more in charge if you take an active role in the decision.

Your kidney team should tell you about all treatment options and the pros and cons of each. But you make the choice based on your needs, lifestyle, medical conditions, and current level of kidney function. In order to make this decision, you need to learn about all the treatments.

  • Talk to the professionals who are treating you
  • Ask questions: What treatments are done at home? Am I eligible for home treatment? How will my choice of treatment affect my health and lifestyle? At this point in my kidney disease, is one choice better than another? Will one treatment better than another? Will one treatment better protect my remaining kidney function? Which one?
  • Think about how this decision will affect your life.
  • Talk to your family, friends and other people who care about you.
  • Visit the National Kidney Foundation website for helpful resources.

Reference: Have your thought about Dialysis at Home? – National Kidney Foundation /  material from publication Number 12-10-0337_KBA

Crown Dialysis Center is a Medicare Certified State-of-the-art facility offering all modalities of dialysis treatments.

A team of qualified health professionals manage the dialysis center under the leadership of Board Certified Nephrologist, Bharat K. Gupta MD.

Crown Dialysis is a leading-edge facility specialize in Staff Assisted Hemo-Dialysis at your home on your schedule.