The Diabetic Exchange lists are developed to provide categories of foods with similar macronutrient content (carbohydrate, protein and fat). However the focus is on most accurately reflecting the carbohydrate content and overall calories, usually focusing on calorie control.
Under this system, nuts are counted as fat exchanges and which does not recognize the amount of the protein in nuts. Cheese is included in the protein subgroup depending on fat content. Nut milks are not addressed.
However in Renal Exchange lists the focus is not on controlling calories and carbohydrate, but is rather on reflecting the protein, potassium and phosphorus content.
Milk, Cream and Yogurt category is used for buttermilk, light cream, half and half, yogurt, and fluid milk. The Dairy Desserts are used for frozen yogurt, ice cream, puddings and sherbets. The Very high Potasium dairy foods are Chocolate milk, cocoa, hot chocolate and milkshakes. The renal exchanges also have separate categories for non-dairy milks (since milk is very high in potassium and phosphorus and some nut milks are considerably lower).
In the meats, cheese, nuts and legumes are separated from other protein categories. Legumes are in a separate category, not included in lean meats as they are in the Diabetic Exchanges. For this reason the range of fat content for lean meats in the Renal Exchanges is from 2-3 g fat per oz resulting in a change in energy for this category. We use 50 kcal in the Renal Exchanges vs 45 kcal used in Diabetic Exchanges.
Renal exchange lists may vary depending however the following table shows the values for the exchange lists from the Academy of Nutrition and Dietetics developed specifically for person with both diabetes and chronic kidney disease, Making Choices: Meal Planning for People with Diabetes and Chronic Kidney Disease, Stages 3 and 4.
| Nutrition Composition Using the Renal Exchange System | |||||||||||||||
| Exchange Calculations Used | Starchy Foods | Fruits | Veg. Low Starch | Milk (½ Cup) | Meat/Sub (1 oz, 30g) | Fats/Oils | Sweets and Alt. Carbs. | For Na, K and P sources see the food items listed on the NCP website | |||||||
| Non Dairy | Low Fat (1% or below) | Reduced Fat (2%) | Whole | Cheese | Nuts and Legumes | Lean Meat | Medium Fat Meat | High Fat Meat | |||||||
| Energy (kcal) | 80 | 60 | 25 | Varies - Use Manufacturers Data | 50 | 60 | 80 | 80 | 100 | 50 | 75 | 100 | 45 | 60 | |
| Carbohydrate (g) | 15 | 15 | 5 | 6 | 6 | 6 | 1 | 6 | 0 | 0 | 0 | 0 | 15 | ||
| Protein (g) | 3 | 0 | 2 | 4 | 4 | 4 | 7 | 6 | 7 | 7 | 7 | 0 | 0 | ||
| Fat (g) | 1 | 0 | 0 | 1 | 2.5 | 4 | 6 | 5.5 | 2 to 3 | 5.5 | 8 | 5 | Varies | ||
SODIUM
Subdivided into low (0-200 mg) and high sodium (+201 mg) in Exchange lists,
Note: For purposes of evaluating intake use the Sodium Content for Exchanges. The Sodium Content for Exchanges includes more specific categories; Low, Medium, High and Very High. However, when providing meal plans for patients use the Exchange lists with only two categories to make it easier for patients to understand
PHOSPHORUS
Subdivided into low (0 to 110 mg) and high phosphorus (+110 mg) (See Practice Consideration)
POTASSIUM
Subdivided into three categories, lower (0-200 mg), higher (201-399 mg), and very high potassium (+400 mg) (See Practice Consideration)
Meal plans would normally specify the number of exchanges and maximum number of high sodium, phosphorus and potassium within each category to stay within a nutrition prescription that specifies calories, protein, carbohydrate, sodium, phosphorus, potassium and fluid starting with sources of protein:
- Meats
- Cheese
- Nuts/Nut Butters
- Starchy Foods/Altenate Carbohydrate (Desserts)
- Fuits/Juices
- Starchy Vegetables
- Non-StarchyVegetables
- Mil and Dairy Desserts
- Nondiary Milk Substitutes
- Fats
Updated January 27, 2017
References
Diabetes and Chronic Kidney Disease Stages 1 through and 4: Nutrition Guidelines. Nutrition Care Manual. Available at https://www.nutritioncaremanual.org. Accessed July 31, 2016.
Ro, L, Munson, L, Eds. Making Choices: Meal Planning for People with Diabetes and Chronic Kidney Disease Stages 3 and 4. Chicago, IL: Academy of Nutrition and Dietetics; 2015.
Ro, L, Munson, L, Eds. Making Choices: Meal Planning for People with Diabetes and Chronic Kidney Disease Stages 3 and 4. Chicago, IL: Academy of Nutrition and Dietetics; 2015.