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On 5/23/19 Senators Ben Cardin (D-MD) and Roy Blunt (R-MO) introduced S 1676, The Chronic Kidney Disease Improvement in Research and Treatment Act of 2019, a bill to improve the understanding of, and promote access to treatment for, chronic kidney disease. Introduced in 2017 as HR 2644 by Rep Tom Marino (R-PA), it is promising that this act has been reintroduced.

Passing this act would be a big step in proactive care for people who have kidney disease.  It would allow for significant improvements in critical areas including the following:

  • Increase the Number of Nephrologists and Improve Access to Care in Underserved Areas
    The kidney community has been dealing with a lack of nephrologists for years.  Without enough nephrologists to care for the fast-growing population of people who have kidney disease, there will be more patients doing poorly due to the lack of available doctors to care for them.  This will lead to more hospitalizations and an earlier need for dialysis.
  • Access to Medigap for all End Stage Renal Patients
    Though Medicare covers most costs associated with care, the patient is also responsible for a portion.  Many people who have limited incomes are having to pay deductibles and co-pays not covered by Medicare and that causes significant financial strain.  Medigap is private insurance that fills in the gaps between Medicare benefits and what patients have to pay out-of-pocket.  Currently only 28 states offer Medigap coverage to people with End-Stage Renal Disease (ESRD) under the age of 65.  Therefore, some patients under 65 are forced to do what is necessary to become eligible for Medicaid/Medical coverage, which can often cripple them financially.  Reduced need for Medicaid will save the state and taxpayers money in the end as well.
  • Increased Access to Medicare Education Benefit
    Medicare covers six (6) one-hour sessions of kidney disease education by a doctor or qualified nurse/nurse practitioner/social worker if you have stage 4 Chronic Kidney Disease or End-Stage Renal Disease and qualify based on established criteria.  Education is critical to navigate this disease so there needs to be additional access to all patients at various stages, and increased education covered by Medicare.  There has been a decline in patients using this benefit since its inception in 2012.  This may be due to a few factors including: many smaller centers don’t have the staff to run the classes, for many it’s not cost-effective for them to do so due to limited Medicare reimbursement, and many patients aren’t informed about classes because many doctors don’t have information about them.  It’s necessary to have patients educated on what to expect and how to care for themselves once they are on dialysis or as they plan for transplant.  With an increase in funding, improvement in education will benefit the whole healthcare system in the long run.
  • Provide Coverage for Palliative Care
    Often hospice and palliative care are confused, but while hospice care is compassionate care for patients who have a pre-determined limited lifespan, palliative care is compassionate care that can start as early as diagnosis.  It can occur anytime during the span of an illness through end of life.  Medicare generally covers 100% of hospice care but palliative care is paid for by private insurance or the patient themselves.  People who have kidney disease are often burdened by mental and emotional issues in addition to their physical condition, which can lead to insufficient treatment resulting in unforeseen medical setbacks.  Palliative coverage would allow for care that aids in avoiding these setbacks for patients.
  • Information Sharing Between Hospitals and Dialysis Centers
    Communication is key when it comes to everyone receiving the best care.  For people who need dialysis, information comes from many sources and often there is a communication breakdown.  When someone is admitted to a hospital as an in-patient, his/her dialysis center doesn’t always receive all the information needed.  This is often due to the dialysis center not receiving admitting or discharge information, incompatible electronic records systems, different priorities and lack of standardized content.  If everyone is in the know, adverse events like medication mismanagement and readmittance can be greatly reduced and patient care improved.
  • Incentivizing Innovative Technology
    Statistics continually show that research and technological advancements in chronic disease care improve the lives of people who have an illness and lower the financial burden for patients and taxpayers.  However, innovative devices and technology are not reimbursed at the rate or percentage for kidney disease as they are for other chronic illnesses, so there is a lack of incentive to spend time researching new technology for the kidney world.  We have seen firsthand how changes in care, like dialysis machine upgrades and medication improvements, have improved treatment outcomes for people who need them to survive.  Advances in biological sciences, coupled with the increasing availability of clinical data from electronic medical records, as well as improved medical imaging, offer many options for medical advances.
  • Increase Transparency
    Transparency in healthcare is paramount in this modern era.  Public policy changes and the growing number of health care quality information sources suggest that patient access to information regarding safety, quality, and outcomes is becoming increasingly important to patients who want to be actively involved in their treatment.  When people with kidney disease are empowered to understand what is happening with their health, including treatment options, possible outcomes and risks, as well as costs, everyone benefits.

Healthcare providers must provide as much information as possible to ensure safe, quality care so patients, in conjunction with their healthcare team, can make informed decisions.  Healthcare providers also need to engage people with care-planning discussions and ensure they and their families are vested in decision-making.  Additionally, internal transparency leads to improved external transparency so healthcare providers need to assist each other with that.  Using the increasing number of electronic record portals to consolidate information coming from various healthcare sources and being reachable through portals or email, is extremely useful to keep patients informed.

Track this bill’s progress

The post The Chronic Kidney Disease Improvement in Research and Treatment Act of 2019 (S. 1676) appeared first on Renal Support Network.

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Quick-service restaurants provide us with a quick, easy, inexpensive bite when we’re pressed for time. Americans love fast food and there are so many items to choose from! A lot of chains are now offering lower-fat options and if chosen wisely, fast foods can be healthy AND fit into your renal diet. If you are a regular through the drive-up window or frequently dine in at fast food restaurants, keep these tips in mind:

  1. Burgers and sandwiches are high in sodium because they are pre-salted. It may be difficult for the quick-service restaurant to omit the salt. Be sure to ask before you order.

  2. Remember that fries and baked potatoes are rich in potassium. If you can’t imagine a burger without the fries, order a small serving and ask for unsalted where
    it is possible.

  3. Ketchup, mustard and pickles are all high in sodium. Keep condiments, special sauces and dressings to a minimum. Request these toppings to be served “on the side” so you can control the amount.

  4. Beverage sizes typically are large or “super-size” and can contribute to fluid overload if the entire beverage is consumed. Order a small beverage and ask for extra ice so it lasts longer and you don’t drink it as fast.

  5. Balance fast food items with other food choices. As you order, consider the other foods you have eaten or will eat during the day.

  6. Choose broiled, steamed or grilled items over deep fried foods. To trim the fat from fried items, order the regular variety instead of the “extra crispy” and remove the skin before eating. Removing the skin also lowers the sodium content since most batters and coatings usually include seasonings rich in sodium.

  7. Get a breakdown of fat, calories and other nutrition information (potassium, phosphorus or sodium) from the store manager. You can also check out the restaurant’s web site for a complete nutritional analysis of all their menu items. Please note that obtaining information on potassium and phosphorus can be difficult.

  8. Generally speaking, choose meals under 500 calories with less than 30% of the calories from fat. Many items are loaded with sodium so limit your sodium intake for the rest of the day. Watch your fluid intake because these foods will make you more thirsty than usual. Some items may require an increased dose of phosphate binders.

  9. Note the serving size and work with your renal dietitian to safely add these menu items into your eating plan.

  10. Look for places where you control your own ingredients like Chipotle, Subway or where you can build your own pizza.

  11. Plan ahead so you are not famished when you visit a fast  food restaurant. Before you leave the house, eat a healthy snack or take one with you. And be sure to take your phosphorus binders with you if they are prescribed to you.

Download the PDF

Web ID: 4017

The post 11 Kidney-Friendly Fast Food Ordering Tips appeared first on Renal Support Network.

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The trouble with phosphorus: Too much of a good thing
For many people, phosphorus—present in many foods—is a good thing, working with calcium to build strong bones and keep other parts of the body healthy. However, those living with chronic kidney disease (CKD), whose kidneys are unable to filter out excess phosphorus, need to keep close track of phosphorus levels in order to stay healthier.

When the kidneys can no longer keep phosphorus at the right level, it builds and becomes harmful. High phosphorus levels may weaken bones and put a person at risk for increased bone fractures as well as increased risk for cardiovascular disease, which is a disease of the heart and blood vessels.

Though it’s important to avoid foods that are very high in phosphorus in order to help reduce wear and tear on the body’s systems, most CKD patients will also need medication to support that balance. This medication is known as a phosphate binder. There are many options for phosphate binders, but the number of pills needed for managing phosphorus levels can be burdensome. Of the four phosphorus binders on the market, Velphoro 1 is cited as having the most significant reduction for a patients’ pill burden. In studies, most people reached their phosphorus goal with 3 to 4 tablets per day. Usually phosphate binders are taken within minutes before or immediately after meals and snacks.

A kidney-friendly diet: Tips for reducing phosphate consumption
People who are working to lower their consumption of phosphorus-rich foods can choose natural phosphorus-containing foods. The natural phosphorus content will be absorbed less by the body. The following foods will help to satisfy the appetite while absorbing less of the phosphorus:

• Fresh all-natural chicken, steak, fish, turkey

• Natural cheeses (cheddar, goat, mozzarella)

• Heart-healthy cooking oils (olive, canola, vegetable)

• Whole grains (oats, rice, whole wheat pasta)

• Unsalted nuts (peanuts, almonds, peanut butter)

• Low-sodium canned beans (kidney, pinto, chickpeas, garbanzo)

Though it can be difficult to always avoid high phosphorus foods, foods that contain additional phosphate additives will cause your body to absorb more phosphorus. The following foods contain phosphate additives and should be avoided:

• Processed cheese (American, cheese dip, spray cheese)

• Fast food

• Enhanced meats (frozen, pre-cooked)

• Dark cola

• Prepared frozen foods (microwavable meals, snack items)

• Baked goods (pastries, snack cakes)

Thriving
• Talk to your dietitian about managing your unique kidney-healthy diet.

• Read ingredients to hunt down hidden phosphorus (phosphates) so you 
   can keep your level in the healthy range.
• Swap out high-phosphorus foods for lower-phosphorus ones. Try these      
   three recipes at www.freseniuskidneycare.com/eating-well:

1. Velphoro is distributed by Fresenius Medical Care North America.

Find more helpful, kidney-friendly diet and nutrition guidance at
www.freseniuskidneycare.com/eating-well

Additional Resources 

Phosphorus, the Mineral You Need to Know
A better binder for a better you!
Eating well with chronic kidney disease

Grocery List: Foods to Choose for End Stage Renal Disease
Kidney Friendly Recipes

Gina R. Brittain, RD, L.D, is the Lead Dietitian for the Kentucky Region of Fresenius Kidney Care and maintains a Home Therapy patient population. Gina earned her Bachelor of Science degree from the University of Cincinnati and has over 20 years experience as a Registered Dietitian. Since 2017, she has advocated for her patients to thrive while on dialysis.

Web ID: 4016

The post Controlling Phosphorus in Your Diet appeared first on Renal Support Network.

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Many backyard grill masters say that the best way to BBQ ribs is low and slow for hours to bring out the best flavor. With this recipe, you can have tender, tasty ribs done and on your table in one hour!  We fully cook the meat on the grill in a foil pouch first, then we caramelize it on the outside with our fresh, kidney-friendly marinade.

Scroll past the BBQ ribs recipe for ingredients and instructions for the marinade.

Prep Instructions

Remove the rack of ribs from the packaging. (Peel off the membrane on the back of the rack if the butcher has not already done so.)

Place the rack of ribs, bottom side up, on your foil.

Apply your marinade to the bottom of the rack and turn over.

Apply more marinade to the top of the rack and fold the foil over, sealing the sides and top carefully so that no marinade drops out.

Save some remaining marinade for the last caramelizing step on the grill and some for dipping while you eat.

Place your foil wrapped ribs into the refrigerator to marinate while you prep the grill.

Grilling Prep
If you are using a gas grill, preheat high heat and move on to the Grilling Instructions  when your grill is ready to go.

For a charcoal grill, start with a clean grill grate. Remove the grill grate and place the charcoal evenly at the bottom.

Follow the instructions for lighting the charcoal on the back of the bag.

Spray the grill grate with cooking oil and put back onto the grill.

Heat the coals until they turn ash white, about 15 – 20 minutes.

Grilling Instructions

Place the foil packet of ribs on the center of the grill, cover and cook for 50 minutes.

After 50 minutes, remove ribs from the foil and place top side down on the grill. Apply marinade covering entire bottom of the rack. Cover and cook for five minutes.

After five minutes, flip the rack over and apply more marinade covering entire top of the rack, but saving the rest of the marinade for after the ribs are done cooking. Cover and cook for five more minutes.

At this point, your ribs should be nicely caramelized and browned. If not, cook uncovered for a few minutes on each side until they are done browning. Watch them very carefully so they don’t burn.

Remove the fully cooked ribs from the grill and place onto a large serving platter.

Cut up into manageable portions of two or single bone sections from the rack. Serve with the remaining marinade.

Approximate analysis per 2 ribs:
Calories  626
Fat 49 g
Protein  50 g
Carbohydrate  0
Fiber  0
Sodium  118 mg
Potassium  490 mg
Calcium  44 mg
Phosphorus  309 mg
Cholesterol  156 mg

Tasty BBQ Marinade for Ribs
16 Servings

Ingredients
1/4 cup honey
2 tablespoons brown sugar
1/4 cup apple cider vinegar
2 tablespoons sweet onion finely chopped
1 cup water
1 garlic clove, chopped or grated
2 teaspoon dry mustard
2 tablespoons tomato paste
1 teaspoon hot pepper sauce
1 teaspoon brown seasoning sauce
1-1/2 tablespoon unsalted butter
1/4 teaspoon salt
1 tablespoon all-purpose flour

Instructions
Finely chop the onion and mince the garlic clove.

Melt butter over low heat in sauce pan.

Add onion and garlic and heat until lightly browned.

Add the remaining ingredients except flour.

Continue to heat and whisk over medium heat until blended and the sauce begins to lightly boil. Lower heat and add flour.

Whisk until blended and sauce begins to thicken. Cover sauce pan and put aside for marinating ribs for the BBQ grill.

If you are not using right away, store frozen until you are ready to thaw and use or refrigerate for 7 days.

Calories 56 kcal
Fat 8 g
Protein 1 g
Carbohydrate8.97 g
Fiber 1 g
Sodium, 48 mg
Potassium, 76 mg
Calcium, 12 mg
Phosphorus, 14 mg
Cholesterol 1 mg

Recipe Disclaimer: Due to variations in ingredients, the nutritional analyses should be used as a guideline only. A renal dietitian reviews all recipes, but we cannot assure that all values are accurate. Remember to consult a renal care provider with respect to any specific questions or concerns you may have regarding proper renal nutrition or before making any changes in your renal diet.

Web ID 4016

The post Fast and Juicy BBQ Ribs with Marinade appeared first on Renal Support Network.

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Featuring two very kidney-friendly fruits, these mouthwatering mini pineapple upside down cakes are perfect for dinner parties or a backyard BBQ dessert.

Ingredients
Serves 12

3 tablespoons unsalted butter, melted
1/3 cup packed brown sugar
12 canned unsweetened pineapple slices
6 fresh cherries cut into halves and pitted
2/3 cup sugar
2/3 cup fat-free milk
3 tablespoons canola oil
1 egg
1 teaspoon lemon juice
1/2 teaspoon vanilla extract
1-1/3 cups cake flour
1-1/4 teaspoons baking powder
1/4 teaspoon salt

Instructions
Pour butter into a 12 serving muffin pan. square baking pan.

Sprinkle a little brown sugar into each section.

Place one pineapple slices with one cherry half in center of pineapple slices in each section and set aside.

In a large bowl, beat the sugar, milk, oil, egg and extracts until well blended. Combine the flour, baking powder and salt; gradually beat into sugar mixture until blended. Pour into prepared muffin pan.

Bake at 350° for 35-40 minutes or until a toothpick comes out clean. Immediately invert onto a serving plate. Serve warm.

Approximate analysis per serving
Calories  193
Fat 7.48 g
Protein  2.6 g
Carbohydrate 31.68 g
Fiber  .7 g
Sodium 131 mg
Potassium  169 mg
Calcium  67 mg
Phosphorus  88 mg
Cholesterol  56 mg

Recipe Disclaimer: Due to variations in ingredients, the nutritional analyses should be used as a guideline only. A renal dietitian reviews all recipes, but we cannot assure that all values are accurate. Remember to consult a renal care provider with respect to any specific questions or concerns you may have regarding proper renal nutrition or before making any changes in your renal diet.

Web ID 4019

The post Mini Pineapple Upside Down Cakes appeared first on Renal Support Network.

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Many backyard grill masters say that the best way to BBQ ribs is low and slow for hours to bring out the best flavor. With this recipe, you can have tender, tasty ribs done and on your table in one hour!  We fully cook the meat on the grill in a foil pouch first, then we caramelize it on the outside with our fresh, kidney-friendly marinade.

Prep Instructions

Remove the rack of ribs from the packaging. (Peel off the membrane on the back of the rack if the butcher has not already done so.)

Place the rack of ribs, bottom side up, on your foil.

Apply your marinade to the bottom of the rack and turn over.

Apply more marinade to the top of the rack and fold the foil over, sealing the sides and top carefully so that no marinade drops out.

Save some remaining marinade for the last caramelizing step on the grill and some for dipping while you eat.

Place your foil wrapped ribs into the refrigerator to marinate while you prep the grill.

Grilling Prep
If you are using a gas grill, preheat high heat and move on to the Grilling Instructions  when your grill is ready to go.

For a charcoal grill, start with a clean grill grate. Remove the grill grate and place the charcoal evenly at the bottom.

Follow the instructions for lighting the charcoal on the back of the bag.

Spray the grill grate with cooking oil and put back onto the grill.

Heat the coals until they turn ash white, about 15 – 20 minutes.

Grilling Instructions

Place the foil packet of ribs on the center of the grill, cover and cook for 50 minutes.

After 50 minutes, remove ribs from the foil and place top side down on the grill. Apply marinade covering entire bottom of the rack. Cover and cook for five minutes.

After five minutes, flip the rack over and apply more marinade covering entire top of the rack, but saving the rest of the marinade for after the ribs are done cooking. Cover and cook for five more minutes.

At this point, your ribs should be nicely caramelized and browned. If not, cook uncovered for a few minutes on each side until they are done browning. Watch them very carefully so they don’t burn.

Remove the fully cooked ribs from the grill and place onto a large serving platter.

Cut up into manageable portions of two or single bone sections from the rack. Serve with the remaining marinade.

Approximate analysis per 2 ribs:
Calories  626
Fat 48.84 g
Protein  46.95 g
Carbohydrate  0
Fiber  0
Sodium  118 mg
Potassium  490 mg
Calcium  44 mg
Phosphorus  309 mg
Cholesterol  156 mg

Tasty BBQ Marinade for Ribs
16 Servings

Ingredients
1/4 cup honey
2 tablespoons brown sugar
1/4 cup apple cider vinegar
2 tablespoons sweet onion finely chopped
1 cup water
1 garlic clove, chopped or grated
2 teaspoon dry mustard
2 tablespoons tomato paste
1 teaspoon hot pepper sauce
1 teaspoon brown seasoning sauce
1-1/2 tablespoon unsalted butter
1/4 teaspoon salt
1 tablespoon all-purpose flour

Instructions
Finely chop the onion and mince the garlic clove.

Melt butter over low heat in sauce pan.

Add onion and garlic and heat until lightly browned.

Add the remaining ingredients except flour.

Continue to heat and whisk over medium heat until blended and the sauce begins to lightly boil. Lower heat and add flour.

Whisk until blended and sauce begins to thicken. Cover sauce pan and put aside for marinating ribs for the BBQ grill.

If you are not using right away, store frozen until you are ready to thaw and use or refrigerate for 7 days.

Calories 56 kcal
Fat 8 g
Protein 0.45 g
Carbohydrate8.97 g
Fiber 0.5 g
Sodium, 48 mg
Potassium, 76 mg
Calcium, 12 mg
Phosphorus, 14 mg
Cholesterol 1 mg

Recipe Disclaimer: Due to variations in ingredients, the nutritional analyses should be used as a guideline only. A renal dietitian reviews all recipes, but we cannot assure that all values are accurate. Remember to consult a renal care provider with respect to any specific questions or concerns you may have regarding proper renal nutrition or before making any changes in your renal diet.

Web ID 4016

The post Fast and Juicy BBQ Ribs with Marinade appeared first on Renal Support Network.

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Renal Support Network by Renal Recipes - 1w ago

Asparagus is a versatile vegetable that’s tasty in just about any form. Fresh grilled asparagus is delicious as side dish, but it is also delicious chopped in salads, pastas, and rice casseroles.

Ingredients
6 Servings
1-1 1/2 lb fresh Asparagus (12 – 15 large spears)
2-3 tbsp. extra-virgin olive oil
1-1 1/2 tsp. pepper
2-3 tsp lemon juice

Instructions
Mix the oil, black pepper and lemon juice in a shallow dish wide enough to roll the asparagus into and completely cover with mixture.

Wash and trim the woody ends of the asparagus spears. Tip: Hold the spear just below the tip with one hand and at the end with the other and gently bend. The spear will naturally give where the woody ends stop, and the tender asparagus starts.

Roll the asparagus into the oil mixture and leave in the dis. Place the tray onto a dish to keep the oil from dripping keep in the refrigerator to marinate until the grill is ready.

Prepare charcoal or gas barbecue and heat medium-high heat.

Lightly spray vegetable grilling tray, a grill basket or sheet of heavy-duty tin foil folded into a shallow tray with olive oil spray to keep the spears from sticking to the pan.

Arrange the asparagus onto a vegetable grilling tray and pour any remaining oil from the dish onto the spears.

Grill asparagus in the pan or on the tin foil until tender and beginning to brown, turning frequently, about 5 minutes. Transfer to platter. Sprinkle with salt to taste. Serve warm or at room temperature.


Approximate analysis per serving
Calories 47
Fat 3.12 g
Protein  1.92 g
Carbohydrate 4.17 g
Fiber  1.8 g
Sodium  62 mg
Potassium  196 mg
Calcium  20 mg

Recipe Disclaimer: Due to variations in ingredients, the nutritional analyses should be used as a guideline only. A renal dietitian reviews all recipes, but we cannot assure that all values are accurate. Remember to consult a renal care provider with respect to any specific questions or concerns you may have regarding proper renal nutrition or before making any changes in your renal diet.

Web ID 4018

The post BBQ Asparagus appeared first on Renal Support Network.

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Renal Support Network by Renal Recipes - 1w ago

Summer grilling, having a blast! This savory recipe goes with any main dish you also have going on the BBQ this summer.

Ingredients
Serves 8

3 tablespoons olive oil
1 tbs grated parmesan cheese
1 tsp teaspoon dried thyme
1 tsp parsley
1/2 teaspoon black pepper
4 fresh corn on the cob, cut into 8 halves

Instructions
Husk and clean the corn (or you can buy 4 prepped ears from the produce section of the store).

Mix the oil, cheese, thyme, parsley and black pepper in a dish wide enough to roll the corn into and completely cover with mixture.

Place the corn in the mixture and roll to thoroughly coat corn.

Place all of the corn onto the center of a heavy-duty aluminum foil sheet.

Fold up the edges of the foil sheet to create a tray making sure not to leave space for oil to drip onto the grill.

Place the foil tray on the grill over medium heat and cook for 15-20 minutes turning as browning is done one each side.

Approximate analysis per serving:

Calories  109
Fat 5.73 g
Protein  2.26 g
Carbohydrate 14.93 g
Fiber  1.8 g
Sodium  15 mg
Potassium  189 mg
Calcium  9 mg
Phosphorus  59 mg
Cholesterol  1 mg
3 tablespoons olive oil
1 tablespoon grated parmesan cheese
1 tsp teaspoon dried thyme
1 tsp parsley
1/2 teaspoon black pepper

Recipe Disclaimer: Due to variations in ingredients, the nutritional analyses should be used as a guideline only. A renal dietitian reviews all recipes, but we cannot assure that all values are accurate. Remember to consult a renal care provider with respect to any specific questions or concerns you may have regarding proper renal nutrition or before making any changes in your renal diet.

Web ID 4017

The post BBQ Corn on the Cob appeared first on Renal Support Network.

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A backyard BBQ is a simple and meaningful way to spend Father’s Day bonding with your dad. So, get your grill on and you’re sure to make lasting father-son or father-daughter memories. And don’t limit yourself to just Father’s Day, the whole family can enjoy these tasty kidney friendly BBQ recipes all year long!

Fast and Juicy Ribs and Marinade

BBQ Corn on the Cob

BBQ Asparagus

Mini Pineapple Upside Down Cakes

Web ID 7051

The post Father’s Day Kidney Friendly BBQ appeared first on Renal Support Network.

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