Celebrated Nutritionist Katy Wilkens

To dietitian and nutritionist Katy Wilkens, salt is a four-letter word. For more than 45 years she has been an anti-salt mobilizer, educating the public on the serious health effects of this white powder and teaching people with kidney disease and diabetes how to live without it. 

Wilkens, who retired in 2021 from a 42-year career with local nonprofit dialysis provider Northwest Kidney Centers and has written healthy recipe columns for Northwest Primetime since 2013, lives her practice. She has written hundreds, if not thousands, of tasty and simple low-sodium recipes, many of which are available to the public on the Northwest Kidney Centers website. She has a magnificent garden at her Kenmore home, where she and her husband Rich grow pounds and pounds of fresh fruits and vegetables year-round. Inside, dozens of cookbooks of foods from around the world are scattered on tables and bookshelves. Wilkens not only teaches people with kidney disease how to eat a diet that is appropriate for their personal health situation, the assistant scoutmaster of troop 582 has also spent years teaching young adults to cook healthily. 

During a recent cooking class at her home, Wilkens said, “One of the new girls in the troop was there and she was following a recipe that they had printed off the internet and it had salt. She says, `where is your salt?’ And one of the boys turned to her and answers ‘there is no salt in this kitchen!’” 

Wilkens learned to cook from her grandmother and had her first garden at a local pea patch when she was in middle school in North Seattle. She earned a bachelor of science degree in home economics and a master’s degree in nutritional sciences from the University of Washington. In 1979 she was named head dietitian for Northwest Kidney Centers, the world’s first out-of-hospital dialysis provider. At that time, the groundbreaking organization that spawned from the University of Washington was only 17 years old, so Wilkens essentially grew up with it. She helped the lead physicians create and carry out protocols and research projects for dietary health for all kidney patients – those on dialysis and those who were at risk of having to go on dialysis because their kidneys were failing. 

Katy Wilkens in her garden demonstrating the length of a carrot she grew in her first garden as a middle-schooler in North Seattle. Photo by Cynthia Flash

 

When Wilkens began her career, no guidelines on nutritional care for dialysis patients existed, so she gathered registered dietitians from around the region and together they wrote them. The result was the first “Suggested Guidelines for the Nutrition Care of Renal Patients” adopted by the Academy of Nutrition and Dietetics for the nation. For more than 30 years she has authored the chapter on kidney disease in the college textbook most used by U.S. dietitians in their course work.

For 39 years, Katy G. Wilkens has written the chapter on Medical Nutrition Therapy for Renal Disorders for Krause and Mahan’s Food & the Nutrition Care Process, a college-level nutrition textbook that for more than 50 years has presented the most up-to-date dietetics content available in the ever-changing field of nutrition to ensure dietitians provide optimal nutritional care. Photo by Cynthia Flash

 

A Fellow of the National Kidney Foundation (NKF), Wilkens has been a driving force behind many programs and initiatives in the local and national renal community. She has been honored by the NKF’s Council on Renal Nutrition with its two highest awards for excellence in education and for significant contributions in renal nutrition. She is proud have received the patient-nominated Medal of Excellence in kidney nutrition from the American Association of Kidney Patients. Most recently she served on the international workgroup panel on chronic kidney disease and diabetes for KDIGO, the global nonprofit organization developing and implementing clinical practice guidelines for kidney disease. She currently serves on the advisory board for the Kidney Research Institute’s study on continuous glucose monitoring in dialysis patients.

Clearly, helping people live longer with chronic kidney disease and diabetes is a calling for Wilkens, whose lifelong goal is to keep people off dialysis by helping them understand the potential ill effects of the foods they consume – especially those with too much salt.   

Throughout her career Wilkens has advocated for progress by the U.S. Food and Drug Administration to lower sodium levels in the American diet. “You can't work with people on dialysis and not be affected by the amount of time, money, human energy and misery it causes,” she said. “If something as simple as changing what you and your family eat could stop, or at least postpone that from happening, that would be a really good thing.”

Katy Wilkens retired as Nutrition and Fitness Manager from the Northwest Kidney Center in 2021 after a trailblazing career in renal nutrition

 

 

Wilkens said she often hears from dialysis patients who say, “if someone had told me that I could have done something to stay off dialysis, I would have done it.” That includes focusing on a kidney- and heart-healthy diet. “It's really hard to sit across a dialysis machine from someone and not recognize that if maybe they had had good nutrition information, they wouldn't be there. Not everyone who has a high-salt intake ends up on dialysis, a terrific number of them die from heart disease, stroke and kidney failure before reaching dialysis.”

Her goal has always been to get the information to people in a way they can understand it, and help problem solve with them as active participants so they can make changes, empowering them to postpone or stay off dialysis.  

In her job at Northwest Kidney Centers, Wilkens oversaw 30 dietitians and routinely met with a caseload of some of the 2,000 patients the organization serves, helping them learn how to eat a kidney-healthy diet. She aimed to teach them that they could be comfortable creating meals that were healthy for them and also tasted great. “That can often be through some pretty simple changes, like using unsalted butter instead of salted butter, or choosing a different salad dressing, or avoiding processed meats,” she said. After looking at an individual’s lab results, and working with the patient and family, Wilkens would customize her advice to make sure each understood what foods would be most beneficial or harmful to them. 

Most recently, she has turned her attention to patients with diabetes, a disease that affects 11.3% of people in the United States. Of those with diabetes, nearly 40% have chronic kidney disease. Yet most people with diabetes don’t know they have kidney disease. Wilkens advises those with diabetes to ask their doctor to regularly run kidney health lab tests and to make sure they understand what the results mean.

“In the past 20 years or so I have realized that the low hanging fruit to keep people out of dialysis centers is teaching people with diabetes. Some 40% of those will develop kidney failure. The ones who survive will make up half the people on dialysis. These folks are already identified long before they reach dialysis, and yet referral rates for them to Registered Dietitian Nutritionists is abysmal. Only about 6% of patients are referred for nutritional counseling,” she said. 

Wilkens encourages anyone diagnosed with diabetes to see a dietitian regularly — at least once a year, and three or four times during the first year after diagnosis. “Think of them like a ‘nutrition trainer,’” she said. “You see them over and over to fine tune what you are doing or to help when things change. If you have Medicare, the good news is that it pays for Medical Nutrition Therapy (MNT) for people with diabetes and also pays for separate nutrition visits for people with stage 3 to 5 chronic kidney disease.” 

Even for those who aren’t on Medicare, Wilkens argues that the amount of money per visit to a dietitian is equal to a nice restaurant meal, and worth the price. “If you could spend a small amount of money to see a dietitian who could keep you off dialysis for two years or longer, would it be worth it? We are so weird in this country about not paying for preventative health care.” 

There is no question that dialysis is hard. When done in a clinic, it tethers patients to a machine four to five hours at a time, three days a week, cycling blood through to clean it of the water and waste that the kidneys are no longer able to filter. Patients often don’t feel well following a treatment and spend the rest of the day resting. It’s like flying from Seattle to Chicago three times a week. Although dialysis saves lives, it is not an easy treatment to have to undergo indefinitely – until or if a kidney transplant is found. 

Wilkens understands the biochemistry that keeps a person healthy and the food science behind good nutrition. The trick, she said, is translating the science onto the plate. 

“You have to be a biochemist, a diagnostician, a behavior modification therapist and a good listener,” said Wilkens, who carries the titles MS, RDN and FNKF for master of science, Registered Dietitian Nutritionist, and Fellow of the National Kidney Foundation. “You have to be able to translate complex science that is changing all the time into practical solutions, helping the patient set attainable goals. You have to translate it so that the layperson knows what to buy at the grocery store. It is almost like translating a different language.” 

In retirement, Katy Wilkens plans to continue speaking to large professional groups. Photo courtesy nwkidney.org

 

In retirement, Wilkens believes her highest impact is working on worldwide kidney nutrition guidelines, speaking to large professional groups – including the American Diabetes Association last summer, and Northwest Renal Dietitians this spring – and teaching dietitians so they can carry the message forward. “What I decided is I can be a really good dietitian, but only to about 100 to 150 patients. But if I can be a really good mentor dietitian to other dietitians, then I can reach more patients. It’s like dropping a pebble in a pond; the ripples go further than you could ever imagine.” 

Resources:  

• Free Eating Well, Living Well classes teach people how to eat healthier to slow the progress of kidney disease and postpone dialysis. Learn more at www.nwkidney.org/classes

• Find tasty and easy salt-free recipes at https://www.nwkidney.org/living-with-kidney-disease/recipes/