Medical nutrition therapy (MNT), nutrition education, and counseling are essential components for effective management of end-stage kidney disease (ESKD). Patients with ESKD have to alter their diets and to implement new eating behaviors, sometimes irrespective of ethnic and cultural food preferences because of their high content of specific nutrients. Ethnic and cultural factors influence dietary adherence. Therefore, assessing cultural issues surrounding food and food preferences may help improve dietary adherence. A large percentage of the ESKD population in the United States is black and Hispanic, with cultural food preferences that are particularly high in potassium, phosphorus, and sodium. This article provides an overview of the role of culture and ethnicity in food habits and dietary adherence, a list of cultural and ethnic foods that should be examined and incorporated in the development of an appropriate renal diet meal plan for black and Hispanic Americans with ESKD, and practical recommendations for cross-cultural nutrition counseling. If MNT is to be effective in the medical management of patients from different cultural and ethnic backgrounds, it must incorporate more traditional and customary foods in the renal diet meal plan.