Renal Dietitians Lack Time And Resources To Collect And Analyze Dietary Intake Data

Previous research indicated that renal dietitians lack the time and computer software to implement the KDOQI nutrition guidelines for assessing dietary intake. This study used an online survey to determine the frequency and method of collecting and analyzing dietary intake data among renal dietitians in the USA and overseas. The link to the survey was emailed to the members of the RenalRD listserve (n=2077), the International Society of Renal Nutrition and Metabolism (n=93), the Academy of Nutrition and Dietetics Renal Practice Group (n=2362), and the National Kidney Foundation Council on Renal Nutrition (n=1491). Only currently practicing renal dietitians were asked to respond; 599 usable responses were received. A response rate cannot be calculated due to membership overlap between the 4 organizations, although individuals were asked to answer only once. Respondents were 99% female, 91% worked in the USA, 45% had a M.S. degree or higher, and 21% were Board Certified Specialists in Renal Nutrition. Dietitians worked mostly in dialysis (hospital based facility 30%, Fresenius 18%, DaVita 17%) and 5% worked in a pre-dialysis CKD clinic. Median patient load was 120/Full Time Equivalent (inner quartile range 100-150). Dietitians reported that they collected dietary intake data most frequently when labs were abnormal (70%), yearly (41%), and at the first visit only (35%). They did not collect intake data more frequently due to lack of time (42%) and not having analysis software (24.9%). Only 10% of renal dietitians reported that the frequency of diet analysis was determined by following the KDOQI guidelines, while 58.5% reported deciding on their own when to collect data. The most common methods of data collection were the “typical day” recall (50%) and the 24-hour recall (37%). Only 8% reported using a 3-day food record (as recommended by KDOQI). Methods of diet analysis were “estimation in my head” (62%), “calculate by hand” (25%), computer software (6%) and internet analysis sites (7%). These data show that most dietitians are not following the KDOQI nutrition guidelines for frequency or method of diet analysis, and new, inexpensive, and rapid methods of diet assessment must be explored

Nutrition in Kidney Disease

XXXV, 478 p. 30 illus., 14 illus. in color.onlin

Flavonoids and heart health : Proceedings of the ILSI North America Flavonoids Workshop

This article provides an overview of current research on flavonoids as presented during a workshop entitled, "Flavonoids and Heart Health," held by the ILSI North America Project Committee on Flavonoids in Washington, DC, May 31 and June 1, 2005. Because a thorough knowledge and understanding about the science of flavonoids and their effects on health will aid in establishing dietary recommendations for bioactive components such as flavonoids, a systematic review of the science of select flavonoid classes (i.e., flavonols, flavones, flavanones, isoflavones, flavan-3-ols, anthocyanins, and proanthocyanidins) was presented. The objectives of the workshop were to 1) present and discuss current research on flavonoid intake and the relation between flavonoids and heart health; 2) develop information that could lead to expert consensus on the state-of-the-science of dietary intake of flavonoids on heart health; and 3) summarize and prioritize the research needed to establish the relations between specific flavonoids and heart health. Presentations included the basics of the biology of flavonoids, including the types and distribution in foods, analytical methodologies used to determine the amounts in foods, the bioavailability, the consumption patterns and potential biomarkers of intake, risk assessment and safety evaluation, structure/function claims, and the proposed mechanism(s) of the relation between certain flavonoids and heart health endpoints. Data presented support the concept that certain flavonoids in the diet can be associated with significant health benefits, including heart health. Research gaps were identified to help advance the science

Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism.

Poor nutritional status and protein-energy wasting are common among maintenance dialysis patients and associated with unfavorable outcomes. Providing foods, meal trays, snack boxes, and/or oral nutritional supplements during hemodialysis can improve nutritional status and might also reduce inflammation, enhance health-related quality of life, boost patient satisfaction, and improve survival. Potential challenges include postprandial hypotension and other hemodynamic instabilities, aspiration risk, gastrointestinal symptoms, hygiene issues, staff burden, reduced solute removal, and increased costs. Differing in-center nutrition policies exist within organizations and countries around the world. Recent studies have demonstrated clinical benefits and highlight the need to work toward clear guidelines. Meals or supplements during hemodialysis may be an effective strategy to improve nutritional status with limited reports of complications in real-world scenarios. Whereas larger multicenter randomized trials are needed, meals and supplements during hemodialysis should be considered as a part of the standard-of-care practice for patients without contraindications

New Insights Into Dietary Approaches to Potassium Management in Chronic Kidney Disease

Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD

Assessing Global Kidney Nutrition Care

Background and objectivesNutrition intervention is an essential component of kidney disease management. This study aimed to understand current global availability and capacity of kidney nutrition care services, interdisciplinary communication, and availability of oral nutrition supplements.Design, setting, participants, & measurementsThe International Society of Renal Nutrition and Metabolism (ISRNM), working in partnership with the International Society of Nephrology (ISN) Global Kidney Health Atlas Committee, developed this Global Kidney Nutrition Care Atlas. An electronic survey was administered among key kidney care stakeholders through 182 ISN-affiliated countries between July and September 2018.ResultsOverall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care. Only 48% of the 155 countries have dietitians/renal dietitians to provide this specialized service. Dietary counseling, provided by a person trained in nutrition, was generally not available in 65% of low-/lower middle\u2013income countries and \u201cnever\u201d available in 23% of low-income countries. Forty-one percent of the countries did not provide formal assessment of nutrition status for kidney nutrition care. The availability of oral nutrition supplements varied globally and, mostly, were not freely available in low-/lower middle\u2013income countries for both inpatient and outpatient settings. Dietitians and nephrologists only communicated \u201csometimes\u201d on kidney nutrition care in 6560% of countries globally.ConclusionsThis survey reveals significant gaps in global kidney nutrition care service capacity, availability, cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries