Practices And Opinions On In-Center Food Consumption Across 1,223 Facilities In The United States

In the United States, the practices and opinions of healthcare providers regarding eating on dialysis are unknown. The purpose of this study was to understand healthcare provider opinions and in-center hemodialysis patient practices regarding eating while at the dialysis center. In June 2011, over 1200 registered dietitians within a large dialysis organization in the US were surveyed on current practices and opinions of patient food consumption during dialysis treatment using an online survey. 1223 of 1665 (73%) dialysis facilities responded to the food consumption survey. n=1222 Permitted No Guidelines Not allowed n (%) n (%) n (%) Eating on dialysis 803 (66%) 67 (5%) 352 (29%) Drinking on dialysis 907 (75%) 87 (7%) 228 (19%) 218 (18%) of the respondents stated that the facility practice for consuming nutritional supplements (eg., liquid nutritional supplements and/or protein bars) while on dialysis was different than the policy for consuming food while on dialysis. Interestingly, 1203 (98%) of the respondents stated consuming food before or after dialysis was allowed. The top reasons for facility practices that allowed eating during dialysis were: prevention of hypoglycemia on dialysis, improved kcal intake on dialysis days, and the opportunity to provide counseling on food products currently chosen by the patient. The top reasons for facility practices not permitting eating during dialysis included: potential adverse events associated with hypotension, GI symptoms, choking, infection, pest control, and spills. Further analyses are warranted to determine whether there is a correlation between allowing patients to eat during dialysis treatment and an improvement in the nutritional status of the patients

To eat or not to eat-international experiences with eating during hemodialysis treatment.

Providing food or nutrition supplements during hemodialysis (HD) may be associated with improved nutritional status and reduced mortality; however, despite these potential benefits, eating practices vary across countries, regions, and clinics. Understanding present clinic practices and clinician experiences with eating during HD may help outline best practices in this controversial area. Therefore, the objective of this study was to examine clinical practices and experiences related to eating during HD treatment. We surveyed clinicians about their clinic practices during the 2014 International Society of Renal Nutrition and Metabolism Conference. We received 73 responses from six continents. Respondents were primarily dietitians (71%) working at units housed in a hospital (63%). Sixty-one clinics (85%) allowed patients to eat during treatment, with 47 of these patients (65%) actively encouraging eating. Fifty-three clinics (73%) provided food during HD. None of the nine clinics from North America, however, provided food during treatment. The majority (47 clinics; 64%) provided supplements during treatment. Clinics in the hospital setting were more likely to provide food during treatment, whereas outpatient clinics were less likely to provide nutrition supplements (P≤ 0.05 for both). We also asked clinicians about their experience with six commonly cited reasons to restrict eating during treatment using a four-point scale. Clinicians responded they observed the following conditions "rarely" or "never": choking (98%), reduced Kt/V (98%), infection control issues (96%), spills or pests (83%), gastrointestinal issues (71%), and hypotension (62%). Our results indicate that while eating is common during treatment in some areas, disparities may exist in global practices, and most of the proposed negative sequelae of eating during HD are not frequently observed in clinical practice. Whether these disparities in practice can explain global differences in albumin warrants further research to help inform decisions regarding eating during HD