Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status

Campbell, Katrina L.; Ash, Susan; Zabel, Rachel; McFarlane, Catherine; Juffs, Philip; Bauer, Judy

doi:10.1053/j.jrn.2008.11.002

Cited by 45 publications

(53 citation statements)

References 27 publications

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“…In a study by Campbell et al on patients with CKD stages 4-5, the nutritional counseling had a significant impact on body mass and improvement of energy intake, which in turn translated into significant improvements in symptoms, cognitive functioning, and quality of life [45]. Similar results were obtained in a cohort study in hemodialysis patients, which reported a significant reduction of malnutrition following a 6-month dietetic review [46].…”

Section: Safety Of Nt (Table 4)mentioning

confidence: 58%

A Delphi consensus panel on nutritional therapy in chronic kidney disease

et al. 2016

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The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad consensus regarding NT in CKD across a wide range of management areas. These clinician-led consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.

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Section: Safety Of Nt (Table 4)mentioning

confidence: 58%

A Delphi consensus panel on nutritional therapy in chronic kidney disease

et al. 2016

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“…8 A retrospective study of maintenance hemodialysis patients showed that when renal dieticians implemented standardized nutrition guidelines, there was a decrease in the proportion of patients with malnutrition as measured by the Subjective Global Assessment Scale (from 14% at baseline to 3% after two years), increased dietary energy and protein intake, decreased serum phosphate, and stable serum albumin, potassium, and dry weight. 9 More frequent contact with a dietitian might also be more beneficial for patients with kidney disease. 10 Unfortunately, studies that address this question have been small and retrospective.…”

Section: Discussionmentioning

confidence: 99%

Prehemodialysis Care by Dietitians and First-Year Mortality After Initiation of Hemodialysis

Slinin

Guo

Gilbertson

et al. 2011

American Journal of Kidney Diseases

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Background Since January 2002, Medicare has provided payment for medical nutrition therapy for patients with chronic kidney disease. Few patients receive dietary counseling before end-stage renal disease (ESRD) onset; whether such counseling is associated with improved outcomes is unknown. Study design Retrospective cohort analysis. Setting and participants Patients who initiated hemodialysis June 1, 2005-May 31, 2007, in the US, for whom predialysis dietitian care was reported on the Centers for Medicare & Medicaid Services Medical Evidence Report. Predictor Dietitian care before ESRD onset. Outcome Time to death. Measurements Propensity score for dietitian care calculated using logistic regression; Cox regression analysis used to compare time to death by predialysis dietitian care overall and stratified by tertiles of propensity score, adjusting for baseline characteristics. Results Most patients (88%) received no dietitian care; 9% received dietitian care for ≤ 12 months, and 3% received dietitian care for > 12 months before dialysis initiation (total n = 156,440). Predialysis dietitian care was independently associated with higher albumin and lower total cholesterol at dialysis initiation. There was evidence of an independent association between predialysis dietitian care for > 12 months and decreased mortality during the first year on dialysis for the second tertile of propensity score. Adjusted mortality hazards ratios (95% confidence interval) were 1.16 (0.44–3.09; P = 0.8), 0.81 (0.71–0.93; P = 0.002), and 0.93 (0.86–1.01; P = 0.1) in the first, second, and third tertiles of propensity score, respectively. Limitations Information on dietitian care was missing from 18.6% of Medical Evidence Reports, and has low sensitivity; including only incident dialysis patients precluded evaluation of an association between dietitian care and CKD progression; observational design allowed possibility of residual confounding. Conclusions Our study suggests an independent association between predialysis dietitian care for > 12 months and lower mortality during the first year on dialysis.

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“…Limited evidence exists pertaining to the impact of individualized nutritional intervention by a renal dietitian on clinical outcomes among patients with CKD. 12 Based on the Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines in CKD, adults with CKD stage III-IV are recommended a diet with adequate energy to maintain desirable body weight and normal protein near the level of 0.6-0.8 g/kg/day. 13 In addition, the European Society for Clinical Nutrition and Metabolism guidelines recommend that oral nutritional supplements and tube feeding offer the possibility of increasing nutrient intake in patients with inadequate dialysis and restrict protein intake at 0.55-0.6 g/kg/day in predialysis CKD cases.…”

Section: Discussionmentioning

confidence: 99%

The effect of ONCE Renal on minerals and electrolytes in predialysis patients with chronic kidney disease

Satirapoj

Prapakorn

Punpanich

et al. 2016

IJNRD

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Background: Malnutrition is one common adverse consequence in patients with advanced chronic kidney disease (CKD), and most patients have a lower-than-normal dietary energy intake. The present study was undertaken to examine whether orally administered ONCE Renal formula (ORF) supplement would improve energy intake without minerals and electrolytes disturbances in predialysis patients with CKD. Methods: All eligible nondiabetic patients with CKD received ORF supplement for 1 week. Nutrition markers, renal function, and minerals and electrolytes were evaluated before and after supplementing. All patients kept a 3-day food record and were interviewed by a registered dietitian. Results: A total of 29 patients with mean age 64.9±13.3 years were included. Mean estimated glomerular filtration rate was 37.7±12.1 mL/min/1.73 m 2 . A significant increase was observed in amount of energy, fat, fiber, calcium, and magnesium intake after 1 week of ORF supplement. Moreover, in comparison with baseline values, the patients displayed decreased dietary protein intake and blood urea nitrogen and increased serum magnesium. However, no significant change was found in renal function, nutritional markers (body weight, prealbumin, albumin, and protein equivalence of total nitrogen appearance), serum calcium, phosphorus, sodium, potassium, and bicarbonate. Conclusion:In patients with CKD, ingestion of ORF was well tolerated and had a positive effect with an increase in dietary energy, fat, and fiber intake, as well as a decreased dietary protein intake. No mineral or electrolyte abnormalities were observed during the study.

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Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status

Cited by 45 publications

References 27 publications

A Delphi consensus panel on nutritional therapy in chronic kidney disease

A Delphi consensus panel on nutritional therapy in chronic kidney disease

Prehemodialysis Care by Dietitians and First-Year Mortality After Initiation of Hemodialysis

The effect of ONCE Renal on minerals and electrolytes in predialysis patients with chronic kidney disease

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