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Registered dietitian nutritionists and perceptions of liberalizing the hemodialysis diet

  • Welte, Alyssa L. (Department of Family and Consumer Sciences, Illinois State University) ;
  • Harpel, Tammy (Department of Family and Consumer Sciences, Illinois State University) ;
  • Schumacher, Julie (Department of Family and Consumer Sciences, Illinois State University) ;
  • Barnes, Jennifer L. (Department of Family and Consumer Sciences, Illinois State University)
  • Received : 2018.09.05
  • Accepted : 2019.03.20
  • Published : 2019.08.01

Abstract

BACKGROUND/OBJECTIVES: The objective of this study was to assess the level of awareness, comfort, and likelihood of liberalizing the hemodialysis diet in practicing renal registered dietitian nutritionists (RDN). SUBJECTS/METHODS: An original, cross-sectional survey was sent to the Academy of Nutrition and Dietetics' Renal Practice Group in May 2017, consisting primarily of renal dietitians. RESULTS: A total of 187 renal dietitians responded to the survey designed to assess their current practices regarding the renal diet for hemodialysis patients and how comfortable they would be liberalizing the current restrictions. On average, 16.3% of dietitians are extremely likely to liberalize the restrictions on various food groups including fruits and vegetables, beans and legumes, and whole grains. CONCLUSIONS: RDN feel confident in their ability to interpret and apply evidence-based literature into practice, and they are moderately comfortable liberalizing the renal diet. The participants were generally more comfortable liberalizing the phosphorus restriction than the potassium restriction, and the sodium restriction remains important to control interdialytic weight gain and hypertension. Future research is needed to establish efficacy of a liberalized diet as well as interventions to help RDN feel more comfortable implementing a liberalization of the renal diet.

Keywords

References

  1. Eknoyan G, Levin A, Levin NW; National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42 Suppl 3:S1-201. https://doi.org/10.1016/S0272-6386(03)00111-2
  2. Khoueiry G, Waked A, Goldman M, El-Charabaty E, Dunne E, Smith M, Kleiner M, Lafferty J, Kalantar-Zadeh K, El-Sayegh S. Dietary intake in hemodialysis patients does not reflect a heart healthy diet. J Ren Nutr 2011;21:438-47. https://doi.org/10.1053/j.jrn.2010.09.001
  3. Biruete A, Jeong JH, Barnes JL, Wilund KR. Modified nutritional recommendations to improve dietary patterns and outcomes in hemodialysis patients. J Ren Nutr 2017;27:62-70. https://doi.org/10.1053/j.jrn.2016.06.001
  4. Calvo MS, Uribarri J. Contributions to total phosphorus intake: all sources considered. Semin Dial 2013;26:54-61. https://doi.org/10.1111/sdi.12042
  5. Noori N, Sims JJ, Kopple JD, Shah A, Colman S, Shinaberger CS, Bross R, Mehrotra R, Kovesdy CP, Kalantar-Zadeh K. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iran J Kidney Dis 2010;4:89-100.
  6. St-Jules DE, Goldfarb DS, Sevick MA. Nutrient non-equivalence: does restricting high-potassium plant foods help to prevent hyperkalemia in hemodialysis patients? J Ren Nutr 2016;26:282-7. https://doi.org/10.1053/j.jrn.2016.02.005
  7. United States Renal Data System. 2016 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2016.
  8. Burrowes JD, Russell GB, Rocco MV. Multiple factors affect renal dietitians' use of the NKF-K/DOQI Adult Nutrition Guidelines. J Ren Nutr 2005;15:407-26. https://doi.org/10.1053/j.jrn.2005.05.002
  9. Hall-McMahon EJ, Campbell KL. Have renal dietitians successfully implemented evidence-based guidelines into practice? A survey of dietitians across Australia and New Zealand. J Ren Nutr 2012;22:584-91. https://doi.org/10.1053/j.jrn.2011.09.004
  10. Johnston B, Coole C, Narayanasamy M, Feakes R, Whitworth G, Tyrell T, Hardy B. Exploring the barriers to and facilitators of implementing research into practice. Br J Community Nurs 2016;21:392-8. https://doi.org/10.12968/bjcn.2016.21.8.392
  11. Metcalfe C, Lewin R, Wisher S, Perry S, Bannigan K, Moffett JK. Barriers to implementing the evidence base in four NHS therapies: dietitians, occupational therapists, physiotherapists, speech and language therapists. Physiotherapy 2001;87:433-41. https://doi.org/10.1016/S0031-9406(05)65462-4
  12. McEvoy MP, Williams MT, Olds TS. Evidence based practice profiles: differences among allied health professions. BMC Med Educ 2010;10:69. https://doi.org/10.1186/1472-6920-10-69
  13. Hand RK, Steiber A, Burrowes J. Renal dietitians lack time and resources to follow the NKF KDOQI guidelines for frequency and method of diet assessment: results of a survey. J Ren Nutr 2013;23:445-9. https://doi.org/10.1053/j.jrn.2012.08.010
  14. Noori N, Kalantar-Zadeh K, Kovesdy CP, Murali SB, Bross R, Nissenson AR, Kopple JD. Dietary potassium intake and mortality in long-term hemodialysis patients. Am J Kidney Dis 2010;56:338-47. https://doi.org/10.1053/j.ajkd.2010.03.022
  15. Gallen IW, Rosa RM, Esparaz DY, Young JB, Robertson GL, Batlle D, Epstein FH, Landsberg L. On the mechanism of the effects of potassium restriction on blood pressure and renal sodium retention. Am J Kidney Dis 1998;31:19-27. https://doi.org/10.1053/ajkd.1998.v31.pm9428447
  16. Kalantar-Zadeh K, Tortorici AR, Chen JL, Kamgar M, Lau WL, Moradi H, Rhee CM, Streja E, Kovesdy CP. Dietary restrictions in dialysis patients: is there anything left to eat? Semin Dial 2015;28:159-68. https://doi.org/10.1111/sdi.12348
  17. Morris RC Jr, Sebastian A, Forman A, Tanaka M, Schmidlin O. Normotensive salt sensitivity: effects of race and dietary potassium. Hypertension 1999;33:18-23. https://doi.org/10.1161/01.HYP.33.1.18
  18. Wilkens KG, Juneja V, Shanaman E. Medical nutrition therapy for renal disorders. In: Mahan LK, Escott-Stump S, Raymond JL, editors. Krause's Food and Nutrition Care Process. 13th ed. St. Louis, MO: Elsevier Saunders; 2012. p.799-831.
  19. Carrigan A, Klinger A, Choquette SS, Luzuriaga-McPherson A, Bell EK, Darnell B, Gutierrez OM. Contribution of food additives to sodium and phosphorus content of diets rich in processed foods. J Ren Nutr 2014;24:13-9. https://doi.org/10.1053/j.jrn.2013.09.003
  20. Rigby AJ, Scribner BH, Ahmad S. Sodium, not fluid, controls interdialytic weight gain. Nephrol News Issues 2000;14:21-2.
  21. Chazot C. Opinion: can chronic volume overload be recognized and prevented in hemodialysis patient? Semin Dial 2009;22:482-6. https://doi.org/10.1111/j.1525-139X.2009.00642.x
  22. Charra B, Chazot C, Jean G, Laurent G. Long, slow dialysis. Miner Electrolyte Metab 1999;25:391-6. https://doi.org/10.1159/000057480
  23. Kayikcioglu M, Tumuklu M, Ozkahya M, Ozdogan O, Asci G, Duman S, Toz H, Can LH, Basci A, Ok E. The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis. Nephrol Dial Transplant 2009;24:956-62. https://doi.org/10.1093/ndt/gfn599
  24. Roy LG, Shetty MS, Urooj A. Effect of nutritional intervention on malnutrition indicators in patients on haemodialysis. J Ren Care 2013;39:39-46. https://doi.org/10.1111/j.1755-6686.2013.12000.x

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