Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis

Waal, Desiree de; Heaslip, E.; Callas, Peter W.

doi:10.1053/j.jrn.2015.08.002

Cited by 38 publications

(31 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are in keeping with previous reports which demonstrated favorable effects of renal diets [24–27]. The novelty of this paper is found in the implementation of a personalized, step-wise nutritional approach, that is tailored to the needs of the individual patient and designed to obtain specific nutritional targets.…”

Section: Discussionsupporting

confidence: 88%

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

et al. 2016

View full text Add to dashboard Cite

BackgroundDietary treatment is helpful in CKD patients, but nutritional interventions are scarcely implemented. The main concern of the renal diets is its feasibility with regards to daily clinical practice especially in the elderly and co-morbid patients. This study aimed to evaluate the effects of a pragmatic, step-wise, personalized nutritional support in the management of CKD patients on tertiary care.MethodsThis is a case-control study. It included 823 prevalent out-patients affected by CKD stage 3b to 5 not-in-dialysis, followed by tertiary care in nephrology clinics; 305 patients (190 males, aged 70 ± 12 years) received nutritional support (nutritional treatment Group, NTG); 518 patients (281 males, aged 73 ± 13 years) who did not receive any dietary therapy, formed the control group (CG). In the NTG patients the dietary interventions were assigned in order to prevent or correct abnormalities and to maintain a good nutritional status. They included manipulation of sodium, phosphate, energy and protein dietary intakes while paying special attention to each patient’s dietary habits.ResultsPhosphate and BUN levels were lower in the NTG than in the CG, especially in stage 4 and 5. The prevalence of hyperphosphatemia was lower in the NTG than in CG in stage 5 (13.3 % vs 53.3 %, p < 001, respectively), in stage 4 (4.1 % vs 18.3 % vs, p < 0.001) and stage 3b (2.8 % vs 9.5 % p < 0.05). Serum albumin was higher in NTG than in CG especially in stage 5 . The use of calcium-free intestinal phosphate binders was significantly lower in NTG than in CG (11 % vs 19 % p < 0.01), as well as that of Erythropoiesis stimulating agents (11 % vs 19 %, p < 0.01), and active Vitamin D preparations (13 % vs 21 %, p < 0.01).ConclusionsThis case-control study shows the usefulness of a nutritional support in addition to the pharmacological good practice in CKD patients on tertiary care. Lower phosphate and BUN levels are obtained together with maintenance of serum albumin levels. In addition, a lower need of erythropoiesis stimulating agents, phosphate binders and active Vitamin D preparations was detected in NTG. This study suggests that a nutritional support may be useful in the management of the world-wide growing CKD burden.

show abstract

Section: Discussionsupporting

confidence: 88%

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

et al. 2016

View full text Add to dashboard Cite

show abstract

“…With average annual heath care costs per patient for dialysis equivalent to AUS$80,000; delaying dialysis should be a target of health service delivery . The results of this study indicate that DC could delay TTD by 223 days.…”

Section: Discussionmentioning

confidence: 83%

“…Nutrition therapy is a key component of chronic kidney disease (CKD) treatment and a multidisciplinary team (MDT) approach, including dietetics, has been reported as the most effective model of care for optimal dialysis preparation . Nutrition therapy for pre‐dialysis is used to address comorbidities associated with progression (such as hypertension, hyperglycaemia and proteinuria), manage nutrition‐related uraemic symptoms and reduce the risk of protein‐energy malnutrition . Adequate caloric intake and reductions in dietary sodium, protein, fluid and electrolytes such as potassium and phosphate (when indicated) are required to manage advanced CKD and progression factors …”

Section: Introductionmentioning

confidence: 99%

“…While dietetic consultation (DC) for patients with advanced CKD (Stages 4‐5) is recommended, standardised referral pathways to dietitians are not commonplace in renal services and DC is often under‐appreciated in CKD management . Further, health‐care costs of managing CKD and facilitating dialysis have placed an immense burden on health‐care systems worldwide . Thus, interventions focused on delaying disease progression have been recommended .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The association between dietetic consultation and time to dialysis for patients attending a pre‐dialysis clinic: A retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

Aim A multidisciplinary approach, including dietetics, is considered the optimal model of care for dialysis preparation. Dietetic consultation (DC) focuses on symptom management and dietary changes to delay time to dialysis. Evidence of the effectiveness of DC on time to dialysis is limited. This study aimed to investigate the impact of DC on time to dialysis for patients attending a pre‐dialysis clinic. Methods A retrospective cohort study was designed to include all patients attending outpatient pre‐dialysis clinics at a large metropolitan renal service between January 2014 and March 2018. Time to dialysis (days) was compared between patients that received DC and those who did not. Cox proportional hazards analysis allowing for adjustment of differences and confounders was undertaken. Results A cohort of 246 patients was identified. Median estimated glomerular filtration rate was 16mL/min per 1.73 m2 (interquartile range = 13–20) at initial pre‐dialysis clinic visit and 63% commenced dialysis during the study period. Only 41% of patients received dietetic consultation. Significantly fewer patients needed to commence dialysis in the DC group compared to the no‐DC group (hazards ratio 0.63; 95% confidence interval (CI) 0.45–0.89; P = 0.008 Cox proportion hazard). The DC group commenced dialysis significantly later than the no‐DC group; 933 days (95% CI 832–1034) versus 710 days (95% CI 630–790) respectively, after the initial pre‐dialysis clinic visit; log–rank 0.005. Conclusion DC provided to patients attending a pre‐dialysis clinic was associated with a delayed time to dialysis. Standardised referral pathways to improve patient access to renal dietetic services are recommended to optimise care.

show abstract

“…Optimum treatment to slow the progression of chronic kidney disease (CKD) in the early stages frequently requires improvements in diet that generally target the underlying causes of the disease (e.g., diabetes and hypertension) (de Waal, Heaslip, & Callas, 2016; National Kidney Disease Educational Program, 2015). For example, numerous studies report that consumption of diets rich in fruits and vegetables help reduce risk of CKD and its progression (Goraya et al, 2012; Lin et al, 2011; Nettleton et al, 2008), while weight loss for persons with CKD reduces proteinuria, blood pressure, and further renal function decline (Navaneethan et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease

et al. 2017

View full text Add to dashboard Cite

Using mindful eating to improve specific dietary recommendations has not been adequately studied. This feasibility study examined an intervention, self-management of dietary intake using mindful eating, with 19 participants that had mild to moderate chronic kidney disease, using a prospective, single group, pretest–posttest design. The intervention had six weekly classes focused on self-management using mindful eating, goal-setting, problem-solving, and food label reading. Weight, body mass index (BMI), 3-day 24-h dietary recalls and fasting blood samples were measured. Participants improved significantly in mean weight (203.21 ± 42.98 vs 199.91 ± 40.36 lbs; P = 0.03) and BMI (32.02 ± 5.22 vs 31.57 ± 5.27 kg/m2; P = 0.04), but not in dietary intake nor blood measures with the exception of cis-beta-carotene levels (0.020 + 0.012 vs 0.026 + 0.012 mcg/mL; P = 0.008), which correlates to fruit and vegetable servings. These promising results warrant further testing of the intervention in randomized control trials.

show abstract

Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis

Abstract: Results suggest that people with CKD who received MNT were less likely to start dialysis and had improved nutritional biomarkers than participants who did not receive MNT.

Cited by 38 publications

References 12 publications

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

Nutritional support in the tertiary care of patients affected by chronic renal insufficiency: report of a step-wise, personalized, pragmatic approach

The association between dietetic consultation and time to dialysis for patients attending a pre‐dialysis clinic: A retrospective cohort study

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease

Contact Info

Product

Resources

About