Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions

Kramer, Holly; Jimenez, Elizabeth Yakes; Brommage, Deborah; Vassalotti, Joseph A.; Montgomery, Elizabeth; Steiber, Alison; Schofield, Marsha

doi:10.1016/j.jand.2018.05.023

Cited by 48 publications

(50 citation statements)

References 53 publications

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“…These results are not surprising given Medicare coverage for DC in non‐dialysis dependent patients commenced in 2002 and under‐utilization of these services by physicians has been documented as a barrier to patients accessing pre‐dialysis DC . Instead, DC often occurs for the first time once patients have commenced dialysis, as US dialysis centres are mandated to provide dietetic services . Australian data on the number of patients that receive pre‐dialysis DC has not been previously published for comparison.…”

Section: Discussionmentioning

confidence: 83%

“…However, only 12% of patients had received pre‐dialysis DC as per 2005‐2007 US Centres for Medicare & Medicaid Services Medical Evidence Reports. These results are not surprising given Medicare coverage for DC in non‐dialysis dependent patients commenced in 2002 and under‐utilization of these services by physicians has been documented as a barrier to patients accessing pre‐dialysis DC . Instead, DC often occurs for the first time once patients have commenced dialysis, as US dialysis centres are mandated to provide dietetic services .…”

Section: Discussionmentioning

confidence: 99%

“…10 A retrospective study that included 156,440 patients on haemodialysis, found significant improvements in mortality (HR 0.85) in patients who received DC for more than 12 months prior to dialysis. 10 23 Instead, DC often occurs for the first time once patients have commenced dialysis, as US dialysis centres are mandated to provide dietetic services. 10,23 Australian data on the number of patients that receive pre-dialysis DC has not been previously published for comparison.…”

Section: Discussionmentioning

confidence: 99%

“…10 23 Instead, DC often occurs for the first time once patients have commenced dialysis, as US dialysis centres are mandated to provide dietetic services. 10,23 Australian data on the number of patients that receive pre-dialysis DC has not been previously published for comparison. Replication of a similar retrospective cohort study on the impact of DC on TTD with a larger sample size in differing cultural contexts would be useful to confirm the findings presented.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…6,7 In part due to lack of diagnosis, ACEinhibitor/ARB medications are prescribed to only 60% of adults with CKD and cardiovascular disease 8 or diabetes, 9,10 and only 10% of patients with non-dialysisdependent CKD ever meet with a dietitian for medical nutrition therapy. 6 This lack of treatment is compounded by poor patient self-management due to a lack of CKD awareness and education. 11 Until it is very advanced, CKD predominantly is a laboratory-based diagnosis, and most older adults have serum creatinine measured at least annually, with automatic reporting of estimated glomerular filtration rate (eGFR).…”

mentioning

confidence: 99%