Nutrition practices of renal dietitians in hemodialysis centers throughout the United States: a descriptive study.

OBJECTIVE

Little is known about either the current practices of dietitians in hemodialysis (HD) centers or the practice guidelines that dietitians themselves would like to see developed or revised. This study sought to (1) describe a broad range of nutrition practices among renal dietitians working with adults receiving maintenance HD therapy throughout the United States; (2) determine the extent to which these practices are consistent with professionally accepted guidelines, references, and resources; and (3) ascertain areas in renal nutrition for which dietitians might like the clinical practice guidelines developed or revised.

DESIGN

This was a cross-sectional study conducted by postal mail.

PARTICIPANTS

A survey was mailed to all domestic members of the Council on Renal Nutrition of the National Kidney Foundation (n=1270). All respondents who identified themselves as renal dietitians working with adult maintenance HD patients in dialysis centers were included in the study.

DESCRIPTION

The survey queried dietitians regarding a broad range of nutrition practices, including healthy body weight, adjusted body weight, energy requirements, clinical nutrition indicators, metabolic parameters, fluid management, serum potassium, and vitamin supplementation. Dietitians were also asked which guidelines, if any, they would like developed or revised.

RESULTS

A response rate of 68.3% was obtained. The results suggest that (1) there is substantial disparity between renal dietitians' practices and Kidney Disease Outcomes Quality Initiative nutrition guidelines in several areas, e.g., the guidelines on weight and on energy requirements; (2) dietitians' reported practices are congruent with Kidney Disease Outcomes Quality Initiative guidelines regarding metabolic parameters (e.g., diabetes); and (3) there is substantial variability among dietitians in several areas of practice, including determination of interdialytic weight gain goals. The majority of dietitians agreed that new guidelines need to be developed for interdialytic weight gain (64%) and for vitamin supplementation (80%). Among those who indicated that current guidelines need to be revised (n=333), 25% specified guidelines related to weight, and 23% specified guidelines related to energy requirements.

CONCLUSIONS

This study highlights many areas in need of further research, and identifies areas in which renal dietitians would like practice guidelines developed or revised. As such, it may have implications for organizations such as the Kidney Foundation and the American Dietetic Association in their efforts to promote consistent, evidence-based practices among dietitians.