Jimenez Elizabeth Yakes, Kelley Kathryn, Schofield Marsha, Brommage Deborah, Steiber Alison, Abram Jenica K, Kramer Holly
Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.
Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM.
Kidney Med. 2020 Nov 11;3(1):31-41.e1. doi: 10.1016/j.xkme.2020.09.005. eCollection 2021 Jan-Feb.
RATIONALE & OBJECTIVE: Nutrition management can slow the progression of chronic kidney disease (CKD) and help manage complications of CKD, but few individuals with CKD receive medical nutrition therapy before initiating dialysis. This study aimed to identify knowledge, attitudes, experiences, and practices regarding medical nutrition therapy and barriers and facilitators to medical nutrition therapy access for individuals with CKD stages G1-G5 from the perspective of patients and providers.
Cross-sectional study composed of anonymous surveys.
SETTING & POPULATION: Adults with CKD stages G1-G5 and medical providers and registered dietitian nutritionists who regularly see patients with CKD stages G1-G5 were recruited by email using National Kidney Foundation and Academy of Nutrition and Dietetics databases and through the National Kidney Foundation 2019 Spring Clinical Meetings mobile app.
Descriptive analyses and Fisher exact tests were conducted with Stata SE 16.
Respondents included 348 patients, 66 registered dietitian nutritionists, and 30 medical providers. In general, patients and providers had positive perceptions of medical nutrition therapy and its potential to slow CKD progression and manage complications, and most patients reported interest in a medical nutrition therapy referral. However, there were feasibility concerns related to cost to the patient, lack of insurance coverage, and lack of renal registered dietitian nutritionists. There was low awareness of Medicare no-cost share coverage for medical nutrition therapy across patients and providers. About half the practices did not bill for medical nutrition therapy and those that did reported issues with being paid and low reimbursement rates.
Results may not be generalizable due to the small number of respondents and the potential for self-selection, nonresponse, and social desirability bias.
Many patients with CKD stages G1-G5 are interested in medical nutrition therapy and confident that it can help with disease management, but there are feasibility concerns related to cost to the patient, insurance coverage, and reimbursement. There are significant opportunities to design and test interventions to facilitate medical nutrition therapy access for patients with CKD stages G1-G5.
营养管理可减缓慢性肾脏病（CKD）的进展并有助于管理CKD的并发症，但很少有CKD患者在开始透析前接受医学营养治疗。本研究旨在从患者和医疗服务提供者的角度，确定CKD 1-5期患者在医学营养治疗方面的知识、态度、经验和实践，以及获取医学营养治疗的障碍和促进因素。
由匿名调查组成的横断面研究。
通过使用美国国家肾脏基金会和营养与饮食学会数据库以及美国国家肾脏基金会2019年春季临床会议移动应用程序，通过电子邮件招募了CKD 1-5期的成人患者、经常诊治CKD 1-5期患者的医疗服务提供者以及注册营养师。
使用Stata SE 16进行描述性分析和Fisher精确检验。
受访者包括348名患者、66名注册营养师和30名医疗服务提供者。总体而言，患者和医疗服务提供者对医学营养治疗及其减缓CKD进展和管理并发症的潜力有积极的看法，并且大多数患者表示有兴趣接受医学营养治疗转诊。然而，存在与患者费用、缺乏保险覆盖以及缺乏肾脏注册营养师相关的可行性问题。患者和医疗服务提供者对医疗保险为医学营养治疗提供的免费分担覆盖的知晓率较低。大约一半的医疗机构没有对医学营养治疗进行计费，而那些计费的机构报告了支付方面的问题和低报销率。
由于受访者数量较少以及存在自我选择、无应答和社会期望偏差的可能性，结果可能无法推广。
许多CKD 1-5期患者对医学营养治疗感兴趣，并相信它有助于疾病管理，但存在与患者费用、保险覆盖和报销相关的可行性问题。有很大的机会设计和测试干预措施，以促进CKD 1-5期患者获得医学营养治疗。
