School of Medicine, Western Sydney University, Building 30, Campbelltown NSW, Campbelltown, 2560, Australia.
School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Building 41, Wollongong, NSW, 2522, Australia.
BMC Nephrol. 2022 Apr 22;23(1):158. doi: 10.1186/s12882-022-02790-y.
Therapeutic strategies, including dietary intervention, to target non-dialysis dependent Chronic Kidney Disease (CKD) progression have been at the forefront of recent renal research. Nephrologists and other renal health professionals are key stakeholders in the dietary management of patients with non-dialysis dependent CKD and referrals to dietetic services. The aims of this study were to explore (i) health professional perceptions regarding the role of diet in managing non-dialysis dependent CKD, and (ii) health professional practices regarding the provision of dietary advice and referrals to dietetic services.
A 31-item online survey was emailed to members of professional renal networks and associations in Australia and New Zealand. Data was analysed descriptively. Categorical variables were assessed to determine associations between referral frequency, demographic variables, health professional role (non-dietetic versus dietetic) and perceptions of the role of diet.
Overall, 189 health professionals completed the survey. Nephrologists (42%), renal nurses (29%) and renal dietitians (24%) were the most common respondents. Non-dietetic health professionals rated the importance of diet in the management of non-dialysis dependent CKD significantly lower than renal dietitians (73% versus 98% ranked as very-extremely important, p = 0.002). Fifty percent of non-dietetic health professionals referred patients to renal dietetic services never or 0-25% of the time. Reasons for not referring included perceptions there is a lack of evidence that diet reduces CKD progression, perceptions that patients will not adhere to dietary recommendations, and a desire to reduce visit burden for patients. Barriers to accessing dietetic services were perceived to be significant and include lengthy wait times and inadequate dietetic staffing.
Inconsistencies exist between non-dietetic health professionals and dietitians regarding the importance of diet in non-dialysis dependent CKD. Referral practices appear to be influenced by beliefs about the evidence base and perceptions regarding the ability of dietitians to meet referral demand. Raising awareness for non-dietetic health professionals working in nephrology regarding the evidence on diet and CKD progression is needed. An improved understanding of this evidence base may improve knowledge and referral patterns. Further, an increase in renal dietetic staffing is recommended to enhance patient access to services.
针对非透析依赖型慢性肾脏病（CKD）进展的治疗策略，包括饮食干预，一直是最近肾脏研究的重点。肾病学家和其他肾脏健康专业人员是非透析依赖型 CKD 患者饮食管理和向营养服务机构转介的关键利益相关者。本研究的目的是探讨：（i）健康专业人员对饮食在管理非透析依赖型 CKD 中的作用的看法；（ii）健康专业人员提供饮食建议和向营养服务机构转介的实践情况。
向澳大利亚和新西兰的专业肾脏网络和协会的成员发送了一份 31 项在线调查。对数据进行描述性分析。评估了分类变量，以确定转介频率、人口统计学变量、健康专业人员角色（非营养科与营养科）和对饮食作用的看法之间的关联。
共有 189 名健康专业人员完成了调查。肾病学家（42%）、肾脏护士（29%）和肾脏营养师（24%）是最常见的受访者。非营养科的健康专业人员对饮食在非透析依赖型 CKD 管理中的重要性的评价明显低于肾脏营养师（73%对 98%的人认为非常重要或极其重要，p=0.002）。50%的非营养科健康专业人员从未或将患者转介至肾脏营养服务机构，或转介率为 0-25%。不转介的原因包括认为饮食对 CKD 进展没有降低作用的看法、认为患者不会遵守饮食建议的看法，以及减少患者就诊负担的愿望。认为获取营养服务机构的服务存在障碍，包括等待时间长和营养服务人员配备不足。
非营养科健康专业人员和营养师对饮食在非透析依赖型 CKD 中的重要性的看法存在不一致。转介实践似乎受到对证据基础的看法以及对营养师满足转介需求能力的看法的影响。需要提高从事肾脏科工作的非营养科健康专业人员对饮食与 CKD 进展相关证据的认识。进一步提高对这一证据基础的了解，可能会改善知识和转介模式。此外，建议增加肾脏营养师的人员配备，以增加患者获得服务的机会。
