Renal diet requirement education must be holistic to change patient nutrient intake
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In a study of 63 patients with nondialysis-dependent chronic kidney disease stages 3 to 5, investigators found nutrient intake did not conform to dietary requirements, even when patients were aware of recommended nutrient volume limits.
“These results highlight the need for intensive counseling strategies to [elicit] behavior change and present an opportunity to delay progression of CKD and manage complications such as hypertension, cardiovascular events and electrolyte abnormalities,” Melanie Betz, MS, RD, CSR, CSG, LDN, and colleagues wrote. “Instruction efforts should go beyond providing nutrient-based diet information, and instead emphasize healthy food patterns and incorporate counseling to promote behavior change.”
Betz and colleagues recruited patients from an outpatient clinic and included patients with comorbidities common in CKD, such as diabetes and heart disease, to create a study sample representative of the CKD population. Researchers assessed patient knowledge of whether 23 common foods were high in potassium, sodium or phosphorus by calculating the percentage correctly identified on a chronic kidney disease questionnaire (CKDQ) and evaluated whether patient knowledge correlated with diet adherence based on VioScreen Food Frequency Questionnaire (FFQ) patient self-reports.
Final analysis included 63 patients (52.4% were men; 41.3% were Black patients; CKD 60.3% had stage 3; 27% had hyperkalemia; 9.4% had hyperphosphatemia; average BMI: 29.9 kg/m2; average creatinine: 2.4 mg/dL; average glomerular filtration rate: 30.9 mL/min; 4.8% reported food insecurity). Researchers compared calculated patient nutrient intake with recommendations and found patients exceeded recommended daily intake of protein (145% to 193% of recommendation), sodium (135% to 208%), phosphorus (119% to 148%) and saturated fat (145% to 290%), but did not consume enough fiber (men: 45% to 57%; women: 71% to 85%). Among patients who did not have hyperkalemia, 32% of men and 43% of women consumed enough potassium. Patients who had hyperkalemia consumed about the same amount of potassium as those who did not have hyperkalemia (2,327 mg vs. 2,564 mg). Compared with other racial groups, Black patients’ nutrient and food group intake was lower (calorie: 1,468 vs. 1,137; carbohydrate: 166 g vs. 128 g; sodium: 2,566 mg vs. 1,942 mg; phosphorus: 929 mg vs. 730 mg; saturated fat: 20 g vs. 14 g; discretionary solid fat: 30.6 g vs. 21.8 g; meat: 1.48 oz vs. 0.77 oz; grains: 4.41 oz vs. 3.10 oz; dairy: 1.10 vs. 0.73). Nutrient intake did not vary significantly between patients who were and those who were not aware of the need to restrict intake (potassium: 1,793 mg vs. 2,076 mg; phosphorus: 785 mg vs. 907 mg; protein: 54.4 mg vs. 54.7 mg), although patients who were aware of the need to restrict phosphorus consumed fewer servings of high-phosphorus foods per day (diary: 0.76 servings vs. 1.12 servings; meat: 0.93 vs. 1.43 servings).
“Disconnect between knowledge and adherence to nutrition recommendations suggests that health professionals need to do more than provide information to change patient behavior,” researchers wrote. They suggested clinicians can use motivational interviewing and refer patients to registered dietician nutritionists to close this gap.
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