Chronic Kidney Disease: Should You See a Dietitian? | Loyola Medicine
Tuesday, August 7, 2018

Only 10 Percent of Non-dialysis Kidney Patients Ever See a Dietitian

 
MAYWOOD, IL – In patients with chronic kidney disease, medical nutrition therapy can slow the progression and significantly reduce healthcare costs.
 
But 90 percent of non-dialysis kidney disease patients never meet with a dietitian, according to an article in the Journal of the Academy of Nutrition and Dietetics. The lead author is Holly Kramer, MD, MPH, of Loyola Medicine and Loyola University Chicago Stritch School of Medicine.
 
"Most adults with chronic kidney disease remain poorly informed of how diet influences disease management and progression," Dr. Kramer and colleagues wrote.
 
About 30 million Americans –  or 15 percent of adults – have chronic kidney disease, and the incidence is expected to increase in the next 20 years due to the obesity epidemic and aging population. Nearly half of adults age 65 and older are expected to develop kidney disease during their lifetimes. Medicare spends $33 billion a year on dialysis patients, and costs for non-dialysiskidney patients are higher than the costs of treating stroke or cancer.
 
Medical nutrition therapy (MNT) is one of the most important ways to slow the progression and prevent kidney failure. MNT consists of individualized nutrition assessment, care planning and dietary education by a registered dietitian nutritionist. MNT has been shown to improve blood sugar control and blood pressure, thus slowing kidney disease progression and delaying or preventing the need for dialysis or a kidney transplant.
 
Although patients may receive dietary counseling from physicians or nurses, such counseling often is brief and involves only broad suggestions such as reducing salt or protein intake. By contrast, MNT includes an in-depth individualized nutrition assessment, personalized treatment plan and periodic monitoring and reassessment. The National Kidney Foundation and Academy of Nutrition and Dietetics recommend MNT for all persons with kidney disease, regardless of stage.
 
There are several reasons why so few kidney patients receive MNT. Some physicians do not refer patients to MNT under the mistaken belief the service isn’t covered. Other doctors may not recognize the strong role dietary factors play in kidney disease, or lack confidence that MNT will be effective. Some patients may be reluctant to invest the time and money in MNT. Moreover, only a limited number of registered dietitian nutritionists are trained in kidney disease management and many are not enrolled as Medicare providers.
 
More research is needed to study the barriers to MNT and effective solutions, the authors wrote. "The high burden, cost and growth of chronic kidney disease requires urgent action, and MNT services must be part of any broad plan to reduce [kidney failure] incidence and improve public health."
 
The study is titled "Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions."
 
Dr. Kramer is an associate professor in the department of public health sciences of Loyola University Chicago Stritch School of Medicine and in Loyola's Medicine's division of nephrology and hypertension in the department of medicine.
 
In addition to Dr. Kramer, other co-authors are Elizabeth Yakes Jimenez, PhD, RDN, LD, of the University of New Mexico Health Science Center and Academy of Nutrition and Dietetics; Deborah Brommage, MS, RDN, Elizabeth Montgomery and Joseph Vassalotti, MD, of the National Kidney Foundation; and Alison Steiber PhD, RDN, and Marsha Schofield, MS, RD, of the Academy of Nutrition and Dietetics.
 

About Loyola Medicine

Loyola Medicine is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC) in Maywood, Gottlieb Memorial Hospital (GMH) in Melrose Park, MacNeal Hospital in Berwyn and convenient locations offering primary and specialty care services from more than 1,772 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. The medical center campus is also home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. GMH is a 247-licensed-bed community hospital with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments in a convenient community setting. Loyola Medicine is a member of Trinity Health, one of the nation’s largest health systems with 94 hospitals in 22 states.

About Trinity Health

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 93 hospitals, as well as 122 continuing care programs that include PACE, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $17.6 billion and assets of $23.4 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 131,000 colleagues, including 7,500 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services — ranked by number of visits — in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit www.trinity-health.org. You can also follow @TrinityHealthMI on Twitter.