During Malnutrition Awareness Month dietitians and other healthcare providers have the opportunity to amplify the conversation around malnutrition
and champion education on available tools and treatments for malnutrition management. However, in the setting of chronic kidney disease (CKD)
and end-stage renal disease (ESRD) it may not be as easy or straightforward as we think.

In recent conversation regarding the state of nutrition research in the dialysis patient population one dietitian reported that the research available
is substantial, especially if you utilize resources through the National Kidney Foundation (NKF) such as the Pocket Guide to Nutrition Assessment
of the Patient with Kidney Disease. While truly an invaluable resource as it provides guidance on common practice, dietitians and other providers
may be surprised to learn that the evidence used in the guide and similarly the KDOQI Nutrition Guidelines 2020 Update is not always based on
strong research.

In fact, 47% of the recommendations made in the KDOQI Guidelines are opinion based. There are 19 statements or recommendations pertaining to protein and energy requirements as well as nutrition supplementation, of those more than half are Opinion based indicating no evidence or too low a quality
of evidence was available to apply a GRADE score.

Summary of KDOQI Guideline Statements and GRADE Scores

 

When it comes to research, it seems the evidence we rely on is not as substantial as we might think. And that makes sense because nutrition and CKD
are both complex on their own, much less when trying to research the impact of one on the other.

And every day there seems to be yet another nutrition-related topic that we need more information on. For example, we heard from one dietitian that,
“I feel there should be a lot more research regarding sleep, nutrition, and favorable outcomes for patients on dialysis. I also would like to see a lot more research on physical activity as well as use of [herbal] supplements in ESRD patients and how they impact lab values.”

But the list does not stop there. Another pointed out, “We seem to have many clinicians excited for the benefits GLP-1’s can provide in relation to weight, waist circumference, and phosphate levels but I am not finding enough research to outline the risk factors relating to malnutrition as it pertains
to ESRD patients specifically. I was curious about physical therapy benefits or prescribed weight training benefits for malnourished patients, but this simply isn’t something that PT can provide in an acute situation. I’d love to see a system combined with GLP-1 use as it pertains to reducing malnourishment
that includes dietitians as well as other interdisciplinary team members.”

And if you polled renal RDs across the nation, the list would likely get longer.

We know what the research wish list is, but how do we go about crossing things off the list? It really comes down to getting more research out there
whether it be observational or controlled trials. And this is where a healthcare practitioner like you can come in.

Healthcare providers, including dietitians and nurses, have the ability and the passion to contribute to science. Think about an intervention you routinely use with your patients. It could be anything from behavior change counseling techniques to prescribing IDPN for your patients. What have you noticed
in response to these interventions? What data is easily accessible to you when you evaluate the progress of these patients?
That information, gathered all together, is a scientific abstract that can be submitted as a poster presentation for NKF Spring Clinicals, FNCE,
and beyond which enhances the understanding for all care providers.

This month as we bring awareness to malnutrition, let’s also bring awareness to the strengths and opportunities afforded to healthcare providers to further the science and understanding of malnutrition and the influence of treatments on patient outcomes.

To learn more about Patient Care America’s research efforts, check out our research landing page at Research along with abstracts
(for inspiration) presented at past national conferences including NKF Spring Clinicals, ANNA National Symposium, and ASN Kidney Week;
available through our Clinician Portal.

References

  • Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Campbell, K. L., Carrero, J. J., Chan, W., … & Kaysen, G. A. (2020). KDOQI clinical practice guideline
    for nutrition in CKD: 2020 update. American Journal of Kidney Diseases, 76(3), S1-S107.

 

We thank our guest blogger Maiya Slusser, MS, RDN, CD, CNSC, Director, Research and Education for sharing her knowledge and writing this blog post!