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Copyright (c) 2024 Thikra Yousef Ibrahem Otaif, Manal Ibrahim Mohammed Dahlan, Abdulrahman Yahya H Oqda, Sami Ahmed Mohammed Fgihi, Sultan Yahya Mohammed Mughawi, Jaber Abdoh H Haddadi, Maha Ibrahim Mohammed Sultan, Reem Mohammed Mousa Alfaifi, Manahil Abdurahman Noradin Yar, Abdullah Ali Al Johani, Maryam Mohammed Abdulrahman Alshnqiti, Nasser Abdialeaziz Ahmad Alkhamis
This work is licensed under a Creative Commons Attribution 4.0 International License.
Renal Diets Decoded: A Narrative Review of Unified Educational Strategies Across the Care Team
Corresponding Author(s) : Thikra Yousef Ibrahem Otaif
Saudi Journal of Medicine and Public Health,
Vol. 1 No. 2 (2024)
Abstract
Background: Dietary management is a cornerstone of chronic kidney disease (CKD) and end-stage renal disease (ESRD) care, yet its implementation is frequently fragmented. Inconsistent messaging from various healthcare providers leads to patient confusion, non-adherence, and suboptimal clinical outcomes. This fragmentation underscores a critical need for a cohesive, team-based educational strategy.
Aim: This narrative review aims to critically examine the current state of dietary education delivery in renal care, identify sources of inconsistency, and propose a unified, role-specific model for interdisciplinary collaboration to standardize patient education.
Methods: A comprehensive literature search was conducted across multiple databases (PubMed, CINAHL, Scopus) for studies published between 2010-2024, focusing on renal diet education, interdisciplinary care, health literacy, and patient adherence.
Results: Evidence confirms that disjointed education adversely affects patient outcomes. A model structured around clear role delineation—where the nephrologist defines biochemical targets, the specialized renal dietitian develops the core plan, the nurse provides continuous reinforcement, and the medical secretary ensures resource accessibility—emerges as a promising framework. Integration of DEXA scans for bone health monitoring provides objective dietary feedback.
Conclusion: Adopting a standardized, tiered educational framework that leverages the unique skills of each care team member can significantly enhance message consistency, patient understanding, dietary adherence, and ultimately, clinical prognosis in CKD/ESRD populations.
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- Block, G. A., Kilpatrick, R. D., Lowe, K. A., Wang, W., & Danese, M. D. (2013). CKD–mineral and bone disorder and risk of death and cardiovascular hospitalization in patients on hemodialysis. Clinical journal of the American Society of Nephrology, 8(12), 2132-2140. DOI: 10.2215/CJN.04260413
- Buur, L. E., Bekker, H. L., Madsen, J. K., Søndergaard, H., Kannegaard, M., Khatir, D. S., & Finderup, J. (2023). Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review. JBI Evidence Synthesis, 21(8), 1582-1623. DOI: 10.11124/JBIES-22-00261
- Byham-Gray, L. D. (2020). Comparative Effectiveness Research and Renal Nutrition. In Nutrition in Kidney Disease (pp. 653-660). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-44858-5_36
- Cheng, T. C., Huang, S. H., Kao, C. L., & Hsu, P. C. (2022). Muscle wasting in chronic kidney disease: mechanism and clinical implications—a narrative review. International Journal of Molecular Sciences, 23(11), 6047. https://doi.org/10.3390/ijms23116047
- Cupisti, A., Gallieni, M., Avesani, C. M., D’Alessandro, C., Carrero, J. J., & Piccoli, G. B. (2020). Medical nutritional therapy for patients with chronic kidney disease not on dialysis: the low protein diet as a medication. Journal of Clinical Medicine, 9(11), 3644. https://doi.org/10.3390/jcm9113644
- Cupisti, A., Bolasco, P., D’Alessandro, C., Giannese, D., Sabatino, A., & Fiaccadori, E. (2021). Protection of residual renal function and nutritional treatment: first step strategy for reduction of uremic toxins in end-stage kidney disease patients. Toxins, 13(4), 289. https://doi.org/10.3390/toxins13040289
- Einhorn, L. M., Zhan, M., Walker, L. D., Moen, M. F., Seliger, S. L., Weir, M. R., & Fink, J. C. (2009). The frequency of hyperkalemia and its significance in chronic kidney disease. Archives of internal medicine, 169(12), 1156-1162. doi:10.1001/archinternmed.2009.132
- Evenepoel, P., Claes, K., Meijers, B., Laurent, M. R., Bammens, B., Naesens, M., ... & Kuypers, D. (2019). Bone mineral density, bone turnover markers, and incident fractures in de novo kidney transplant recipients. Kidney international, 95(6), 1461-1470. https://doi.org/10.1016/j.kint.2018.12.024
- Fraser, S. D., Roderick, P. J., May, C. R., McIntyre, N., McIntyre, C., Fluck, R. J., ... & Taal, M. W. (2015). The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC nephrology, 16(1), 193. https://doi.org/10.1186/s12882-015-0189-z
- Hawthorne, G., Lightfoot, C. J., Smith, A. C., Khunti, K., & Wilkinson, T. J. (2023). Multimorbidity prevalence and patterns in chronic kidney disease: findings from an observational multicentre UK cohort study. International Urology and Nephrology, 55(8), 2047-2057. https://doi.org/10.1007/s11255-023-03516-1
- Ikizler, T. A., & Cuppari, L. (2021). The 2020 updated KDOQI clinical practice guidelines for nutrition in chronic kidney disease. Blood Purification, 50(4-5), 667-671. https://doi.org/10.1159/000513698
- Jimenez, E. Y., Kelley, K., Schofield, M., Brommage, D., Steiber, A., Abram, J. K., & Kramer, H. (2021). Medical nutrition therapy access in CKD: a cross-sectional survey of patients and providers. Kidney Medicine, 3(1), 31-41. https://doi.org/10.1016/j.xkme.2020.09.005
- Kalantar-Zadeh, K., Jafar, T. H., Nitsch, D., Neuen, B. L., & Perkovic, V. (2021). Chronic kidney disease. The lancet, 398(10302), 786-802. https://doi.org/10.1016/S0140-6736(21)00519-5
- Kalantar-Zadeh, K. (2013). Patient education for phosphorus management in chronic kidney disease. Patient preference and adherence, 379-390. https://doi.org/10.2147/PPA.S43486
- Lambert, K., Mullan, J., & Mansfield, K. (2017). An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC nephrology, 18(1), 318. https://doi.org/10.1186/s12882-017-0734-z
- Lee, J. K., McCutcheon, L. R., Fazel, M. T., Cooley, J. H., & Slack, M. K. (2021). Assessment of interprofessional collaborative practices and outcomes in adults with diabetes and hypertension in primary care: a systematic review and meta-analysis. JAMA network open, 4(2), e2036725-e2036725. doi:10.1001/jamanetworkopen.2020.36725
- Lindblom, S., Ytterberg, C., Flink, M., Carlsson, A. C., Stenberg, U., Tistad, M., ... & Laska, A. C. (2023, January). The use of teach back at hospital discharge to support self-management of prescribed medication for secondary prevention after stroke—Findings from a feasibility study. In Healthcare (Vol. 11, No. 3, p. 391). MDPI. https://doi.org/10.3390/healthcare11030391
- McGill, J. B., Haller, H., Roy-Chaudhury, P., Cherrington, A., Wada, T., Wanner, C., ... & Rossing, P. (2022). Making an impact on kidney disease in people with type 2 diabetes: the importance of screening for albuminuria. BMJ open diabetes research & care, 10(4). https://doi.org/10.1136/bmjdrc-2022-002806
- Moran, H. R. M., Maurice-Ventouris, M., Alharbi, M., Harley, J. M., & Lachapelle, K. J. (2022). A scoping review to identify competencies for transcatheter cardiovascular procedures. The Journal of Thoracic and Cardiovascular Surgery, 164(6), e457-e469. https://doi.org/10.1016/j.jtcvs.2020.11.096
- Naber, T., & Purohit, S. (2021). Chronic kidney disease: role of diet for a reduction in the severity of the disease. Nutrients, 13(9), 3277. https://doi.org/10.3390/nu13093277
- Novick, T. K., Diaz, S., Barrios, F., Cubas, D., Choudhary, K., Nader, P., ... & Jacobs, E. A. (2021). Perspectives on kidney disease education and recommendations for improvement among Latinx patients receiving emergency-only hemodialysis. JAMA Network Open, 4(9), e2124658-e2124658. doi:10.1001/jamanetworkopen.2021.24658
- Riemann, L., Lubasch, J. S., Heep, A., & Ansmann, L. (2021). The role of health literacy in health behavior, health service use, health outcomes, and empowerment in pediatric patients with chronic disease: a systematic review. International journal of environmental research and public health, 18(23), 12464. https://doi.org/10.3390/ijerph182312464
- Scialla, J. J., & Anderson, C. A. (2013). Dietary acid load: a novel nutritional target in chronic kidney disease?. Advances in chronic kidney disease, 20(2), 141-149. https://doi.org/10.1053/j.ackd.2012.11.001
- Schoenthaler, A., Luerassi, L., Teresi, J. A., Silver, S., Kong, J., Odedosu, T., ... & Ogedegbe, G. (2011). A practice-based trial of blood pressure control in African Americans (TLC-Clinic): study protocol for a randomized controlled trial. Trials, 12(1), 265. https://doi.org/10.1186/1745-6215-12-265
- St-Jules, D. E., Goldfarb, D. S., Pompeii, M. L., & Sevick, M. A. (2017). Phosphate additive avoidance in chronic kidney disease. Diabetes Spectrum, 30(2), 101-106. https://doi.org/10.2337/ds16-0048
- Sullivan, M. K., Rankin, A. J., Jani, B. D., Mair, F. S., & Mark, P. B. (2020). Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMJ open, 10(6), e038401. https://doi.org/10.1136/bmjopen-2020-038401
- Uhlig, K., Berns, J. S., Carville, S., Chan, W., Cheung, M., Guyatt, G. H., ... & Kasiske, B. L. (2016). Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee. Kidney international, 89(4), 753-760. https://doi.org/10.1016/j.kint.2015.11.030
- Washington, T. R., Hain, D. J., Zimmerman, S., & Carlton-LaNey, I. (2018). Identification of potential mediators between depression and fluid adherence in older adults undergoing hemodialysis treatment. Nephrology Nursing Journal, 45(3), 251-258.
- Wheeler, D. C., & Winkelmayer, W. C. (2017). KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) foreword. Kidney international supplements, 7(1), 1-59. https://doi.org/10.1016/j.kisu.2017.04.001
- Yan, M. T., Chao, C. T., & Lin, S. H. (2021). Chronic kidney disease: strategies to retard progression. International journal of molecular sciences, 22(18), 10084. https://doi.org/10.3390/ijms221810084
- Young, A., Orchanian-Cheff, A., Chan, C. T., Wald, R., & Ong, S. W. (2021). Video-based telemedicine for kidney disease care: a scoping review. Clinical Journal of the American Society of Nephrology, 16(12), 1813-1823. DOI: 10.2215/CJN.06660521
References
Block, G. A., Kilpatrick, R. D., Lowe, K. A., Wang, W., & Danese, M. D. (2013). CKD–mineral and bone disorder and risk of death and cardiovascular hospitalization in patients on hemodialysis. Clinical journal of the American Society of Nephrology, 8(12), 2132-2140. DOI: 10.2215/CJN.04260413
Buur, L. E., Bekker, H. L., Madsen, J. K., Søndergaard, H., Kannegaard, M., Khatir, D. S., & Finderup, J. (2023). Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review. JBI Evidence Synthesis, 21(8), 1582-1623. DOI: 10.11124/JBIES-22-00261
Byham-Gray, L. D. (2020). Comparative Effectiveness Research and Renal Nutrition. In Nutrition in Kidney Disease (pp. 653-660). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-44858-5_36
Cheng, T. C., Huang, S. H., Kao, C. L., & Hsu, P. C. (2022). Muscle wasting in chronic kidney disease: mechanism and clinical implications—a narrative review. International Journal of Molecular Sciences, 23(11), 6047. https://doi.org/10.3390/ijms23116047
Cupisti, A., Gallieni, M., Avesani, C. M., D’Alessandro, C., Carrero, J. J., & Piccoli, G. B. (2020). Medical nutritional therapy for patients with chronic kidney disease not on dialysis: the low protein diet as a medication. Journal of Clinical Medicine, 9(11), 3644. https://doi.org/10.3390/jcm9113644
Cupisti, A., Bolasco, P., D’Alessandro, C., Giannese, D., Sabatino, A., & Fiaccadori, E. (2021). Protection of residual renal function and nutritional treatment: first step strategy for reduction of uremic toxins in end-stage kidney disease patients. Toxins, 13(4), 289. https://doi.org/10.3390/toxins13040289
Einhorn, L. M., Zhan, M., Walker, L. D., Moen, M. F., Seliger, S. L., Weir, M. R., & Fink, J. C. (2009). The frequency of hyperkalemia and its significance in chronic kidney disease. Archives of internal medicine, 169(12), 1156-1162. doi:10.1001/archinternmed.2009.132
Evenepoel, P., Claes, K., Meijers, B., Laurent, M. R., Bammens, B., Naesens, M., ... & Kuypers, D. (2019). Bone mineral density, bone turnover markers, and incident fractures in de novo kidney transplant recipients. Kidney international, 95(6), 1461-1470. https://doi.org/10.1016/j.kint.2018.12.024
Fraser, S. D., Roderick, P. J., May, C. R., McIntyre, N., McIntyre, C., Fluck, R. J., ... & Taal, M. W. (2015). The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC nephrology, 16(1), 193. https://doi.org/10.1186/s12882-015-0189-z
Hawthorne, G., Lightfoot, C. J., Smith, A. C., Khunti, K., & Wilkinson, T. J. (2023). Multimorbidity prevalence and patterns in chronic kidney disease: findings from an observational multicentre UK cohort study. International Urology and Nephrology, 55(8), 2047-2057. https://doi.org/10.1007/s11255-023-03516-1
Ikizler, T. A., & Cuppari, L. (2021). The 2020 updated KDOQI clinical practice guidelines for nutrition in chronic kidney disease. Blood Purification, 50(4-5), 667-671. https://doi.org/10.1159/000513698
Jimenez, E. Y., Kelley, K., Schofield, M., Brommage, D., Steiber, A., Abram, J. K., & Kramer, H. (2021). Medical nutrition therapy access in CKD: a cross-sectional survey of patients and providers. Kidney Medicine, 3(1), 31-41. https://doi.org/10.1016/j.xkme.2020.09.005
Kalantar-Zadeh, K., Jafar, T. H., Nitsch, D., Neuen, B. L., & Perkovic, V. (2021). Chronic kidney disease. The lancet, 398(10302), 786-802. https://doi.org/10.1016/S0140-6736(21)00519-5
Kalantar-Zadeh, K. (2013). Patient education for phosphorus management in chronic kidney disease. Patient preference and adherence, 379-390. https://doi.org/10.2147/PPA.S43486
Lambert, K., Mullan, J., & Mansfield, K. (2017). An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease. BMC nephrology, 18(1), 318. https://doi.org/10.1186/s12882-017-0734-z
Lee, J. K., McCutcheon, L. R., Fazel, M. T., Cooley, J. H., & Slack, M. K. (2021). Assessment of interprofessional collaborative practices and outcomes in adults with diabetes and hypertension in primary care: a systematic review and meta-analysis. JAMA network open, 4(2), e2036725-e2036725. doi:10.1001/jamanetworkopen.2020.36725
Lindblom, S., Ytterberg, C., Flink, M., Carlsson, A. C., Stenberg, U., Tistad, M., ... & Laska, A. C. (2023, January). The use of teach back at hospital discharge to support self-management of prescribed medication for secondary prevention after stroke—Findings from a feasibility study. In Healthcare (Vol. 11, No. 3, p. 391). MDPI. https://doi.org/10.3390/healthcare11030391
McGill, J. B., Haller, H., Roy-Chaudhury, P., Cherrington, A., Wada, T., Wanner, C., ... & Rossing, P. (2022). Making an impact on kidney disease in people with type 2 diabetes: the importance of screening for albuminuria. BMJ open diabetes research & care, 10(4). https://doi.org/10.1136/bmjdrc-2022-002806
Moran, H. R. M., Maurice-Ventouris, M., Alharbi, M., Harley, J. M., & Lachapelle, K. J. (2022). A scoping review to identify competencies for transcatheter cardiovascular procedures. The Journal of Thoracic and Cardiovascular Surgery, 164(6), e457-e469. https://doi.org/10.1016/j.jtcvs.2020.11.096
Naber, T., & Purohit, S. (2021). Chronic kidney disease: role of diet for a reduction in the severity of the disease. Nutrients, 13(9), 3277. https://doi.org/10.3390/nu13093277
Novick, T. K., Diaz, S., Barrios, F., Cubas, D., Choudhary, K., Nader, P., ... & Jacobs, E. A. (2021). Perspectives on kidney disease education and recommendations for improvement among Latinx patients receiving emergency-only hemodialysis. JAMA Network Open, 4(9), e2124658-e2124658. doi:10.1001/jamanetworkopen.2021.24658
Riemann, L., Lubasch, J. S., Heep, A., & Ansmann, L. (2021). The role of health literacy in health behavior, health service use, health outcomes, and empowerment in pediatric patients with chronic disease: a systematic review. International journal of environmental research and public health, 18(23), 12464. https://doi.org/10.3390/ijerph182312464
Scialla, J. J., & Anderson, C. A. (2013). Dietary acid load: a novel nutritional target in chronic kidney disease?. Advances in chronic kidney disease, 20(2), 141-149. https://doi.org/10.1053/j.ackd.2012.11.001
Schoenthaler, A., Luerassi, L., Teresi, J. A., Silver, S., Kong, J., Odedosu, T., ... & Ogedegbe, G. (2011). A practice-based trial of blood pressure control in African Americans (TLC-Clinic): study protocol for a randomized controlled trial. Trials, 12(1), 265. https://doi.org/10.1186/1745-6215-12-265
St-Jules, D. E., Goldfarb, D. S., Pompeii, M. L., & Sevick, M. A. (2017). Phosphate additive avoidance in chronic kidney disease. Diabetes Spectrum, 30(2), 101-106. https://doi.org/10.2337/ds16-0048
Sullivan, M. K., Rankin, A. J., Jani, B. D., Mair, F. S., & Mark, P. B. (2020). Associations between multimorbidity and adverse clinical outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMJ open, 10(6), e038401. https://doi.org/10.1136/bmjopen-2020-038401
Uhlig, K., Berns, J. S., Carville, S., Chan, W., Cheung, M., Guyatt, G. H., ... & Kasiske, B. L. (2016). Recommendations for kidney disease guideline updating: a report by the KDIGO Methods Committee. Kidney international, 89(4), 753-760. https://doi.org/10.1016/j.kint.2015.11.030
Washington, T. R., Hain, D. J., Zimmerman, S., & Carlton-LaNey, I. (2018). Identification of potential mediators between depression and fluid adherence in older adults undergoing hemodialysis treatment. Nephrology Nursing Journal, 45(3), 251-258.
Wheeler, D. C., & Winkelmayer, W. C. (2017). KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) foreword. Kidney international supplements, 7(1), 1-59. https://doi.org/10.1016/j.kisu.2017.04.001
Yan, M. T., Chao, C. T., & Lin, S. H. (2021). Chronic kidney disease: strategies to retard progression. International journal of molecular sciences, 22(18), 10084. https://doi.org/10.3390/ijms221810084
Young, A., Orchanian-Cheff, A., Chan, C. T., Wald, R., & Ong, S. W. (2021). Video-based telemedicine for kidney disease care: a scoping review. Clinical Journal of the American Society of Nephrology, 16(12), 1813-1823. DOI: 10.2215/CJN.06660521