Nutrition Information Hard to Find, Access for Patients with Kidney Disease

Proper nutrition has been recognized globally across all medical specialties as a foundation for health and wellness. Nutrition or the lack of is often the cause of disease and can be modified or enhanced to treat disease.

Whether it be reducing salt intake in patients with hypertension or heart disease or increasing calories and protein in malnourished patients, dietary modifications can be a key part of both prevention and treatment of disease. There exists no better example of a pathologic condition where nutrition has a large impact than kidney disease.

Kidney disease is a global problem of great magnitude. Some estimates put the global burden of kidney disease at close to one billion adults and this number appears to be increasing.¹ There is broad agreement among clinicians that nutrition intervention is a key component in managing chronic kidney disease (CKD). Through proper nutrition, patients with CKD can have a higher quality of life and more years without depending on kidney replacement therapy (KRT), or dialysis, which is both costly and time-consuming.² The key targets of nutritional therapy in CKD include: preventing protein-energy wasting, intervening early when protein-energy wasting occurs, and ameliorating cardiovascular risk factors related to CKD.²

Knowing that nutrition is important is a good start, but evidence suggest that nutritional information is not getting to patients with CKD.² Surveys conducted globally indicate that in addition to there being a shortage of dietitians able to provide nutritional education to patients with kidney disease, many of those patients receive either suboptimal or no support at all.² Dr. Yee-Moon Wang and colleagues at the University of Hong Kong examined excerpts from the Global Kidney Health Atlas Team’s surveys. Specifically, Dr. Wang looked at surveys dealing with the current global availability, capacity, and cost of kidney nutrition services as well as the communication between nutritionists and kidney specialists. What they found was startling.

The results of the survey showed:

1. Less than half of the over 150 countries included had dietitians who specifically provide kidney nutrition support.
2. Communication between dietitians and kidney specialists was spotty at best.
3. Less than half of countries perform formal assessments of nutrition status for CKD patients.
4. Oral nutrition supplement availability varied widely from country to country.
5. Counseling by a trained nutritionist is not provided in almost two-thirds of low and lower-middle income countries and never available in almost one-quarter of low-income countries.

In an editorial Dr. Arpana Lyengar and Dr. Valerie Luyckx state,

“This global survey is an important wakeup call to countries across the income spectrum. (Further) It exposes gaps and concerns related to kidney nutrition care, serving up a plate full of food for thought, that must now be followed by action.”

One of the key findings of the study, significant heterogeneity between localities, regions, and countries, comes as no great surprise. There exist great disparities between health systems based on socioeconomic, geographical, and technological lines. The density of dietitians versus populations size can be a significant factor. Compounding the problem, it is often countries of low socioeconomic status where CKD rates are the highest. There is no quick solution to this problem.

The authors agree that assessment is a good place to start.² As with most medical conditions, identification of those at risk is key. Once identified resources such as available dietitians and educational materials can be allocated, and connections made with renal specialists. Reducing a need for dialysis whether through preventative education or nutritional support in the form of supplements and or healthy food would reduce the global burden of CKD in terms of both quality of life and cost.

The authors of this study highlight the primary implication of these finding as a call to action to raise global awareness and the importance of kidney nutrition assessment and care.² They believe that increased global advocacy and a shift in governmental prioritization and allocation of funds toward a campaign designed to promote nutritional support for kidney disease will lead to better quality of life, a reduced need for dialysis, and in the long run, cost savings for the very communities making the investment in supporting the dietary needs of their citizens suffering from kidney disease.

References:

1. Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C: A single number for advocacy and communication- worldwide more than 850 million individuals have kidney diseases. Kidney Int 96: 1048–1050, 2019
2. Yee-Moon Wang, A., Okpechi, I. G., Fen Ye, C.P. K., et al. Assessing global kidney nutrition care. CJASN 17: 38–52, 2022. doi: https://doi.org/10.2215/CJN.07800621