ONLY 10% of NON-DIALYSIS KIDNEY PATIENTS EVER SEE A DIETITIAN.

This article arrived in my mailbox yesterday but I wasn't able to get to it until today. I thought the information was interesting and decided to share it. It came in as part of a newsletter from the American Association of Kidney Patients aakp.org

August 1, 2018, Loyola University Health System

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 a report 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-dialysis kidney 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 of kidney disease 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 typically involve 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 therapy 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, Ph.D., RDN, LD, of the University of New Mexico Health Science Center and the Academy of Nutrition and Dietetics; Deborah Brommage, MS, RDN, Elizabeth Montgomery and Joseph Vassalotti, MD, of the National Kidney Foundation; and Alison Steiber Ph.D., RDN, and Marsha Schofield, MS, RD, of the Academy of Nutrition and Dietetics.

Explore further: Kidney disease patients have higher out-of-pocket costs than stroke and cancer patients

Journal reference: Journal of the Academy of Nutrition and Dietetics

Provided by: Loyola University Health System

[orangecity41 NKF Ambassador]

I copied this from Medicare.Gov. A Doctor referral is needed for Medicare patients.

"Nutrition therapy services (medical)

How often is it covered?

Medicare Part B (Medical Insurance) covers medical nutrition therapy (MNT) services and certain related services. A Registered Dietitian or nutrition professional who meets certain requirements can provide these services. But, only your doctor can refer you for these services. MNT services may include:

An initial nutrition and lifestyle assessment

Individual and/or group nutrition therapy services

Follow-up visits to check on your progress in managing your diet

If you're in a rural area, you may be able to get MNT through telehealth. A Registered Dietitian or other nutrition professional in a different location would provide the service.

If you get dialysis in a dialysis facility, Medicare covers MNT as part of your overall dialysis care.."

[Hidden in reply to orangecity41]

OC, I was on Medicare when I found out I had CKD and the PCP I was seeing at the time provided me with the referral. She wrote it so that I could go to any RD I wanted and that's what I did. I checked out several and went with the one who took the time on the phone and with an e-mail to explain the steps to be taken to evaluate my personal situation and then meet for initially, up to three times. Now when my labs change I just have to send her my values that are either above or below normal and I get back instructions for how to change my meal plan. When I submitted the claims through Medicare everything was taken care of by them and my supplemental insurance plan.

If I hadn't done the research about CKD I never would have known about finding a Renal Dietitian. When I started my diet about 2 and a half years ago I did see a nutritionist but seeing an RD was critical for developing an individual kidney-friendly meal plan.

[lowraind]

I also received it yesterday. What makes it frustrating is that even though I asked to see a dietitian, all they gave me was a Diabetic Dietitian, and even at that point, I knew more about the foods I should not eat than she did. Until the medical field gets serious about this, the ckd epidemic will get worse.

[Bassetmommer NKF Ambassador in reply to lowraind]

I know what you are saying about finding a good dietician. Were I worked, we would go through CDE's (certified dietician educator) like water. And what was often true is they really had no idea about the interplay of some diseases with diet. Diabetes is not the only chronic illness affected by diet.

[Hidden in reply to Bassetmommer]

Exactly. I saw a "regular" nutritionist at first, before CKD, and lost about 140 lbs. When I found out then that I was at Stage 3 I had to find an RD to get detailed information on kidney-friendly meals. Add to that my T2D and Hypertension and one or two other things and I really had to follow and adjust my food intake, and exercise. It isn't easy but it is doable.

[rabbit01 in reply to lowraind]

Yep could not agree more. You would think that the evidence supports itself. Yet they seem to be totally against us seeing a proper renal dietician.

[rabbit01]

As usual a great and relevant article Mr kidney. This makes me so angry as this is exactly what I have been through. This must be about the 6th time I have written about this on this forum. I can only speak based on my experiences living in the South east of England. I was diagnosed with 18% eGFR in April 2015. I do not have any underlying problems such as high blood pressure or diabetes.

After being delivered this devastating news and told I would be on dialysis within 6 months I did my own research on the internet and learnt that diet was so important to prolonging a dialysis free life. I asked the nephrologist point blank and several times about getting a referral to a renal dietician and he was so dismissive and when I was insistent he categorically told me that renal dietitians were a waste of time and at my late stage it was a waste of everyone’s time as it was too late.

Despite this I had a telephone consolation with a renal dietician nurse and I have to say that she did not have any specific information on me such as blood results so all I got was “well reduce salt and cut down on protein” So based on this poor support it was a complete waste of time seeing her. But all my diet choices have been based on what I have learnt on this forum and the internet and I am convinced that without making these choices I would have been on dialysis by now. I cannot understand why the medical profession are so ignorant of the importance of diet changes in delaying dialysis. I really consider that taking my own action on diet has resulted in me have over 3 years dialysis free since being diagnosed at 18% when at that time they told me I had at best 6 months.

[cmaxwell78 NKF Ambassador]

When I progressed to stage 3, I asked if it was time for me to see a dietician. My father was ESRD and had a transplant last 30 years so I know no other life than watching how this disease works in other people. I was told it wasn't time for a dietician

[RonaldoResuelto]

Another reason so few non-dialysis kidney patients see a dietician is because, according to the National Kidney Foundation, Medicare does not cover a dietician until the patient is at stage 4.

kidney.org/news/kidneyCare/...

[Lynne0762 in reply to RonaldoResuelto]

My dietitian was paid for my medicare. check that again.

[Lynne0762]

I went to a diatition for my stage 3 kidney issues. recommended: Mediterian diet (sp?) fruits and veggies. The answer for any ailment. but I cannot do much fiber due to slow motility....causes constipation. So....live on fruit? About to give up on diet.

[Hidden in reply to Lynne0762]

The heavy dependence on that is why it's not recommended for CKD patients. Was your dietitian a trained renal dietitian? It does make a big difference.