RBT Roundtable: The Renal Diet

What role does your organization play in nutrition through its products or services?

Wager: For nearly 40 years, AAKP has been a proponent of providing patients with information to allow them and their healthcare team to make the best healthcare choices. We provide nutritional information in all of our publications, including our electronic newsletters—Diet Tips & Bits, Kidney Beginnings: The Magazine, aakpRENALIFE and most recently aakpDelicious, a magazine focusing on the nutritional needs of all kidney patients. AAKP provides the AAKP Nutrition Counter to patients. It’s one our most popular brochures. The AAKP Nutrition Counter is a pocket-sized brochure containing the nutritional values for standard portions of more than 300 commonly used foods, as well as menu items from 11 fast-food restaurants. The nutritional values include protein, calorie, sodium, potassium and phosphorus levels—dietary values that must be closely monitored in kidney patients. We believe, and many studies have confirmed, that when patients are educated about their disease and are in charge of and confident in making their healthcare choices, they receive the best outcomes.

Trahan: We prefer to be proactive in starting nutritional supplements versus reactive with our patient population, maybe trying a liquid supplement while on dialysis in some instances helps the patient feel better after dialysis and adds to their kcal/protein intake. Customized meal plans offer the patients more structure and guidance within their renal diet as well as making them feel very special when they are handed a customized meal plan made with their specific requests; it’s our little secret that it helps them with their own compliance and well-being.

Karalis: To address CRN’s research agenda, we recently formed a Research Steering Committee to identify best-demonstrated practices and barriers to research and implement educational tools to overcome some of these barriers. Additionally, there are many other products and services available to CRN members including a subscription to the Journal of Renal Nutrition, Pocket Guide to Nutritional Assessment of the Adult Renal Patient, online CE programs and other professional resources, patient education tools, research grants and educational stipends. Currently, the NKF/CRN and American Dietetic Association Renal Practice Group are finalizing Standards of Practice and Standards of Professional Performance for Nephrology Dietitians. The methodology is based on the ADA Nutrition Care Process and Model and the Scope of Dietetics Practice Framework.

Keo: At Fresenius Medical Care, we address nutrition through our services and renal pharmaceuticals. Our services side has daily contact with the patients at our dialysis units. Physicians, nurses, dietitians, social workers and technicians are continually reinforcing good health habits to our patients. Our first pharmaceutical product, PhosLo (calcium acetate), is a first line phosphate binder used by thousands of kidney disease patients nationally. The physician that developed PhosLo years ago did so to treat his young daughter with the safest binder he could create. It is well tolerated and has a strong safety profile and over 17 years of use. PhosLo continues to provide patients with good phosphorus control, safety, and is covered by 100 percent of Medicare Part D plans. PhosLo is indicated for the control of hyperphosphatemia in end-stage renal failure and does not promote aluminum absorption. PhosLo should be taken with meals.

Hawkins: Genzyme has an excellent phosphate binder that has helped so many patients within the renal community. Since the introduction of Renagel (sevelamer hydrochloride) and now with Renvela (sevelamer carbonate), we have focused our efforts on bone and mineral metabolism. In doing so, we are looking at how we can help patients achieve the best outcomes with regard to phosphorus control. We have in place a wide array of educational resources for both patients and healthcare professionals; these include patient education tools in both English and Spanish, clinical education pieces for professionals, and continuing education for nurses, dietitians and social workers. We feel it is important to empower providers within the renal community to help them educate their patients to achieve optimal phosphorus levels.

Benner: DaVita sets the foundation for optimal nutritional care by ensuring our dietitians are experts in the field of nephrology nutrition. We have developed a formal nephrology nutrition training program with mentoring, modules, learning activities, references and a competency assessment that all of our dietitians are required to successfully complete prior to providing direct patient care. DaVita also provides ongoing education programs for all of our dietitians with education days dedicated specifically to their specialty.

DaVita utilizes a standardized nutrition assessment tool that is cutting-edge, incorporating the Malnutrition Inflammation Score as part of its comprehensive patient assessment. DaVita has numerous education tools and resources for our dietitians to use in educating our patients. There is a wide variety of education tools at various literacy levels, languages and topic specific. We have an internal intranet department site called the Dietitian Connection. This resource has numerous tools, patient education handouts, ready-to-post bulletin board items and a discussion forum for dietitians to discuss and share nutrition challenges and solutions.

To reach out to the kidney care community and to serve as a resource to those who suffer from kidney disease, we have a robust website with many kidney nutrition resources. We recently released DaVita Diet Helper, an online meal planner where patients can input their individual diet prescription to obtain menus and recipes specifically designed for their unique dietary and nutrition needs. There are many nutrition related articles, diet and cooking video clips and recipes on DaVita.com. Our dietitian team continues to add a new recipe to the site each week of the year so our recipe resource continues to expand beyond the current 500-plus recipes.

We recently launched a new community program called EYE on CKD, which stands for “Expand Your Expertise in CKD Nutrition.” This education program is offered to community-based dietitians to expand their knowledge and expertise in the area of CKD nutrition. We have held programs in California, Texas and Maryland. We believe these programs will have a positive impact on the nutritional care of patients in early CKD and dialysis patients hospitalized in community or extended care facilities. RBT