Medical Nutrition Therapy Access in CKD: A Cross-sectional Survey of Patients and Providers

Authors

Elizabeth Yakes Jimenez, Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM; College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM
Kathryn Kelley, Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
Marsha Schofield, Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL
Deborah Brommage, National Kidney Foundation, New York, NY
Alison Steiber, Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
Jenica K. Abram, Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
Holly Kramer, Division of Nephrology and Hypertension, Department of Public Health Sciences and Medicine, Loyola University Medical Center, Maywood, IL

Document Type

Article

Publication Date

1-1-2021

Abstract

RATIONALE & OBJECTIVE: Nutrition management can slow the progression of chronic kidney disease (CKD) and help manage complications of CKD, but few individuals with CKD receive medical nutrition therapy before initiating dialysis. This study aimed to identify knowledge, attitudes, experiences, and practices regarding medical nutrition therapy and barriers and facilitators to medical nutrition therapy access for individuals with CKD stages G1-G5 from the perspective of patients and providers.

STUDY DESIGN: Cross-sectional study composed of anonymous surveys.

SETTING & POPULATION: Adults with CKD stages G1-G5 and medical providers and registered dietitian nutritionists who regularly see patients with CKD stages G1-G5 were recruited by email using National Kidney Foundation and Academy of Nutrition and Dietetics databases and through the National Kidney Foundation 2019 Spring Clinical Meetings mobile app.

ANALYTICAL APPROACH: Descriptive analyses and Fisher exact tests were conducted with Stata SE 16.

RESULTS: Respondents included 348 patients, 66 registered dietitian nutritionists, and 30 medical providers. In general, patients and providers had positive perceptions of medical nutrition therapy and its potential to slow CKD progression and manage complications, and most patients reported interest in a medical nutrition therapy referral. However, there were feasibility concerns related to cost to the patient, lack of insurance coverage, and lack of renal registered dietitian nutritionists. There was low awareness of Medicare no-cost share coverage for medical nutrition therapy across patients and providers. About half the practices did not bill for medical nutrition therapy and those that did reported issues with being paid and low reimbursement rates.

LIMITATIONS: Results may not be generalizable due to the small number of respondents and the potential for self-selection, nonresponse, and social desirability bias.

CONCLUSIONS: Many patients with CKD stages G1-G5 are interested in medical nutrition therapy and confident that it can help with disease management, but there are feasibility concerns related to cost to the patient, insurance coverage, and reimbursement. There are significant opportunities to design and test interventions to facilitate medical nutrition therapy access for patients with CKD stages G1-G5.

Publication Title

Kidney Med

ISSN

2590-0595

Volume

3

Issue

1

First Page

31

Last Page

41

DOI

10.1016/j.xkme.2020.09.005

Recommended Citation

Jimenez EY, Kelley K, Schofield M, Brommage D, Steiber A, Abram JK, Kramer H. Medical Nutrition Therapy Access in CKD: A Cross-sectional Survey of Patients and Providers. Kidney Med. 2020 Nov 11;3(1):31-41.e1. doi: 10.1016/j.xkme.2020.09.005. PMID: 33604538; PMCID: PMC7873758.