Medical Nutrition Therapy Slows Time to Dialysis

CKD patients who did not participate in medical nutrition therapy were 3 times more likely to start dialysis than those who did.
CKD patients who did not participate in medical nutrition therapy were 3 times more likely to start dialysis than those who did.

Chronic kidney disease (CKD) patients who receive medical nutrition therapy (MNT) from a registered dietitian (RD) with renal expertise may improve their nutritional status and delay dialysis initiation, according to a new study.

Researchers further discovered that patients who start MNT at an earlier stage of CKD (3 or 4) have slower progression to end-stage renal disease than those who receive it at stage 5.

“MNT with an RD with renal experience should be encouraged when a patient is diagnosed with kidney disease,” suggested lead researcher Desiree de Waal, RD, of the University of Vermont Medical Center in Burlington, and colleagues. “Improved nutritional awareness can contribute to a slowing in the progression of kidney disease and improved nutritional biomarkers…”

MNT usually involves nutrition counseling by a RD to help reduce CKD progression and complications, such as protein energy wasting, electrolyte imbalances, vitamin deficiencies, and mineral and bone disorders.  

For the study, the investigators examined the medical records of 265 CKD patients treated at a single outpatient clinic in Vermont from 2003-2013. Of these, 147 received MNT from an RD.

Results published in the Journal of Renal Nutrition showed that patients receiving MNT had a smaller decline in estimated glomerular filtration rate: 0.3 vs. 9.9 mL/min/1.73 m2 for non-MNT patients. After adjusting for CKD stage, that difference grew between groups. In addition, the non-MNT group was 3 times more likely to start dialysis; that rose to nearly 3.5 times for stage 3 and 4 CKD patients not receiving MNT. 

The researchers also examined patients' nutritional status. Albumin and markers of CKD mineral and bone disorders (phosphorus, calcium, and intact parathyroid hormone) were more likely to be in the normal range for patients receiving MNT. The study did not assess patient survival.

Study limitations included small numbers of patients and lack of accounting for healthy behaviors and co-existing illnesses besides diabetes. 

Source

  1. De Waal, D; Heaslip, E; and Callas, P. Journal of Renal Nutrition; doi: 10.1053/j.jrn.2015.08.002.
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