The following article features coverage from the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings. Click here to read more of Renal and Urology News’ conference coverage.

Many chronic kidney disease (CKD) patients not on dialysis are interested in medical nutrition therapy (MNT) to manage disease and slow progression, but few believe they can afford MNT. Clinicians can help close critical information gaps for patients and foster access to these services.

A team led by Elizabeth Yakes Jimenez, PhD, RDN, LD, of the Academy of Nutrition and Dietetics, and Holly Kramer, MD, MPH, of Loyola University, reported new survey findings from 348 patients with CKD (aged 55 years or older; 72% female; 83% white) in a poster presentation at the live-virtual National Kidney Foundation 2020 Spring Clinical Meetings.

Only half of respondents (51.2%) expressed confidence in knowing what to eat to manage CKD, despite seeking helpful advice from the internet (69.8%), doctors (54.8%), nutrition handouts (48.8%), friends and family (44.4%), and smart phone apps (20.6%).


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At least 90% were aware that dietary changes can reduce CKD complications and felt capable of making any necessary changes. Although the vast majority of respondents (83%) also were willing to adjust eating habits, only 44% felt that they could easily afford to see a registered dietitian nutritionist (RDN).

More than 90% of respondents were covered by health insurance, commonly through an employer plan (40.5%) and/or Medicare (36.5%). Yet 85% or more did not know that Medicare covers 3 hours of MNT for CKD in the first year and 2 hours in each subsequent year. In addition, 93% did not know that Medicare covers additional hours of MNT with a second referral in the same year. Among survey respondents, 82.4% had comorbid hypertension and 35.6% had prediabetes or diabetes.

The survey also showed that 78.6% of patients with CKD agreed that MNT is important. Nearly two-thirds wanted to be referred to an RDN and believed they could easily attend an extra appointment.

“We need to focus on finding effective ways to increase awareness and use of the Medicare benefit so that providers are recommending MNT and referring for it as early as possible in the progression of CKD and so that patients get the nutrition-based approaches they need and want,” Ms Jimenez told Renal & Urology News. “MNT with an RDN includes nutrition assessment and diagnosis, nutrition intervention, including individualized education, counseling and referrals, and careful monitoring and evaluation to promote lifestyle modifications that will slow or prevent the progression of CKD.”

“Almost two-thirds of medical providers reported that they rarely or never refer patients with early stage chronic kidney disease (CKD) to a registered dietitian nutritionist for MNT,” Dr Kramer added. “From my perspective as a nephrologist, this is a missed opportunity to prevent CKD progression. Providers should focus on developing relationships with RDNs trained in CKD and collaborating with them to educate patients on MNT benefits and options.”

The Academy of Nutrition and Dietetics and the National Kidney Foundation have developed clinical nutrition practice guidelines for chronic kidney disease (CKD), which recommend medical nutrition therapy (MNT) for all stages of CKD.

The team offered the following resources for medical providers and their patients:

Medicare Coverage: Billing and Coding

Medical Nutrition Therapy (MNT) Coding

Work With an RDN

Kidney Disease and Diet

Working With a Dietitian

Finding an Expert

Nutrition Therapy Services

Read more of our coverage of the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings by visiting the conference page.

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Reference

Jimenez EY, Kelley K, Brommage D, et al. Patient perspectives on access to medical nutrition therapy for nondialysis dependent chronic kidney disease. Data presented at the live-virtual 2020 National Kidney Foundation Spring Clinical Meetings held March 25 to 29. ePoster 298.