Journal Article Reveals Most Non-Dialysis Kidney Patients Never See a Dietitian

National Kidney Foundation President-Elect Leads Study
New York – Thursday, August 2, 2018 – An eye-opening Journal of the Academy of Nutrition and Dietetics article has reported that 90 percent of non-dialysis kidney disease patients never meet with a dietitian. The lead author of the study is Holly Kramer, MD, MPH, nationally-known kidney disease researcher and incoming President of the National Kidney Foundation (NKF).
The high percentage is in spite of the fact that medical nutrition therapy can slow the progression of chronic kidney disease and significantly reduce healthcare costs for patients, according to Dr. Kramer, Associate Professor in Public Health Sciences at Loyola University Chicago Stritch School of Medicine and in the Loyola Medicine Division of Nephrology and Hypertension. "Most adults with chronic kidney disease remain poorly informed of how diet influences disease management and progression," writes Dr. Kramer with article co-authors: Joseph Vassalotti, MD - Deborah Brommage, MS, RDN - and Elizabeth Montgomery, all of NKF; Elizabeth Yakes Jimenez, PhD, RDN, LD, of the University of New Mexico Health Science Center; and Alison Steiber PhD, RDN, and Marsha Schofield, MS, RD, of the Academy of Nutrition and Dietetics.
The study – titled "Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions” – cites that about 15 percent of adults in the U.S. have chronic kidney disease, and the incidences are 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.
“The patient starting hemodialysis treatment in the U.S., typically meets with a registered dietitian for the first time in the dialysis clinic,” said Dr. Vassalotti, Chief Medical Officer of NKF. This paper describes potential solutions to increase the use of medical nutrition therapy earlier in the journey of the person with kidney disease.”
NKF and Academy of Nutrition and Dietetics (AND) agree that medical nutrition therapy (MNT) is one of the most important ways to slow the progression and prevent kidney failure – and is recommended for all people with kidney disease, regardless of age. 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.      
Yet, very few kidney patients receive MNT. Some reasons cited include physicians not referring patients under the mistaken belief MNT isn’t covered by insurance, doctors not recognizing 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. Also, a limited number of registered dietitian nutritionists are trained in kidney disease management and many are not enrolled as Medicare providers.
Dr. Kramer and Journal article co-authors assert that more research is needed to study the barriers to MNT and effective solutions, writing "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." NKF recognizes the importance of MNT and nutrition intervention in general for patients with kidney disease. NKF Kidney Disease Outcome Quality Initiative (KDOQI) in collaboration with AND, is updating its Clinical Practice Guideline on Nutrition in CKD. The guideline will provide evidence-based recommendations for assessment, prevention and treatment of protein-energy wasting, mineral and electrolyte disorders, and other metabolic disorders associated with kidney disease, as well as provision of MNT. The Council on Renal Nutrition (CRN) functions as a professional council within the framework of the NKF and networks with other organizations to support the NKF's goal of making lives better for those with CKD through education, outreach and research in the field of nutrition as it pertains to prevention, eradication and treatment of kidney and urologic diseases.
Kidney Disease Facts
In the United States 30 million adults are estimated to have chronic kidney disease—and most aren’t aware of it.  1 in 3 American adults are at risk for chronic kidney disease.  Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity and family history.  People of African American, Hispanic, Native American, Asian or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end stage renal disease (kidney failure).
The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease. For more information about NKF visit