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. 2022 Jan;17(1):38-52.
doi: 10.2215/CJN.07800621. Epub 2022 Jan 3.

Assessing Global Kidney Nutrition Care

Angela Yee-Moon Wang  1 , Ikechi G Okpechi  2   3 , Feng Ye  4 , Csaba P Kovesdy  5 , Giuliano Brunori  6 , Jerrilynn D Burrowes  7 , Katrina Campbell  8 , Sandrine Damster  9 , Denis Fouque  10 , Allon N Friedman  11 , Giacomo Garibotto  12 , Fitsum Guebre-Egziabher  13   14 , David Harris  15 , Kunitoshi Iseki  16 , Vivekanand Jha  17   18   19 , Kailash Jindal  4 , Kamyar Kalantar-Zadeh  20 , Brandon Kistler  21 , Joel D Kopple  22 , Martin Kuhlmann  23 , Meaghan Lunney  24 , Denise Mafra  25 , Charu Malik  9 , Linda W Moore  26 , S Russ Price  27 , Alison Steiber  28 , Christoph Wanner  29 , Pieter Ter Wee  30 , Adeera Levin  31 , David W Johnson  32   33   34 , Aminu K Bello  4
Affiliations

Assessing Global Kidney Nutrition Care

Angela Yee-Moon Wang et al. Clin J Am Soc Nephrol. 2022 Jan.

Abstract

Background and objectives: Nutrition intervention is an essential component of kidney disease management. This study aimed to understand current global availability and capacity of kidney nutrition care services, interdisciplinary communication, and availability of oral nutrition supplements.

Design, setting, participants, & measurements: The International Society of Renal Nutrition and Metabolism (ISRNM), working in partnership with the International Society of Nephrology (ISN) Global Kidney Health Atlas Committee, developed this Global Kidney Nutrition Care Atlas. An electronic survey was administered among key kidney care stakeholders through 182 ISN-affiliated countries between July and September 2018.

Results: Overall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care. Only 48% of the 155 countries have dietitians/renal dietitians to provide this specialized service. Dietary counseling, provided by a person trained in nutrition, was generally not available in 65% of low-/lower middle-income countries and "never" available in 23% of low-income countries. Forty-one percent of the countries did not provide formal assessment of nutrition status for kidney nutrition care. The availability of oral nutrition supplements varied globally and, mostly, were not freely available in low-/lower middle-income countries for both inpatient and outpatient settings. Dietitians and nephrologists only communicated "sometimes" on kidney nutrition care in ≥60% of countries globally.

Conclusions: This survey reveals significant gaps in global kidney nutrition care service capacity, availability, cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries.

Keywords: chronic kidney disease; dietitians; global; global health; kidney nutrition care; nutrition supplement; nutritional status; renal nutrition.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Global availability and capacity of kidney nutrition care. (A) Availability of dietitians/renal dietitians for different International Society of Nephrology regions and World Bank income groups. (B) Availability of dietary counseling by a person trained in nutrition (either persons with dietetics or nutrition background, nutritionists, nutrition technicians, or physicians, not necessarily nephrologists who have received training in nutrition) for different World Bank income groups. (C) Dietitians/renal dietitians practice settings in outpatient and inpatient settings and nutrition care availability for patients with nondialysis CKD versus those on maintenance dialysis for different World Bank income groups. (D) Personnel who provide dietitian counseling to patients with CKD and personnel other than dietitians involved in kidney nutrition care for different World Bank income groups. C, Central; E, Eastern/East; N, North; NIS, newly independent states; OSEA, Oceania and Southeast Asia.
Figure 1.
Figure 1.
Global availability and capacity of kidney nutrition care. (A) Availability of dietitians/renal dietitians for different International Society of Nephrology regions and World Bank income groups. (B) Availability of dietary counseling by a person trained in nutrition (either persons with dietetics or nutrition background, nutritionists, nutrition technicians, or physicians, not necessarily nephrologists who have received training in nutrition) for different World Bank income groups. (C) Dietitians/renal dietitians practice settings in outpatient and inpatient settings and nutrition care availability for patients with nondialysis CKD versus those on maintenance dialysis for different World Bank income groups. (D) Personnel who provide dietitian counseling to patients with CKD and personnel other than dietitians involved in kidney nutrition care for different World Bank income groups. C, Central; E, Eastern/East; N, North; NIS, newly independent states; OSEA, Oceania and Southeast Asia.
Figure 2.
Figure 2.
Global availability of various nutrition assessments. Having formal assessment of nutritional status and use of different nutrition tools, including change in body weight and serum albumin, for nutrition assessment across World Bank income groups.
Figure 3.
Figure 3.
Global availability and cost coverage of oral nutrition supplements. Oral nutrition supplement availability and cost coverage in inpatient and outpatient setting across different World Bank income groups.
Figure 4.
Figure 4.
Global interdisciplinary communications in relation to kidney nutrition care delivery. For countries with dietitians/renal dietitians available, feedback to nephrologists on findings of nutrition assessment, dietary prescriptions to patients with CKD, and dietary adherence of patients with CKD across different World Bank income groups.
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