Personalized Nutritional Therapy: How It Can Help Your Patients

Approximately 14 percent of American adults are affected by the daily complications and burden of chronic kidney disease (CKD). While a kidney-specific diet can help better manage comorbidities and mitigate disease complications, the diet can be confusing and difficult for patients to navigate. Personalized nutritional therapy with a renal dietitian can help patients address the dietary challenges specific to their disease and eat foods that can help manage their conditions better. We’ve highlighted the most significant benefits that patients may experience with the therapy below.

1. Improved clinical outcomes and comorbidity management

Medical nutrition therapy (MNT), which includes personalized nutritional therapy as well as nutrition diagnostic and counseling services, can impact kidney-specific lab values. For example, a study that focused on nutrition intervention for patients with CKD stage 4 or 5 pre-dialysis found that:

• Serum phosphate levels were lower in the nutrition intervention group than the control group despite the fact that the use of phosphate binders was greater in the control group patients.
• The use of erythropoiesis stimulating agents therapy was considerably lower in the nutrition intervention group than the control group.
• Albumin was higher in the nutrition intervention group.

MNT can help patients manage chronic diseases like hypertension and diabetes. One study found that patients who met with a dietitian at least two times to receive MNT for diabetes had a one to two percent lower hemoglobin A1c level than patients who had received only basic nutrition education. Another study focusing on low sodium diets for hypertension found that patients who received dietary counseling by a dietitian and followed the sodium-restricted diet had a statistically significant improvement in blood pressure and hydration status.

Diabetes and hypertension are the leading cause of CKD, so often CKD exists with at least one, if not both, of these diagnoses. When an expert in the nutrition field, such as a registered dietitian, provides dietary information, patient labs may be positively impacted and, ultimately, clinical outcomes and overall health may improve.

2. Enhanced nutrition and survival rates 

Some CKD patients significantly limit their food intake as a result of a low understanding of the difficult renal diet, a decrease in appetite or a change in taste (which can occur as symptoms with CKD).  Per research, 28 to 48 percent of patients with CKD stages 3 through 5 are malnourished. Personalized nutritional therapy can help in the following ways.

• One study found that patients who receive personalized nutritional therapy for more than 12 months before initiating dialysis were 34 percent more likely to have a serum albumin greater than 4 gm/dL.
• Another study found that patients with access to a nurse, patient education, medication management and nutrition counseling had a decreased rate of eGFR decline, with the greatest impact to patients with progressive CKD.
• The same study also showed, after one year of dialysis, mortality was eight percent lower in patients who received nutrition therapy at least 12 months before initiating dialysis.

Patients who receive nutrition counseling from a registered dietitian may be more likely to be healthier before and during initiating dialysis, which can help improve their clinical outcomes and quality of life.

3. Improved quality of life

The renal diet is a difficult diet to manage. When a CKD patient receives diet support and guidance from a dietitian, quality of life may significantly improve. In a study, patients with CKD stages 4 and 5 pre-dialysis who received individualized nutrition counseling from a registered dietitian improved across several quality-of-life sub-scales, including CKD symptoms, cognitive function and vitality.

Nutritional counseling and medical nutritional therapy can be provided in several ways, from in-person treatments to virtual appointments, and they can range from fee-for-service to billable. Changing a diet presents many challenges, and additional complex lab results or comorbidities can leave patients feeling overwhelmed or confused. During an overwhelming time and difficult transition, personalized dietary counseling with a renal dietitian can offer patients feelings of empowerment and optimism.