Chronic kidney disease patients living in health care communities, such as nursing facilities and assisted living facilities, face unique challenges related to maintaining a renal-specific diet, according to a study entitled “The nutrition needs of patients with chronic kidney disease in health care community settings, published in the July 2015 issue of the Journal of Renal Nutrition.

Nutrition in an integrated care dialysis setting 

“When initially considered, the average person may be quick to conclude that diets are better managed in health care communities than at home,” wrote author Julie Hulsebus-Colvin, MBA, RD, CDN , from Fresenius Medical Care’s Eastview Dialysis clinic in Victor, New York.

She said people assume that because these environments are usually controlled, they should result in better nutrition intake. But it is this control, and inflexibility regarding meal times and portion sizes, that has a negative effect on a CKD patient’s nutritional status. Other challenges presented by a controlled health care setting include missed meals that may not be compensated for during dialysis sessions, a rigid CKD diet made to cover all patients, low or poor protein content of meals, limited nutritional supplements, suboptimal meal substitutions, poor nutrition labeling, and high potassium levels. Hulsebus-Colvin also noted that staff in health care facilities may not be provided with the proper tools to manage a renal diet.

Survival comparison of daily home hemodialysis vs. conventional dialysis in the nursing home setting

Solutions
The key to improving the diets of renal patients is communication between nephrology dietitians and health care community staff, according to Hulsebus-Colvin. She said renal dietitians can offer CKD nutrition education to the staff, but they must also listen and obtain input from the staff.

“Nephrology dietitians must work together with the health care community staff to ensure the integration of nutrition intake goals and continuity of nutrition care for CKD patients,” wrote Hulsebus-Colvin.

Phosphorus Pyramid helps chronic kidney disease patients limit dietary phosphorus 

“Coordinating nutrition care for CKD patients is an ongoing, team effort dependent on consistent communication and participation between both nephrology caregivers and the health care community,” wrote Hulsebus-Colvin. “Although communication and participation are ideal in theory, it can be difficult to achieve with overworked staff and busy schedules. Prescribing providers in health care communities may be uncomfortable easing up on residents’ nutrition intake restrictions. Tension may arise if criticism is present and goals fail to align. However, maintaining a broad view of each other’s perspective and placing the CKD patient first will lead to better outcomes and improved integration and continuity of nutrition care.”