In–center nutrition practices of clinics within a large hemodialysis provider in the United States

Debbie Benner, Mary Burgess, Maria Stasios, Becky Brosch, Ken Wilund, Sa Shen, Brandon Kistler

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives Eating during hemodialysis treatment remains a controversial topic. It is perceived that more restrictive practices in the United States contribute to poorer nutritional status and elevated mortality compared with some other parts of the world. However, in–center food practices in the United States have not been previously described. Design, setting, participants, & measurements In 2011, we conducted a survey of clinic practices and clinician (dietitian, facility administrator, and medical director) opinions related to in–center food consumption within a large dialysis organization. After the initial survey, we provided clinicians with educational materials about eating during treatment. In 2014, we performed a follow-up survey. Differences in practices and opinions were analyzed using chi-squared tests and logistic regression. Results In 2011, 343 of 1199 clinics (28.6%) did not allow eating during treatment, 222 clinics (18.2%) did not allow drinking during treatment, and 19 clinics (1.6%) did not allow eating at the facility before or after treatment. In 2014, the proportion of clinics that did not allow eating during treatment had declined to 22.6% (321 of 1422 clinics), a significant shift in practice (P<0.001). Among the 178 (6.8%) clinics that self-reported that eating was “more allowed” in 2014, the main reason for this shift was an increased focus on nutritional status. Among clinicians, a higher percentage encouraged eating during treatment (53.1% versus 37.4%; P<0.05), and facility administrators and medical directors were less concerned about the seven reasons commonly cited for restricting eating during treatment in 2014 compared with 2011 (P<0.05 for all). Conclusions We found that 28.6% and 22.6% of hemodialysis clinics within the United States restricted eating during treatment in 2011 and 2014, respectively, a rate more than double that found in an international cohort on which we previously published. However, practices and clinician opinions are shifting toward allowing patients to eat. Additional research is warranted to understand the effect that these practices have on patient outcomes and outline best practices.

Original languageEnglish (US)
Pages (from-to)770-775
Number of pages6
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number5
DOIs
StatePublished - 2016

Keywords

  • Blood pressure
  • Follow-up studies
  • Hemodialysis
  • Humans
  • Logistic models
  • Nutrition
  • Nutritional status
  • Renal dialysis
  • United States

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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