Abstract
BackgroundDietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD.MethodsThe Web of Science and Scopus databases were searched using the search terms ‘adherence’ and ‘end stage kidney disease’. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence.ResultsMost of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence.ConclusionDietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.
Highlights
Dietary modification is an important component of the management of end stage kidney disease (ESKD)
Of the 60 studies, 16 reported the rate of dietary adherence; 28 studies reported both the rate of adherence and factors associated with adherence; and 16 studies only contained details regarding factors associated with adherence (Fig. 1)
For the final synthesis of findings, a total 44 articles reported the rate of dietary adherence, and 44 articles described factors associated with dietary adherence in ESKD
Summary
Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. Driven by an aging population and increasing rates of obesity, diabetes and hypertension, approximately 1 in 8 adults globally are known to have CKD [2]; and it is estimated that about 2% of these individuals with CKD will progress to End Stage Kidney Disease (ESKD) [3]. People with ESKD need to modify their intake of kilojoules; their fluid and protein intake; reduce their intake of minerals, such as sodium, potassium and phosphate; and potentially increase their intake of vitamins and minerals, such as vitamin C, B, folate, B12 and zinc [12]. Fruits, vegetables and dairy products are often restricted in ESKD due to their potassium or phosphate content
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