SAT-217 DETERMINING WHAT NUTRITIONAL OUTCOMES MATTER TO PATIENTS WITH NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE, SURVEY TO RENAL DIETITIANS AND PATIENTS – A PILOT STUDY

Abstract

Nutrition intervention is vital to improve clinical outcomes of patients with non-dialysis dependent chronic kidney disease (NDCKD), and is often complex and highly individualised. Literature revealed NDCKD patients have low dietary adherence rates which may be related to the discrepancy of treatment goals between patients and healthcare professionals. We aimed to enhance the understanding of patients’ nutritional outcomes by exploring renal dietitians’ and NDCKD patients’ perceptions of what nutritional outcomes matter to the patients. A comprehensive literature review was performed to identify outcomes of nutrition interventions from qualitative and quantitative studies, results of which were used to construct a survey to Australian renal dietitians and NDCKD patients (stages 4-5). All patients had received nutrition intervention and ongoing care for pre-dialysis or conservative pathways. Respondents were asked to rate the importance of intervention outcomes on a nine-point Likert scale with a score of 9 reflecting the highest “importance”. Descriptive statistics and non-parametric t-tests were used to analyse the data. Forty-eight outcome measures were included in the survey, reflecting a range of clinical, nutritional and patient centred-outcomes. Forty-seven dietitians and ten patients (pilot) participated in the survey. Eight patients (80%) had an eGFR less than 20 mL/min. Both dietitian and patient groups rated thirty-five out of forty–eight (73%) outcomes of similar importance (p>0.05). Quality of life and symptom control were perceived by both dietitian and patient groups to be nutritional outcomes of very high importance (8.53±0.88 vs. 8.70±0.48, p=0.86 & 8.48±0.70 vs. 8.70±0.48, p=0.42 respectively). Delaying the need for dialysis was rated the highest by patients (8.80±0.42). Dietitians and patients rated maintaining good rapport, regular contact and support (8.45±0.74 vs. 8.20±0.78, p=0.29) and empowerment/increased ability to follow a special diet for managing kidney disease (8.26± 0.94 vs. 8.10±1.10, p=0.72) as being of higher importance than reaching biochemical targets e.g. serum phosphate (7.23±1.41 vs. 7.89±1.69, p=0.14) or reduced medication use by adhering to the diet (6.85±1.54 vs. 6.90±2.55, p=0.52). The greatest differences in the highest scored priorities between dietitians and patients included the need to delay dialysis (7.49±1.82 vs. 8.80±0.42 p< 0.01) and the desire for better knowledge about how diet can help manage renal disease (7.98±1.10 vs. 8.70±0.67 p=0.03). Other disparities between the dietitian and patient groups included achieving serum cholesterol in normal range (5.23±1.68 vs. 7.90±1.44, p<0.001) and being able to keep track of nutrition progress e.g. understanding nutrition results (7.48±1.56 vs 8.50±0.70, p=0.02). This study revealed that renal dietitians and NDCKD patients share common nutritional outcome priorities and perceive whole body nutritional outcomes as more important than biochemical markers of nutrition. Patients tended to focus on prevention of CKD progression and deferring dialysis, whilst dietitians focused on improvements in nutrition-related knowledge (intermediate outcomes). Nevertheless, there is a need for individualised goal setting to improve patients’ dietary adherence to achieve desirable clinical outcomes.