• Survey results indicate that there’s a global shortage of dietitians to provide kidney nutrition care, and many patients with kidney disease who need nutritional interventions either do not receive them or receive suboptimal therapy with inadequate monitoring.

Newswise — Washington, DC (December 28, 2021) — Dietary and nutritional changes are needed when patients develop kidney disease; however, new research published in CJASN reveals that in many countries, there are significant gaps in care related to the importance of nutrition for maintaining kidney health. 

In individuals with kidney disease, nutritional interventions may slow kidney function decline, potentially delay the need for dialysis or kidney transplantation, and reduce symptoms. In 2018, international experts from the International Society of Nephrology (ISN) Global Kidney Health Atlas Team and International Society of Renal Nutrition and Metabolism (ISRNM) developed a questionnaire for a Global Kidney Nutrition Care Atlas aimed at evaluating kidney nutrition care services across countries. Angela Yee-Moon Wang, MD, PhD (Queen Mary Hospital, The University of Hong Kong) and her colleagues examined 2 aspects of kidney nutrition care included in the Atlas: current global availability, capacity, and cost of kidney nutrition care services; and communication between dietitians and nephrologists in the delivery of kidney nutrition care.

For the Atlas, a survey was administered electronically to key kidney care stakeholders (nephrology leaders, policymakers, and consumer organization representatives) in 182 ISN-affiliated countries. Overall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care.

Survey responses revealed the following:

  • Only 48% of the 155 countries have dietitians/kidney dietitians to provide kidney nutrition care.
  • Dietary counselling provided by a person trained in nutrition is generally not available in 65% of low/lower-middle income countries and ‘never’ available in 23% of low-income countries.
  • Forty-one percent of the countries do not provide formal assessment of nutrition status for kidney nutrition care.
  • The availability of oral nutrition supplements varies globally and mostly not freely available in low/lower-middle income countries for both inpatient and outpatient settings.
  • Dietitians and nephrologists only communicate 'sometimes' on kidney nutrition care in ³ 60% of countries globally.

“In the long term, the definitive solution to the foregoing problem is to train and provide salary support for adequate numbers of qualified dietitians who have undergone specialized training in kidney nutrition to implement nutrition intervention across the spectrum of kidney disease,” said Dr. Wang. “We hope this report will be an important advocacy tool to promote governmental prioritization and allocation of resources and manpower for this essential component in kidney care worldwide, especially in lower income countries.”

An accompanying editorial provides additional insights into the study’s findings. “This global survey is an important wakeup call to countries across the income spectrum,” the authors wrote. “It exposes gaps and concerns related to kidney nutrition care, serving up a plate full of food for thought, that must now be followed by action!” 

Study authors include Angela Yee-Moon Wang, MD, PhD, Ikechi G. Okpechi, PhD, Feng Ye, MSc, Csaba P. Kovesdy, MD, Giuliano Brunori, MD, Jerrilynn D. Burrowes, PhD, RDN, Katrina Campbell, PhD, Sandrine Damster, Denis Fouque, MD, PhD, Allon N. Friedman, MD, Giacomo Garibotto, MD, Fitsum Guebre-Egzuabher, MD, PhD, David Harris, MD, Kunitoshi Iseki, MD, Vivekanand Jha, MD, PhD, Kailash Jindal, FRCPC,  Kamyar Kalantar-Zadeh, MD, MPH, PhD, Brandon Kistler, PhD, RD, Joel D. Kopple, MD, Martin Kuhlmann, MD, Meaghan Lunney, MSc, Denise Mafra, PhD, Charu Malik, PhD, Linda W. Moore, PhD, RDN, S. Russ Price, PhD, Alison Steiber, PhD, RDN, Christoph Wanner, MD, Pieter ter Wee, MD, PhD, FERA, Adeera Levin, FRCPC, David W. Johnson, PhD, and Aminu K. Bello, PhD. 


Denis Fouque received lecture fees from Fresenius Kabi, BBraun, Vifor and is an advisory board member of Sanofi, Astellas, Lilly, AstraZeneca.

Allon Friedman is a member of scientific advisory board, GI Dynamics. 

Joel D. Kopple served as a consultant and on the advisory board of Nephroceuticals and received a research grant from Shire Pharmaceuticals.

C Kovesdy is a Consultant for Abbott, Akebia, Astra Zeneca, Bayer, Cara Therapeutics, Rockwell and Vifor.  K. Kalantar-Zadeh has received honoraria and/or support from Abbott, Abbvie, ACI Clinical (Cara Therapeutics), Akebia, Alexion, Amgen, Ardelyx, Astra-Zeneca, Aveo, BBraun, Chugai, Cytokinetics, Daiichi, DaVita, Fresenius, Genentech, Haymarket Media, Hospira, Kabi, Keryx, Kissei, Novartis, Pfizer, Regulus, Relypsa, Resverlogix, Sandoz, Sanofi, Shire, Vifor, UpToDate, ZS-Pharma.

Vivek Jha reported grants from BSK, Baxter Healthcare, Biocon, personal fees from Astra Zeneca, Baxter Healthcare, NephroPlus outside the submitted work.

Brandon Kistler received funding from the Academy of Nutrition and Dietetics.

C Wanner has received honoraria for steering committee and advisory board membership, lecturing and travels from Akebia, AstraZeneca, Bayer, Boehringer-Ingelheim, Fresenius Medical Care, Gilead Sciences, GlaxoSmithKlein, Lilly, Sanofi-Genzyme, Vifor.

DW Johnson has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer and AWAK, speaker’s honoraria and travel sponsorships from ONO, and travel sponsorships from Amgen. He is a current recipient of an Australian National Health and Medical Research Council Practitioner Fellowship. Angela Yee-Moon Wang, Guiliano Brunori, Jerrilynn D. Burrowes, Katrina L. Campbell, Giacomo Garibotto, Martin Kuhlmann, Kunitoshi Iseki, Denise Mafra, Linda W. Moore, S. Russ Price, and Pieter ter Wee have no disclosures to make.

The article, titled “Assessing Global Kidney Nutrition Care,” will appear online at http://cjasn.asnjournals.org/ on December 28, 2021, doi: 10.2215/CJN.07620621.

The editorial, titled “Kidney Nutrition Care—Food for Thought,” will appear online at http://cjasn.asnjournals.org/ on December 28, 2021, doi: 10.2215/CJN.14861121.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 21,000 members representing 131 countries. For more information, visit www.asn-online.org.


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