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Kidney Week

Abstract: SA-PO1049

Use of Medical Nutrition Therapy Is Low Among US Veterans with Stage 3-5 Non-Dialysis Dependent CKD

Session Information

Category: CKD (Non-Dialysis)

  • 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Kramer, Holly J., Loyola University Chicago, Maywood, Illinois, United States
  • Markossian, Talar, Loyola University Chicago, Maywood, Illinois, United States
  • Burge, Nick, Hines VA Medical Center, Hines, Illinois, United States
  • Pacold, Ivan M., Hines VA Medical Center, Hines, Illinois, United States
  • Leehey, David J., Hines VA Medical Center, Hines, Illinois, United States
  • Stroupe, Kevin, Hines VA Medical Center, Hines, Illinois, United States
Background

Once chronic kidney disease (CKD) is established, dietary modifications such as decreasing intake of animal protein and salt and increasing intake of fresh fruits and vegetables may slow CKD progression. However, dietary modifications require patient education and close monitoring due to risks of malnutrition and hyperkalemia. Medical Nutrition Therapy (MNT), the individualized nutrition assessment, care planning and dietary education provided by a registered dietitian nutritionist remains an effective intervention for slowing CKD progression and delaying end-stage renal disease (ESRD). We examined MNT utilization among U.S. Veterans with established non-dialysis dependent stage 3-5 chronic kidney disease (CKD-ND) during calendar year 2015. We hypothesized that utilization of MNT may be low and requires more attention.

Methods

We used data from the VA Corporate Data Warehouse which includes demographics, inpatient and outpatient encounter diagnosis and procedure codes and Current Procedural Terminology (CPT) codes] and patient labs. Since a percentage of Veterans receive their care from non-VA sources, we linked data from the Center for Medicare & Medicaid Services Medicare administrative databases to capture non-VA health care use. CKD status was based on presence of at least two estimated glomerular filtration rate (eGFR) values < 60 ml/min/1.73 m2 in outpatient laboratory data spaced 90+ days apart.

Results

There were 242,865 Veterans age ≧50 years with at least two eGFR<60 ml/min/1.73 m2 spaced 90+ days apart during calendar year 2014 with no history of dialysis or transplantation. Mean age was 76.4 years (standard deviation 9.6) and 96.7% were male and most were white with 14.9% reporting black race. During calendar year 2015, only 9.6% of Veterans with stage 3-5 CKD-ND saw a VA dietician and 0.1% saw a Medicare reimbursed dietician. MNT utilization overall was significantly higher among black vs. whites (13.9% vs. 9.0%, p<0.001). Only 1.7% of Veterans with stage 3-5 CKD-ND were enrolled in the VA MOVE! program designed to increase exercise.

Conclusion

Utilization of MNT is very low in U.S. Veterans with stage 3-5 CKD-ND. Increasing utilization of MNT for patients with CKD-ND should be a priority for health systems in order to delay ESRD.

Funding

  • Veterans Affairs Support