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Abstract: TH-PO600

Development of an International Standard Set of Nutritional Priorities for Patients with Non-Dialysis CKD

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Bellizzi, Vincenzo, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
  • Carrero, Juan Jesus, Karolinska Institutet, Stockholm, Sweden
  • Chauveau, Philippe, Aurad-Aquitaine, Gradignan, France
  • Calella, Patrizia, Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio Ruggi d'Aragona, Salerno, Italia, Italy
  • Johansson, Lina, Imperial College Healthcare NHS Trust, London, United Kingdom
  • Molina, Pablo, Department of Nephrology. Hospital Universitario Dr Peset., Valencia, Spain
  • Sezer, Siren, Atilim University Faculty of Medicine, Ankara, Turkey
  • Fouque, Denis, University Claude Bernard, Pierre Benite, France

Group or Team Name

  • European Renal Nutrition (ERN) working group at the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA).
Background

Protein energy wasting is common in CKD and associated with poor outcome. Many studies have been conducted to improve nutrition in CKD, but outcomes may not be relevant to patients / clinicians and are variable. These problems can diminish the value of interventions as means to improve patient’s lives. This project aims to identify areas of intervention and improvement in nutritional management of non-dialysis CKD based on shared priorities of stakeholders.

Methods

This Delphi consensus project involved 4 phases: systematic review to identify topics reported in studies involving nutritional outcomes (domains, measures) in non-dialysis CKD; review round of topics by 10 expert nephrologists in nutritional care; second review round by 105 Stakeholders (dietitians, nurses, patients) to refine the international Delphi survey to be distributed worldwide (Dec.2018 – May.2019) to patients, caregivers, clinicians, researchers, to develop consensus on clinical and research priorities in nutrition in non-dialysis CKD. The survey included 60 topics grouped in 5 categories, 11 sub-categories. Participants were invited to rate topics priority (importance) by 9-point Likert scale. Consensus for topic prioritization was defined as the combination of median ≥7 and ≥70% participants scoring 7-9 and <15% scoring 1-3 on the Likert.

Results

1.224 subjects completed the survey; 43% were physicians, 25% dietitians, 16% patients, 8% nutritionists and 8% nurses; 62% were female and 87% from Europe. 30 topics reached priority consensus by health-care providers; patients gave priority to only 15 topics. All stakeholders agreed with prioritizing topics supporting patients to choose and personalize of diet; patients gave low priority to common issues of research interest, low-protein, low-sodium, renal progression (<65%), energy, quality proteins, malnutrition (<55%), or no priority, very-low, vegetarian, DASH, Mediterranean diets (<25%).

Conclusion

This project emphasizes agreements and disagreements among stakeholders in what matter the most regarding nutritional care management of patients with non-dialysis CKD. These differences should be considered in research and clinical practice; establishing targets to prioritize will enhance the relevance and impact of research and patient care.