by Robin Allen
What a great webinar in June, Nutrition, Exercise and Renal Disease presented by Dr. Ken Wilund. We had 283 attendees and over 100 comments in the chat pod. The discussion was lively and much information was shared. If you missed the webinar, Registered Dietitians can still earn CPEUs by listening to the recording and completing the evaluation located on the event page. Dr. Wilund and his lab recently published a paper in the Journal of Renal Nutrition, Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients in the Journal of Renal Nutrition. This study was discussed in the webinar is now available at the link above.
The following are some of the key takeaways the participants commented on:
- The renal diet is difficult to follow, and compliance is poor. Dietitians closely monitor lab values individualize meal plans to provide a well-balanced diet.
- The key to success is getting the entire clinical team involved. Repetition is important to helping patients stay on their diet especially for sodium (Na+) restriction. Telling them once is not enough! It takes a team approach constantly to repeat the message, including the doctors, nurses, techs, family members and the bus driver.
- Sodium restriction is vital to avoid chronic volume overload. The recommendation from this webinar is 1 mg sodium/ 1 kilocalorie as the rule. Once again, it takes the entire medical team to reinforce this rule.
- Education should focus on sodium restriction. Liberalize the diet restrictions and focus on encouraging non-processed foods. Restrictions of potassium (K+) and phosphorus (P) from non-processed/whole foods should be largely eliminated. Differentiate between organic and inorganic P. Few restrictions should be placed on fresh fruit, vegetables, nuts, legumes, and dairy. The health benefits from these foods outweigh the unsubstantiated risks.
- Intradialytic hypotension has reduced with Dr. Izmir volume control policy: Dr. Izmir’s clinic in Turkey has had great results with strict dietary salt restriction to limit intradialytic weight gain (IDWG) and cessation of anti-hypertensive medications to prevent intradialytic hypotension. This volume control strategy has also been associated with lower rates of hospitalization, lower mortality, normalized blood pressure (BP) in the absence of BP meds, improved cardiac structure and function, improved body composition and markers of nutritional status, and reduced intradialytic hypotension.
- There is a difference in the way Europe and the U.S. treat end-stage renal disease (ESRD). In Europe dialysis is not started if life expectancy is not good. Also, Doctors in Europe can stop dialysis if patients are non-compliant. In the U.S. dialysis is started no matter the life expectancy and continued whether patients are compliant or not.
- Exercise is an important component of chronic renal disease (CRD) treatment. Demonstrated benefits include better body composition, improved muscle strength and physical function, improved cardiovascular structure and function, improved dialysis efficiency and improved quality of life!
I encourage you to watch this webinar if you have not seen it and share this information with others. Also please provide your opinion as to whether you would consider some of these options for treatment at your clinic. There are some great opportunities for discussion.
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Heiwe et al. Am J Kidney Dis. 2014 Sep; 64(3):383-93 http://www.ncbi.nlm.nih.gov/pubmed/24913219
Barcellos et al. Clin Kidney J. 2015 Dec; 8(6):753-65 http://www.ncbi.nlm.nih.gov/pubmed/24913219
This post was written by Robin Allen, a member of the Military Families Learning Network (MFLN) Nutrition and Wellness team that aims to support the development of professionals working with military families. Find out more about the MFLN Nutrition and Wellness concentration on our website, on Facebook, on Twitter, and LinkedIn.