Usefulness of nutrition facts label for persons with chronic kidney disease.

OBJECTIVE: We sought to determine what information should be included on the nutrition facts label (NFL) to improve its usefulness for individuals with chronic kidney disease (CKD). DESIGN: Our survey asked for frequency of food-label reading, use of information on the label related to specific nutrients, and perceived needs. SETTING: Our survey was internet-based. SUBJECTS: Our subjects included 317 individuals with CKD and caregivers who self-subscribed to electronic mailing lists maintained by nationally based groups providing education and/or support for individuals with CKD. INTERVENTION: The intervention consisted of an analysis of survey results. MAIN OUTCOME MEASURES: Main outcome measures included respondent self-reported behaviors, opinions, attitudes, knowledge, and perceived needs related to the NFL in terms of foods and beverages. RESULTS: Survey respondents (81.8%) rated nutrition as important (39.2%) or very important (42.6%) when making food choices. A roughly equal number (82.6%) indicated reading the NFL often for the amounts of nutrients in a food. However, less than one fourth of the respondents (24.0%) were able to determine the amount of calcium in a food correctly, based on percent daily value (%DV), and many (64.6%) indicated they did not know how to convert the %DV to an absolute amount (the 100% daily value for calcium is 1000 mg). Respondents indicated that they decided not to purchase foods that did not list absolute amounts of nutrients of concern (58.4% for potassium, and 53.9% for phosphorus) on the NFL. CONCLUSIONS: Individuals with CKD would prefer, or find it more useful, to see nutrients of concern listed in absolute amounts on the NFL. They also indicated that potassium and phosphorus should be required on the label, to allow the option of determining whether to include a food in their diet.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for registered dietitians (generalist, specialty, and advanced) in nephrology care.

The American Dietetic Association (ADA) Renal Dietitians Practice Group (RPG) and the National Kidney Foundation Council on Renal Nutrition (NKF CRN), under the guidance of the ADA Quality Management Committee and Scope of Dietetics Practice Framework Sub-Committee, have developed the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care (Supplementary Figures 1, 2, and 3 are available only online at www.jrnjournal.org). The SOP and SOPP documents are based upon the 2008 Revised Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians (RDs)(1), which are part of ADA's Scope of Dietetics Practice Framework(2). The 2008 Revised SOP in Nutrition Care and SOPP, along with the Code of Ethics(3), guide the practice and performance of RDs in all settings.

Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days.

OBJECTIVE: To determine physical activity patterns in chronic hemodialysis patients with a specific emphasis on the difference between dialysis and nondialysis days. Design A cross-sectional single-center study. SETTING: Vanderbilt University Outpatient Dialysis Unit. PATIENTS: Twenty current chronic hemodialysis patients: 10 male, 10 female; 15 black, 5 white; mean age, 50.1 +/- 9.9 years; height, 164.5 +/- 10.9 cm; weight, 82.5 +/- 15.4 kg; length on dialysis, 57.3 +/- 45.3 months. METHODS: Minute-by-minute physical activity was assessed over a 7-day period using a triaxial accelerometer, which consists of raw numbers or counts calculated by the 3 axes of the accelerometer (PA counts). PA counts were extrapolated on a daily and hourly basis. Physical functioning tests included: sit-to-stand, 6-minute walk, and 1-repetition maximal leg press exercise. Laboratory values for serum concentrations of albumin, prealbumin, C-reactive protein, and cholesterol were also collected. MAIN OUTCOME MEASURE: PA counts. RESULTS: Total PA counts were significantly lower on dialysis days when compared with nondialysis days (128,279 +/- 74,009 versus 168,744 +/- 95,168, respectively, P = .025). The average PA counts during the 4-hour dialysis time period were significantly lower on dialysis days when compared with nondialysis days (3,086 +/- 3,749 versus 11,070 +/- 7,695, respectively, P = .001). At postdialysis hours 1 and 2, PA counts on dialysis days were significantly higher than on nondialysis days (11,410 +/- 5,340 versus 9,082 +/- 6,646, P = .008, and 14,048 +/- 9,728 versus 8,662 +/- 6,433, P = .016, respectively). By postdialysis hour 4, PA counts on dialysis days had significantly decreased when compared with nondialysis days (6,068 +/- 6,268 versus 10,512 +/- 7,420 PA counts, P = .01, respectively). From postdialysis hours 5 to 20, there was no significant difference in PA counts between dialysis and nondialysis days. CONCLUSION: This study shows that physical activity is lower on dialysis days when compared with nondialysis days, and this decrease is caused by the lack of activity during the 4-hour hemodialysis procedure. New behavior modification strategies involving physical activity, both during hemodialysis and on nondialysis days, must be examined in this patient population.

The renal dietitian's role in managing hyperphosphatemia and secondary hyperparathyroidism in dialysis patients: a national survey.

PURPOSE: To survey the medical nutrition therapy practices of renal dietitians for the treatment of bone mineral metabolism. OBJECTIVES: To obtain data on phosphorus diet prescription levels. To determine allied team involvement for phosphate binder and Vitamin D therapies. To assess the frequency and target levels for monitoring serum calcium, phosphorus, -phosphorus product, intact PTH and alkaline phosphatase. METHODS: Two renal dietitians from the National Kidney Foundation-Council on Renal Nutrition developed a 5-question survey. This was posted on both the RenalRD Listserv and the NKF-CRN website from January 1 through February 15, 2001. Dietitians were asked to respond using facsimile, e-mail or reply by mail. RESULTS: One hundred and thirty-one surveys were received representing all major dialysis providers in the United States, the British Virgin Islands, and Japan. Results included information for peritoneal and hemodialysis patients. Five different methods for dosing phosphate binders were determined. Prescribed phosphate binders included calcium acetate, sevelamer hydrochloride, and calcium carbonate. 108 out of 131 dietitian respondents (82.5%) have a medical protocol in place for vitamin D therapy. Of the respondents, 47% were directly responsible for implementing the vitamin D protocol. Paricalcitol was the most widely used form of IV Vitamin D. Biochemistry results were as follows: calcium, 16 different ranges from 8.0 mg/dL to 11.5 mg/dL; phosphorus, 13 different ranges from 2.5 mg/dL to 6.5 mg/dL; calcium-phosphorus product, 13 different ranges from 55-75; iPTH, 20 different ranges from 50-300 pg/mL; alkaline phosphatase, 18 different ranges from no records being monitored to a level of 500 mg/dL. CONCLUSION: The survey revealed a large variability in the treatment of bone mineral metabolism. Improved clinical practice guidelines for the health care team are being developed with the National Kidney Foundation (NKF)-Kidney Disease Outcomes and Quality Initiative (KDOQI) bone disease management workgroup.