Academy of Nutrition and Dietetics Commentary on the Phosphorus Recommendation in the KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 Update.

The Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease: 2020 Update recommends adjusting dietary phosphorus to maintain a serum phosphate goal for hemodialysis patients in the normal range (0.81 to 1.45 mmol/L [2.5 to 4.5 mg/dL]). This is lower than the serum phosphate goal used by many dialysis centers (0.97 to 1.78 mmol/L [3.0 and 5.5 mg/dL]). Although context and clinical judgment must always be considered when providing individualized care to patients, a guideline implementation study conducted from December 2020 to December 2022 found that, based on their documentation, registered dietitian nutritionists from two national dialysis chains are almost universally using dialysis center goals instead of the lower phosphate goal recommended by the guideline. This commentary discusses the possible barriers to implementing the Kidney Disease Outcomes Quality Initiative 2020 nutrition guideline's phosphorus recommendation and proposes a systems level approach to promote and support adoption of the recommendation. Calls to action for potential changes in clinician practices, organizational/institutional culture, and government regulations are put forth.

The process and rationale for an online master's program in diabetes education and management.

PURPOSE: Although all certified diabetes educators have been required to have specific clinical training in a health discipline, graduate programs in diabetes education are relatively rare. The purpose of this article is to describe the development of a different approach to educating diabetes educators: an interdisciplinary graduate degree in diabetes education and management. In addition to preparing more diabetes educators, a graduate degree encourages existing diabetes educators to expand their area of expertise and their leadership skills. The article provides a discussion of the current trend toward interprofessional education and describes the challenges associated with mounting an online graduate program. CONCLUSIONS: Those who are engaged in or seeking a career in diabetes education are interested in a graduate degree in the specialty. Such a degree offers a route into diabetes education for those who are not currently in the field as well as a method for current diabetes educators to increase their expertise and their potential for leadership. The time has come to raise the professional standard for diabetes education by providing an academic preparation for diabetes educators.

Vitamin D status is a biological determinant of health disparities.

BACKGROUND: In human beings, dark skin requires more exposure to ultraviolet light to synthesize the same amount of vitamin D as lighter skin. It is has been repeatedly shown that at the latitude of the United States there are vitamin D disparities related to skin color. Although inadequate vitamin D status and health disparities have been associated with many of the same diseases, neither nutrition policy nor public health policy in the United States currently recognizes any role at all for vitamin D as a determinant of health disparities. OBJECTIVE: This study investigated the relationship between health, skin color, and vitamin D nutriture in the US population. DESIGN: The design is cross-sectional, correlational, and can be generalized to the population of the United States. PARTICIPANTS: We used data from 12,505 (unweighted) subjects (3,402 non-Hispanic blacks, 3,143 Mexican Americans, and 5,960 non-Hispanic whites), aged 13 years or older, from the continuous National Health and Nutrition Examination Survey 2003-2006. MAIN OUTCOME MEASURE: Self-rated health, a repeatedly validated indicator of objective health status, was used as a continuous measure of health. STATISTICAL ANALYSES PERFORMED: Using software appropriate for the complex survey design of the National Health and Nutrition Examination Survey, the study consisted of six regression models, one predicting vitamin D status and five predicting self-rated health. RESULTS: Controlling for the covariates sex, interview language, country of birth, tobacco use, age, body mass index, and leisure exercise as well as the socioeconomic variables education and family income, remaining disparities in self-rated health are greatly reduced or eliminated by controlling for serum 25-hydroxyvitamin D levels. CONCLUSIONS: We found that socioeconomic factors are the strongest determinant of skin-color based health disparities in the US population, but that it may not be possible to eliminate health disparities in the United States without eliminating the skin-color-related disparities in vitamin D nutriture.

Nutrition practices of renal dietitians in hemodialysis centers throughout the United States: a descriptive study.

OBJECTIVE: Little is known about either the current practices of dietitians in hemodialysis (HD) centers or the practice guidelines that dietitians themselves would like to see developed or revised. This study sought to (1) describe a broad range of nutrition practices among renal dietitians working with adults receiving maintenance HD therapy throughout the United States; (2) determine the extent to which these practices are consistent with professionally accepted guidelines, references, and resources; and (3) ascertain areas in renal nutrition for which dietitians might like the clinical practice guidelines developed or revised. DESIGN: This was a cross-sectional study conducted by postal mail. PARTICIPANTS: A survey was mailed to all domestic members of the Council on Renal Nutrition of the National Kidney Foundation (n=1270). All respondents who identified themselves as renal dietitians working with adult maintenance HD patients in dialysis centers were included in the study. DESCRIPTION: The survey queried dietitians regarding a broad range of nutrition practices, including healthy body weight, adjusted body weight, energy requirements, clinical nutrition indicators, metabolic parameters, fluid management, serum potassium, and vitamin supplementation. Dietitians were also asked which guidelines, if any, they would like developed or revised. RESULTS: A response rate of 68.3% was obtained. The results suggest that (1) there is substantial disparity between renal dietitians' practices and Kidney Disease Outcomes Quality Initiative nutrition guidelines in several areas, e.g., the guidelines on weight and on energy requirements; (2) dietitians' reported practices are congruent with Kidney Disease Outcomes Quality Initiative guidelines regarding metabolic parameters (e.g., diabetes); and (3) there is substantial variability among dietitians in several areas of practice, including determination of interdialytic weight gain goals. The majority of dietitians agreed that new guidelines need to be developed for interdialytic weight gain (64%) and for vitamin supplementation (80%). Among those who indicated that current guidelines need to be revised (n=333), 25% specified guidelines related to weight, and 23% specified guidelines related to energy requirements. CONCLUSIONS: This study highlights many areas in need of further research, and identifies areas in which renal dietitians would like practice guidelines developed or revised. As such, it may have implications for organizations such as the Kidney Foundation and the American Dietetic Association in their efforts to promote consistent, evidence-based practices among dietitians.