Multiple factors affect renal dietitians' use of the NKF-K/DOQI adult nutrition guidelines

Objective: We investigated the components of the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative Nutrition Guidelines that are implemented by renal dietitians and the types of resources and support available to assist in implementing these guidelines. Design and Participants: A 49-item survey was mailed to 1694 dietitians in the United States. who were members of the National Kidney Foundation Council on Renal Nutrition in June 2003. The survey included sections on clinical practice, tools available to perform nutrition assessments, daily activities of the dietitian, and demographic and professional questions. Results: Of the 1694 surveys mailed, 951 were returned (56% response rate); 848 were useable (89%). The primary employer was for-profit dialysis units (67%) and the mean (+/- SD) number of patients per dietitian was 104.9 +/- 48.3. Virtually all of the dietitians were aware of the nutrition guidelines (97%); 58% read all of the guidelines, whereas only 41% read some of the guidelines. Ninety-two percent of respondents implemented at least one guideline in their clinical practice; 72% and 55% had implemented 5 and 10 guidelines, respectively; but only 5% implemented all of the guidelines. Several barriers to implementation included lack of tools such as computers, calipers, and food models (57%); inadequate time including high dietitian-to-patient ratios (40%); and lack of administrative support from the dialysis unit (29%). Conclusions: There are multiple barriers that prevent the adequate assessment of the nutritional status of dialysis patients. Only after these resources are provided will it be possible to determine the impact of the nutrition guidelines on patient outcomes. (c) 2005 by the National Kidney Foundation, Inc.