When Alexandra Lautenschleger, RDN, LD, consulted a Patient with end-stage renal disease starting dialysis, she realized she had come a long way.

“Patients starting dialysis have already experienced the trauma of realizing that their kidneys are no longer working efficiently. They have to handle new access.

Lautenschleger, a nutritionist at Dialysis Clinic Inc., told Healio/Nephrology News & Issues. “They also have to deal with the new burdens this will place on their families.

“They don’t want to hear anymore about things they can’t do anymore.” Especially about restrictions on products that many people enjoy and that are part of their heritage and lifestyle.

For Lautenschläger of Spartanburg, South Carolina, this means working with patients who love the rich Southern Food.

Faced with resistance to change, she said she began revising handouts to focus on informing patients “what they can and cannot eat.”

She works with the local food co-op, U.S. Department of Agriculture Farms for Families and Hub City Farmers Market Mobile Markets are designed to help patients living in “food deserts” (areas with limited access to healthy foods) in Spartanburg and nearby cities get fresh fruits and vegetables. help

“If they can eat healthier and have access to foods that they can include in their renal diet that they want to eat, it’s a win-win for both us and our patients,” she said.

Loss of Control:

Healio/Nephrology News & Problems said patients may struggle “even with the thought of changing their diet.”

I am trying to present it as a choice. “It is important to understand that you may lose control once you start dialysis. They can feel helpless,” said Pace. “The tipping point for them may be a change in diet.” Fluid overload can be one of the most difficult to control.

Pace provides each new patient with a plastic bottle with measurements so that fluid intake can be tracked and controlled. But no matter how well-informed you are about the dangers of too much bodily fluid every now and then, Pace will know when to stop progressing.

Then she, along with the dietitian, can use a “structured pause” that allows the patient to take a break from certain dietary changes.

“It’s a chance to miss for a while. “We talked every month about the dangers of fluid overload.
Let’s just rest.” I told my patients

“I was worried about the results the first time I tried it. What if the progress we made disappears?” said Pace.

“But often the patient comes back after a month and starts talking about it again. “It means they are showing that they want to take back control of their health.”

One of the challenges in encouraging patients to change their diet is early education before kidney failure develops. Medical Diet (MNT) is a Medicare-covered benefit for people with stage 3-5 chronic kidney disease.

“Less than 18% of patients who get Medicare and are eligible for nutritional therapy benefits do so,” Pace said. MNT “can provide personalized, personalized care that Google can’t,” Pace said.
“In our industry, this is an opportunity to provide a personal connection.”

Motivational Interviewing:

Part of the Pace practice is the Motivational Interview (MI). Involve patients in treatment protocols and “buy in” the idea of ​​changing their behavior.

DaVita Kidney Care’s Senior Nutrition Manager, Jamie Freleng, RD, LD, is an instructor for the DaVita Engaging Patients In The Care (EPIC) program. She participated in MI training for 2,100 nutritionists through EPIC.

“The goal of MI and EPIC is to improve patient interaction,” Freleng told Healio/Nephrology News & Issues. “We want to work with patients and work with them to follow nutrition guidelines they can live with,” she said.

When Freleng joined DaVita, she already had eight years of experience teaching and advising patients on renal diets. “At first, I practiced very traditionally with my patients,” she says. I met with them and their lab and told them what they needed to do to improve the results,” said Freleng.

“Then she was introduced to motivational training and patient counseling. Through extensive research and education, he has shown that my approach does not really work for patients who are not yet motivated to change.”

With EPIC and motivational interviews, “we put a lot of emphasis on the basics,” said Freleng. “Participation is one of those foundations. It’s important to get to know the patient to find a connection and establish mutual understanding,” said Freleng.

MI’s key principles include partnership, acceptance, compassion and resurgence, wrote members of DaVita Clinical Research in their 2020 abstract.

“While each coaching session is tailored to the individual and their needs, there is guidance toward a targeted goal and structure to each session,” the researchers wrote. “Coding and assessment of recorded clinician-patient sessions using a validated tool provides the only way of establishing staff proficiency in, and adherence to, MI techniques.”

“Education is helpful but without addressing behaviors it is futile,” Rebecca Brosch, MS, RDN, CSR, LD, national senior director of nutrition services for DaVita who helped develop the EPIC program and was a co-author on the clinical research abstract.

“An example is education about smoking. Education is not enough as we see many continue to struggle with smoking cessation.

“Understanding the why and providing support for behavior change is an important aspect for any significant lifestyle change,” Brosch, a Nephrology News & Issues Editorial Advisory Board member, said.

Food insecurity, islands:

Sometimes the challenge of behavioral change is not about education, but environment, sources said. Patients with kidney disease may make poor food choices because of a scarcity of healthy foods to eat.

“The SARS-CoV-2 pandemic has substantially affected the way of life of the general population. The distribution, availability and access to food, and even the food security of households around the world, have all changed.”

Cristina Vargas-Vázquez, BD, RD, from the nephrology and mineral metabolism department at the National Institute of Health Sciences and Nutrition “Salvador Zubirán” in Mexico, and colleagues wrote in a recent article published in the Journal of Renal Nutrition.

In a cross-sectional study, researchers evaluated the prevalence of different degrees of Food Insecurity and its association with sociodemographic and dietary factors in 588 adults with CKD, some with and some without renal replacement therapy, between May and October 2021.

Vargas-Vázquez and colleagues used the Mexican Food Security Scale to measure food security as the following categories: food security, mild food insecurity, moderate food insecurity and severe food insecurity. Patients completed a food frequency questionnaire consisting of 12 yes-or-no questions that were ordered from least to greatest severity.

Analyses revealed more than 70% of patients experienced some degree of food insecurity, with modest insecurity being the most prevalent.

Households reported consuming more beans, eggs, sweets/desserts, soft drinks and artificial juice as food insecurity increased, whereas households with food security reported higher consumption of vegetables, fruits and meats.

Vargas-Vázquez and colleagues identified diabetes, hypertension, unpaid occupation, living in the country’s capital, having children at home or a decrease in income due to the pandemic as risk factors of food insecurity.

“Renal health professionals need to include an assessment of the presence of food insecurity of their patients in their daily professional practice.

The results of these assessments could help improve the implementation of programs that provide food and/or nutritional support to vulnerable populations, which include patients with CKD,” Vargas-Vázquez and colleagues wrote.

Lautenschlaeger understands the fragile balance of motivating patients to spend the time to eat the right things – and still allow for keeping some foods patients like.

“My 19 years of experience has taught me there has to be a balance. Access to good food is important, but patients have to make choices.”

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