A survey of supplementation practices in hemodialysis clinics

Chronic kidney disease (CKD) is a condition that is characterized by a progressive decrease in kidney function. With CKD and hemodialysis treatments come many complications that increase the risk for gaps in nutritional intake. Since renal patients are at increased risk for nutritional deficiencies, they may benefit from the use of dietary supplements. Current standards do exist, but there is much controversy concerning the usage of vitamins and minerals to lower risk for nutritional deficiencies, inflammation, and incidence of cardiovascular disease among this population. The purpose of this study was to examine the supplementation practices of dietitians working with CKD patients receiving hemodialysis. A survey instrument was created to evaluate the practices of supplement use among practitioners in hemodialysis clinics. All statistical analyses were performed using SPSS statistical software (version 16.0). Both frequency and Chi-square analyses were conducted to analyze the data. One hundred and sixty-seven responses were received from professionals from various regions across the United States.
In hemodialysis clinics, dietitians were the primary decision makers when it came to the recommendation of supplements to patients. This information is significant as it demonstrates the important role that the dietitian plays in the treatment of dialysis patients. Cost was identified as a major barrier that patients face in taking appropriate supplements and it is also plays a role in influencing the selection of supplements by nutrition professionals. In addition to identifying what inhibits patients from obtaining supplements, the respondents were also asked to provide feedback regarding what vitamins, minerals, phytochemicals, and/or food components should be found in the ideal renal supplement for hemodialysis patients.
When compared to the “standard†renal vitamins currently on the market, the majority of practitioners indicated that the ideal renal supplement should contain amounts of vitamins C, B-6, B-12, and zinc similar to those found in the currently available formulations. On the other hand, almost half of the practitioners felt that ≥2.5 mg of folic acid should be included in the ideal renal supplement, whereas most supplements currently only contain 0.8-1.0 mg. Selenium and vitamin E are not typically found in the current renal supplements on the market and the majority of the respondents indicated that they would like to see at least the Dietary Reference Intake (DRI) amounts included. Interestingly enough, the professionals who responded to the survey also specified that they would like to see other B-complex vitamins, omega-3 fatty acids, lycopene, lutein, resveratrol, CoQ10, and lipoic acid in a supplement for hemodialysis patients. Outcomes indicate that further research is undeniably needed to explore the “optimal†doses of several vitamins, food components, minerals, antioxidants, and phytochemicals for hemodialysis patients. This study presents typical practices and ideas with regards to the supplementation of hemodialysis patients and has generated further questions that need to be explored.