Nutritional management of CKD patients: Perspectives from French nephrologists and dietitians

Abstract

Background: Nutritional recommendations exist in France for patients with chronic kidney disease (CKD) to help slow its progression. However, how health care professionals (HCPs) perceive and implement these recommendations is unknown at the national level.

Objective: This study aimed to document the practices and perceptions of HCPs providing nutritional care to patients with CKD.

Methods: In September 2024, two anonymous online questionnaires were distributed: one to approximately 1400 nephrologists via the Société francophone de néphrologie, dialyse et transplantation (Francophone Society of Nephrology, Dialysis and Transplantation), and the other to approximately 165 dietitians via the Association des diététiciens de néphrologie et nutrition (Association of Nephrology and Nutrition Dietitians). Data collected included respondent characteristics, training in renal nutrition, use of low-protein diets (LPDs), perceived effectiveness and patient adherence, as well as perceived barriers.

Results: A total of 178 nephrologists (19% trained in renal nutrition) and 127 dietitians (59% trained) responded. Between 50% and 75% considered LPDs to be effective. These diets were mainly prescribed to patients with stage 3 to 5 CKD, perceived as motivated and aware of the importance of slowing CKD progression. According to HCPs, about half of patients initiate an LPD, but only 15% to 30% of HCPs believe that as many as half of these patients actually achieve protein intake targets. The main barriers identified were difficulty in changing dietary habits, lack of understanding, concerns about impacting household routines, lack of educational resources, and the absence of reimbursement for specialized products.

Conclusion: HCPs acknowledge the value of LPDs in the nutritional management of CKD, but several barriers hinder their broader implementation and effectiveness.