Academy of Nutrition and Dietetics Commentary on the Phosphorus Recommendation in the KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 Update.
An Academy of Nutrition and Dietetics commentary highlights that the lower serum phosphate goal recommended in the 2020 KDOQI nutrition guideline is rarely being implemented by renal dietitians, who continue to use higher dialysis-center targets.
Background
The KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 Update recommend adjusting dietary phosphorus to maintain a serum phosphate goal in the normal range of 0.81 to 1.45 mmol/L (2.5 to 4.5 mg/dL) for hemodialysis patients. This is lower than the serum phosphate goal of 0.97 to 1.78 mmol/L (3.0 to 5.5 mg/dL) used by many dialysis centers.
Key recommendations
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 were almost universally using dialysis-center goals rather than the lower phosphate goal recommended by the guideline. The commentary discusses possible barriers to implementation and proposes a systems-level approach to promote adoption.
Clinical implications
The commentary issues calls to action for changes in clinician practices, organizational and institutional culture, and government regulations to support adoption of the recommended phosphate goal. It stresses that context and clinical judgment must always guide individualized patient care while encouraging alignment of practice with the updated guideline.
Category
Guidelines
Source
J Ren Nutr
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