Maureen McCarthy

Academy of Nutrition and Dietetics and National Kidney Foundation: Revised 2014 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nephrology Nutrition

Compelling evidence indicates that the incidence of chronic kidney disease (CKD) is increasing because of an aging population and a higher prevalence of cardiovascular disease, diabetes, and hypertension. Nutrition management of patients with CKD requires early disease recognition, appropriate interpretation of the markers and stages of CKD, and collaboration with other health care practitioners. Better management of CKD can slow its progression, prevent metabolic complications, and reduce cardiovascular related outcomes. Caring for patients with CKD necessitates specialized knowledge and skills to meet the challenges associated with this growing epidemic. The Academy of Nutrition and Dietetics Renal Dietitians Practice Group and the National Kidney Foundation Council on Renal Nutrition, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, have updated the 2009 Standards of Practice in Nutrition Care and Standards of Professional Performance as a tool for registered dietitian nutritionists working in nephrology nutrition to assess their current skill levels and to identify areas for additional professional development in this practice area. The Standards of Practice apply to the care of patients/clients with kidney disease. The Standards of Professional Performance consist of six domains of professionalism, including: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how nephrology nutrition principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists working in nephrology nutrition.

Hemodialysis prognostic nutrition index as a predictor for morbidity and mortality in hemodialysis patients and its correlation to adequacy of dialysis

OBJECTIVE Prospectively examine the use of a hemodialysis prognostic nutrition index (HD-PNI) as a predictor for morbidity and mortality in hemodialysis patients and its correlation to adequacy of dialysis. DESIGN Prospective randomized collaborative study group. SETTING There were 211 chronic hemodialysis centers; 202 from 43 United States, 9 from Canada. PATIENTS There were 1527 hemodialysis patients undergoing treatment a minimum of 3 months and at least 18 years of age. Sample mirrored United States Renal Data System data for age, sex, race, and etiology of renal failure. INTERVENTIONS None; routinely collected demographic, biochemical, and clinical data for 8-month baseline and 3-month predictive phases. METHODS HD-PNI calculated from baseline data as linear mathematical equation using level of serum albumin, level of serum creatinine, and number of days and times hospitalized; HD-PNI risk defined as >/=0.8. Adequacy of dialysis calculated as urea reduction ratio (URR) from baseline data; adequacy risk defined as URR of </=65%. MAIN OUTCOME MEASURES Number of times and days hospitalized, mortality. RESULTS For this research, 1167 patients completed the study (76%) with 360 (24%) dropped due to death, incomplete data, transfer, or change in modality. Patients completing study with HD-PNI risk (n = 208, 18%) compared with patients who had no HD-PNI risk (n = 959, 82%) were hospitalized more often (57.2% v 28.5%, P <. 01), hospitalized with infection more often (14.6% v 4.6%, P <.01), and had greater mortality (7.7% v 2.5%, P <.01). Stratification of HD-PNI risk by URR of >/=65% did not significantly improve prediction. CONCLUSIONS Use of HD-PNI is an effective screening tool to identify hemodialysis patients at risk for morbidity and mortality. No correlation was found between URR and HD-PNI.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care

The American Dietetic Association (ADA) Renal Dietitians Practice Group (RPG) and the National Kidney Foundation Council on Renal Nutrition (NKF CRN), under the guidance of the ADA Quality Management Committee and Scope of Dietetics Practice Framework Sub-Committee, have developed the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for Registered Dietitians (Generalist, Specialty, and Advanced) in Nephrology Care (Supplementary Figures 1, 2, and 3 are available only online at www.jrnjournal.org). The SOP and SOPP documents are based upon the 2008 Revised Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians (RDs)(1), which are part of ADAs Scope of Dietetics Practice Framework(2). The 2008 Revised SOP in Nutrition Care and SOPP, along with the Code of Ethics(3), guide the practice and performance of RDs in all settings.

American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for Registered Dietitians (generalist, specialty, and advanced) in nephrology care.

The Joint Standards Task Force of the American Dietetic Association Renal Dietitians Dietetic Practice Group and the National Kidney Foundation Council on Renal Nutrition: Deborah Brommage, MS, RD, CSR, CDN; Maria Karalis, MBA, RD, LDN; and Cathi Martin, RD, CSR, LDN: Co-chairs; Maureen McCarthy, MPH, RD, CSR, LD; Deborah Benner, MA, RD, CSR; Catherine M. Goeddeke-Merickel, MS, RD, LD; Karen Wiesen, MS, RD, LD; Laura Byham-Gray, PhD, RD; Jennie Lang House, RD, CSR, LD; Jessie Pavlinac, MS, RD, CSR, LD; Linda McCann, RD, CSR, LD

Body Mass Index and the Development of New-Onset Diabetes Mellitus or the Worsening of Pre-Existing Diabetes Mellitus in Adult Kidney Transplant Patients

OBJECTIVE The purpose of this study was to determine the relationship between body mass index (BMI) and the development of new-onset diabetes after transplant (NODAT) as well as the worsening of pre-existing diabetes mellitus (DM) in adults after kidney transplantation. DESIGN AND SUBJECTS A medical record review was conducted using the records of 204 adult patients who underwent a first renal transplant between September 2009 and February 2011 at a single transplant center. Patients who received simultaneous transplantation of another organ, who were immunosuppressed for nontransplant reasons, or those who were less than 18 years of age were excluded. MAIN OUTCOME MEASURES Outcome data collected at the time of hospital discharge and at 3, 6, and 12 months after kidney transplantation included the development of NODAT and the components of DM treatment regimens. RESULTS The cumulative incidence of NODAT at discharge and 3, 6, and 12 months post-transplantation was 14.2%, 19.4%, 20.1%, and 19.4%, respectively. The odds of developing NODAT by discharge or 3 or 6 months post-transplantation increased by a factor of 1.11 (95% confidence interval [CI]: 1.0-1.23), 1.13 (95% CI: 1.03-1.24), and 1.15 (95% CI: 1.05-1.27), respectively, per unit increase in pretransplantation BMI. The need for more aggressive DM treatment (suggesting a worsening of DM status) was most usually seen between discharge and 3 months; 50% of patients with preexisting DM required more aggressive DM treatment post-transplantation (X3(2) = 13.25; P = .001). CONCLUSION The odds of developing NODAT at discharge and 3 and 6 months post-transplantation increased per unit of pretransplantation BMI. The most common time for NODAT to develop or for preexisting DM to worsen was within 3 months of kidney transplantation.

Computers and the internet: Tools for lifelong learning

Mastery of computer technology and the resources it brings to renal dietitians will be essential for future practice. The Internet, probably the most valuable resource computers bring to clinical practice, is a potential tool to fulfill goals of lifelong learning. A basic introduction to the Internet and a review of search engines and successful search strategies are provided. Major flaws of the Internet include uncertain quality and accuracy of many materials it provides. Guidelines to evaluate World Wide Web (WWW) materials are similar to guidelines dietitians use to assess written materials. The identification of certain anchor WWW sites with reliable information is a key to successful information retrieval on the Internet.

Advance Care Planning: The Dietitian's Role

THIS IS THE first article in a 2-part series, which is intended to promote an appreciation and advocacy of Advance Care Planning (ACP) for Registered Dietitian Nutritionists (RDNs) in nephrology practice. The first articlewill describe the utilization of palliative care and hospice care among end-stage renal disease (ESRD) patients. The second article in this series will describe the RDN’s role as a key advocate of the interdisciplinary team in the ESRD setting at this critical and sensitive stage of patient care. Elderly patients with ESRD often have significant comorbidities and other deficits that affect their quality of life. An increasing awareness of the burden and impact of ESRD on patients and families is stimulating the development of a framework for ACP in ESRD care. The goal of ACP is to encourage more open discussions involving the complex decisions that relate to the initiation and the withdrawal of dialysis; and the Renal Physicians Association (RPA) has produced valuable resources including guidelines and tools for addressing the complexities of end-of-life decision-making in ESRD patients.

Words of Caution Regarding Research Design When Using the Nutrition Care Process Model

THE NUTRITION CARE Process (NCP), first introduced in 2003, provides a well-defined framework and a standardized terminology to guide Registered Dietitian Nutritionists (RDNs) in planning nutrition care. It has become the central component of standards of practice for the profession of nutrition and dietetics, as presented in Standards of Practice for Nutrition Care and Standards of Professional Performance for Registered Dietitians. The most recent update of the Standards of Practice for Nutrition Care and Standards of Professional Performance for Nephrology Nutrition, published jointly by the National Kidney Foundation and the Academy of Nutrition and Dietetics, adapts the NCP framework for RDNs who provide care to individuals with chronic kidney disease. The standardized terminology for the NCP continues to be updated regularly, with the most recent edition published in 2012. This issue of Journal of Renal Nutrition includes a report on the development and implementation of a renalmodified NCP which is intended to enhance nutrition care planning and outcomes data collection for RDNs in nephrology nutrition. This effort to facilitate data collection is exciting for 2 reasons. First, a major goal of the NCP Model is to support outcomes management systems, which allow RDNs to analyze the results of nutrition intervention for comparison with accepted benchmarks. And second, nephrology nutrition has much to gain from research that uses standardized terminology to describe nutrition care in a consistent manner so that outcomes can be reported and compared in a cross-section of existing practice settings.

Advance Care Planning: The Dietitian's Role (Part 2)

THIS ARTICLE IS part 2 in a series that focuses on nutrition in the advance care planning (ACP) process for individuals with end-stage renal disease (ESRD). It will focus on and address issues related to nutrition at the end of life. Part 1 described characteristics of ESRD patients, risk factors for poor outcomes, and provided some useful communication reference tools that can be used for this population.

Bookmark these favorites: a guide to getting started on the internet

THOUGH IT MAY HAVE BEEN incomprehensible even 10 years ago, hardly a day goes by in the workplace without some reference to a site on the Internet. Tables 1-5 present some of the most frequently used sites for renal dietitians, all of which were last accessed on July 10, 2003. In some cases, under the uniform resource locator (URL), information is provided about the source or sponsor of the particular site because this can help in assessing the quality of information provided. In other cases, the source is obvious (as with .gov sites) and no additional information is provided. Because the Internet is an ever-changing, evergrowing resource, professionals must be prepared for sites to change or disappear. For this reason, it is essential to be familiar with major search engines, such as www.google.com or alltheweb. com. Under the menu item “Services and Tools” on the Google home page, there is an abundance of information to help you use this powerful tool to your advantage. Finally, learn how to bookmark and organize preferred web sites. This will vastly improve the value of the Internet in the workplace.