FO009
PRIORITIES OF NUTRITIONAL ISSUES IN NON-DIALYSIS CKD ACCORDING TO STAKEHOLDERS

INTRODUCTION: Several concerns in renal nutrition still remain ill defined. This study was aimed at evaluating the clinical priority given to major nutritional topics in non-dialysis CKD according to the perspective of the Stakeholders involved in the CKD care, in order to finally develop worldwide applicable clinical statements.

METHODS: A web-based survey in six languages, English, Spanish, French, German, Italian, Portuguese, exploring clinical topics on CKD nutrition, was launched around the world. The topics were selected by mean of a multistep, rigorous process. First, a literature review on nutrition in non-dialysis CKD was performed using the Cochrane Central Register (1.238 papers) plus 8 guidelines, 1 narrative review and 2 consensus papers; a facilitator and a co-facilitator independently selected pertinent papers (n: 302 and 287, respectively) and highlighted the keywords related to nutrition; after removing duplicates and merging the selections, it resulted a list of 180 keywords. Second, the keyword list was submitted to an inner circle of experts (n=9) for critical review, asking to select the most relevant keywords, to remove the non-relevant and to merge the words whenever possible working in a blinded fashion; the single lists went back to the facilitator (1st round Delphi); this process was repeated (2nd round Delphi) to obtain a final list of 50 keywords; to go beyond only the expert nephrologist opinion, the list was submitted to selected Stakeholders (dietitians, nurses, patients; n=105), asking to implement it with lacking topics; finally, a list of 60 keywords grouped in 5 categories and 11 sub-categories was obtained by face-to-face comparisons among the facilitator, the co-facilitator and two methodologists. The final list was used for the survey. Stakeholders in CKD care around the world were invited to the survey to rate the priority (importance) of the topics according the personal perspective by mean of 9-point Likert scale (1-3, limited importance; 4-6, important, but not critical; 7-9, critical importance).

RESULTS: Three weeks after the launch (further 3 recall have been planned at 3 weeks interval each), 256 subjects completed the survey (74% connections) in 11,3 min. Responders were 72% physicians, 17% dietitians, 9% nurses, 2% patients and 76% were from Europe. The educational level was high (55% University; 42% professional degree) and half subjects worked in academic centers, most with either pre-dialysis (95%) or dialysis (96%) or kidney transplanted patients (78%). 29 out of 60 item reached the threshold of 75% of agreement (high priority) for all groups. All Stakeholders strongly agreed with topics related to the need of support for patients in the choice and personalization of the diet. Low priority was given to dietary phosphorous sources, simple sugar restriction, fiber intake and energy restriction for overweight.

CONCLUSIONS: Preliminary results of a worldwide survey on nutritional priorities in non-dialysis CKD evidence an high, largely shared interest of all the Stakeholders in the CKD care on the support to the patient for the choice and the personalization of the nutritional treatment according to its needs; in contrast, the interest on some major nutritional topics in CKD, such as phosphorus, simple sugar, fibers and energy seem to be quite low and different among Stakeholders.