Evaluating the Implementation of Evidence-based Kidney Nutrition Practice Guidelines: The AUGmeNt Study Protocol

Abstract

Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs.Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs. Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian Introduction and PurposeChronic kidney disease (CKD) is one of the leading causes of death in the United States, impacting the lives of 37 million adults.1National Kidney FoundationFacts About Chronic Kidney Disease.https://www.kidney.org/atoz/content/about-chronic-kidney-diseaseDate: 2020Date accessed: October 30, 2020Google Scholar,2Center for Disease Control and PreventionChronic Kidney Disease Basics | Chronic Kidney Disease Initiative | CDC.https://www.cdc.gov/kidneydisease/basics.htmlDate: 2020Date accessed: October 30, 2020Google Scholar CKD grade 5 with kidney replacement therapy via dialysis3Levey A.S. Eckardt K.U. Dorman N.M. et al.Nomenclature for kidney function and disease: report of a kidney disease: Improving global outcomes (KDIGO) consensus conference.Kidney Int. 2020; 97: 1117-1129Abstract Full Text Full Text PDF PubMed Scopus (224) Google Scholar (CKD G5D) affects approximately 720,000 people in the United States4United States Renal Data SystemUS Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2019https://www.usrds.org/2019/view/USRDS_2019_ES_final.pdfDate accessed: July 1, 2020Google Scholar and causes high mortality rates, especially for patients aged 65 years and older.5United States Renal Data SystemChapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018https://www.usrds.org/2018/view/v2_01.aspxDate accessed: July 1, 2020Google ScholarRegistered dietitian nutritionists (RDNs) play an integral role in the multidisciplinary team treating individuals on dialysis, helping to minimize complications and improve patient outcomes by preventing and treating protein-energy wasting, mineral and electrolyte disorders, and other metabolic comorbidities associated with CKD.6Ikizler T.A. Burrowes J.D. Byham-Gray L.D. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar,7Evidence Analysis LibraryEAL-KDOQI (CKD) guideline.https://www.andeal.org/topic.cfm?menu=5303&cat=5557Date: 2020Date accessed: October 30, 2020Google Scholar RDNs provide medical nutrition therapy based on the four-step nutrition care process (NCP)—assessment, diagnosis, intervention, and monitoring/evaluation.8Kent P.S. McCarthy M.P. Burrowes J.D. et al.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.J Acad Nutr Diet. 2014; 114: 1448-1457.e1445Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar,9Swan W.I. Vivanti A. Hakel-Smith N.A. et al.Nutrition care process and model update: toward realizing people-centered care and outcomes Management.J Acad Nutr Diet. 2017; 117: 2003-2014Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar To guide RDN practice within the NCP framework, the Academy of Nutrition and Dietetics’ (Academy) Evidence Analysis Center publishes evidence-based nutrition practice guidelines (EBNPGs). EBNPGs are structured as per the NCP and developed based on systematic reviews.10Handu D. D. A. the Academy to evidence-based Acad Nutr Diet. Full Text Full Text PDF PubMed Scopus Google A. D. Academy of nutrition and dietetics for evidence-based nutrition practice Acad Nutr Diet. 2017; 117: Full Text Full Text PDF PubMed Scopus Google Scholar a the Academy and the National Kidney the EBNPG for CKD to provide evidence-based for the nutrition care of patients with CKD.6Ikizler T.A. Burrowes J.D. Byham-Gray L.D. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar,7Evidence Analysis LibraryEAL-KDOQI (CKD) guideline.https://www.andeal.org/topic.cfm?menu=5303&cat=5557Date: 2020Date accessed: October 30, 2020Google development of EBNPGs based on systematic a of and by the A. D. Academy of nutrition and dietetics for evidence-based nutrition practice Acad Nutr Diet. 2017; 117: Full Text Full Text PDF PubMed Scopus Google Scholar and and the impact of is the EBNPGs are by are RDNs of knowledge of the and of implementation and of is implementation | implementation 2020Date accessed: October 30, 2020Google Scholar or can guideline the implementation of clinical guidelines for care a systematic PubMed Scopus Google Scholar to the implementation of clinical practice T.A. et clinical practice guideline implementation a of systematic by the implementation 2017; PubMed Scopus Google A. and in guideline Scopus Google Scholar on guidelines for other care as and is an to implementation of guidelines for nutrition care and a of EBNPG implementation improve patient and care of guideline on a implementation Acad Nutr Diet. Full Text Full Text PDF PubMed Scopus Google Scholar the Academy to training for and of EBNPG and the impact of EBNPGs on practice and nutrition-related and of for in Renal Nutrition study is a hybrid effectiveness-implementation hybrid PubMed Scopus Google Scholar with a quasi-experimental and for accessed: 2020Google Scholar with RDNs nutrition care to individuals hemodialysis The implementation of the study is to congruence of NCP documentation the Academy of Nutrition and Dietetics Health Informatics Infrastructure with nutrition care in the implementation is to common RDN-reported acceptability, adoption, and adaptation with the an is to the feasibility of estimating the impact of RDN care is with the EBNPG on nutrition-related outcomes for patients on is being to and of and provide on and as implementation is an in nutrition J.D. study 2014; PubMed Scopus Google et and of to in 2017; Scopus Google AUGmeNt study is a hybrid effectiveness-implementation in there are a to an EBNPG implementation and the clinical of care with hybrid PubMed Scopus Google Scholar and aims will using a quasi-experimental and for accessed: 2020Google Scholar RDNs will document initial and follow-up nutrition care for a randomly of patients for and will randomly assigned to one of EBNPG training training or a RDNs will document initial and follow-up nutrition care for a randomly of patients for RDN and in RDN and RDN with EBNPG implementation will via an RDN The study in and is to by and is by the Academy of Nutrition and Dietetics the Renal and a The study by the of Health hemodialysis will to the via an or a of to the patient nutrition care is the based on the for on or for or in of Health and accessed: October 30, 2020Google Scholar To the standards for the the of the individuals are are to the and clinical are or with RDNs will a document before to study of EBNPG training the of the EBNPG to nutrition care for individuals on training is with RDNs an EBNPG is in this a developed by the Academy and an of as as a of the EBNPG developed by the training the plus to the EBNPG implementation toolkit. of the and of the CKD consensus with as dialysis and the Evidence Analysis Center guideline to for patients on dialysis as the implementation for this to the with being to (1) in kidney nutrition guidelines CKD EBNPGs or the Kidney Disease Initiative Disease clinical practice guidelines for nutrition in chronic National Kidney accessed: October 30, 2020Google Analysis kidney disease (CKD) accessed: October 30, 2020Google Scholar implementation (2) for the and by of nutrition and patient the CKD and a to and to implementation medical and by and the RDN knowledge and patient knowledge and medical clinical and The and the to a of and of to for of the et of guidelines for clinical practice in of the Academy of Nutrition and Full Text Full Text PDF Google the chronic kidney disease evidence-based nutrition practice T.A. Burrowes J.D. Byham-Gray L.D. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar,7Evidence Analysis LibraryEAL-KDOQI (CKD) guideline.https://www.andeal.org/topic.cfm?menu=5303&cat=5557Date: 2020Date accessed: October 30, 2020Google the chronic kidney disease evidence-based nutrition practice T.A. Burrowes J.D. Byham-Gray L.D. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar,7Evidence Analysis LibraryEAL-KDOQI (CKD) guideline.https://www.andeal.org/topic.cfm?menu=5303&cat=5557Date: 2020Date accessed: October 30, 2020Google to an implementation a training on implementation and a and The of the implementation and training are to provide the training with of the of to and to of in and to and implementation The implementation the process et and accessed: October 30, 2020Google Scholar is an on people and and developed by the Institute for for 2020Date accessed: October 30, 2020Google Scholar The implementation training with a study the implementation of one CKD by an of the implementation is an to and team of implementation and RDN and study will include RDNs hemodialysis clinics the United States. 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The study will provide RDNs to EBNPG acceptability, adoption, and can to future implementation and to the EBNPG for development of future nutrition Introduction and PurposeChronic kidney disease (CKD) is one of the leading causes of death in the United States, impacting the lives of 37 million adults.1National Kidney FoundationFacts About Chronic Kidney Disease.https://www.kidney.org/atoz/content/about-chronic-kidney-diseaseDate: 2020Date accessed: October 30, 2020Google Scholar,2Center for Disease Control and PreventionChronic Kidney Disease Basics | Chronic Kidney Disease Initiative | CDC.https://www.cdc.gov/kidneydisease/basics.htmlDate: 2020Date accessed: October 30, 2020Google Scholar CKD grade 5 with kidney replacement therapy via dialysis3Levey A.S. Eckardt K.U. Dorman N.M. et al.Nomenclature for kidney function and disease: report of a kidney disease: Improving global outcomes (KDIGO) consensus conference.Kidney Int. 2020; 97: 1117-1129Abstract Full Text Full Text PDF PubMed Scopus (224) Google Scholar (CKD G5D) affects approximately 720,000 people in the United States4United States Renal Data SystemUS Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2019https://www.usrds.org/2019/view/USRDS_2019_ES_final.pdfDate accessed: July 1, 2020Google Scholar and causes high mortality rates, especially for patients aged 65 years and older.5United States Renal Data SystemChapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modalities. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018https://www.usrds.org/2018/view/v2_01.aspxDate accessed: July 1, 2020Google ScholarRegistered dietitian nutritionists (RDNs) play an integral role in the multidisciplinary team treating individuals on dialysis, helping to minimize complications and improve patient outcomes by preventing and treating protein-energy wasting, mineral and electrolyte disorders, and other metabolic comorbidities associated with CKD.6Ikizler T.A. Burrowes J.D. Byham-Gray L.D. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar,7Evidence Analysis LibraryEAL-KDOQI (CKD) guideline.https://www.andeal.org/topic.cfm?menu=5303&cat=5557Date: 2020Date accessed: October 30, 2020Google Scholar RDNs provide medical nutrition therapy based on the four-step nutrition care process (NCP)—assessment, diagnosis, intervention, and monitoring/evaluation.8Kent P.S. McCarthy M.P. Burrowes J.D. et al.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.J Acad Nutr Diet. 2014; 114: 1448-1457.e1445Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar,9Swan W.I. Vivanti A. Hakel-Smith N.A. et al.Nutrition care process and model update: toward realizing people-centered care and outcomes Management.J Acad Nutr Diet. 2017; 117: 2003-2014Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar To guide RDN practice within the NCP framework, the Academy of Nutrition and Dietetics’ (Academy) Evidence Analysis Center publishes evidence-based nutrition practice guidelines (EBNPGs). EBNPGs are structured as per the NCP and developed based on systematic reviews.10Handu D. D. A. the Academy to evidence-based Acad Nutr Diet. Full Text Full Text PDF PubMed Scopus Google A. D. Academy of nutrition and dietetics for evidence-based nutrition practice Acad Nutr Diet. 2017; 117: Full Text Full Text PDF PubMed Scopus Google Scholar a the Academy and the National Kidney the EBNPG for CKD to provide evidence-based for the nutrition care of patients with CKD.6Ikizler T.A. Burrowes J.D. Byham-Gray L.D. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107Abstract Full Text Full Text PDF PubMed Scopus (365) Google Scholar,7Evidence Analysis LibraryEAL-KDOQI (CKD) guideline.https://www.andeal.org/topic.cfm?menu=5303&cat=5557Date: 2020Date accessed: October 30, 2020Google development of EBNPGs based on systematic a of and by the A. D. Academy of nutrition and dietetics for evidence-based nutrition practice Acad Nutr Diet. 2017; 117: Full Text Full Text PDF PubMed Scopus Google Scholar and and the impact of is the EBNPGs are by are RDNs of knowledge of the and of implementation and of is implementation | implementation 2020Date accessed: October 30, 2020Google Scholar or can guideline the implementation of clinical guidelines for care a systematic PubMed Scopus Google Scholar to the implementation of clinical practice T.A. et clinical practice guideline implementation a of systematic by the implementation 2017; PubMed Scopus Google A. and in guideline Scopus Google Scholar on guidelines for other care as and is an to implementation of guidelines for nutrition care and a of EBNPG implementation improve patient and care of guideline on a implementation Acad Nutr Diet. Full Text Full Text PDF PubMed Scopus Google Scholar the Academy to training for and of EBNPG and the impact of EBNPGs on practice and nutrition-related and of for in Renal Nutrition study is a hybrid effectiveness-implementation hybrid PubMed Scopus Google Scholar with a quasi-experimental and for accessed: 2020Google Scholar with RDNs nutrition care to individuals hemodialysis The implementation of the study is to congruence of NCP documentation the Academy of Nutrition and Dietetics Health Informatics Infrastructure with nutrition care in the implementation is to common RDN-reported acceptability, adoption, and adaptation with the an is to the feasibility of estimating the impact of RDN care is with the EBNPG on nutrition-related outcomes for patients on is being to and of and provide on and as implementation is an in nutrition J.D. study 2014; PubMed Scopus Google et and of to in 2017; Scopus Google Scholar

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