A study describes the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Nutritional management for patients on haemodialysis (HD) aims to optimise nutritional status, improve quality of life by minimising symptoms and complications related to excess dietary intake, and empower patients to manage their dietary needs.

Clinicians are tasked to manipulate individual dietary components, including protein, potassium, phosphorus, sodium and fluid, promote general healthy eating, and simultaneously take into consideration comorbid (eg, diabetes, obesity) dietary needs, and patients are expected to adhere to these complex requirements.

Non-compliance to dialysis treatment is associated with higher symptom burden, increased medical complications, reduced quality of life and approximately 30% higher risk of death, with non-compliance to diet and fluid restrictions higher (30%–50% of patients) than for other elements of treatment. 

Renal multidisciplinary teams, comprising nephrologists, nurses and dietitians, play a pivotal role in providing nutritional counselling. Thus, there is a need to understand health professionals’ beliefs and attitudes regarding nutritional management within the context of clinical care.

Renal clinicians regarded nutritional management as an important component of care in HD that required individualised strategies through integrating personal, social and cultural circumstances of patients. They emphasised the need to support patients in developing self-efficacy and self-management skills to become autonomous and take ownership of their dietary management.

However, ineffective multidisciplinary team communication and splintered interteam dynamics, coupled with inadequate staffing and resources, were barriers to implementing behaviour change strategies and also perpetuated conflicting advice and patient confusion.

They also found it challenging when patients were perceived to lack motivation to make dietary changes, which they attributed to difficulties in comprehension of complex concepts, poor access to healthy food, low education attainment, financial constraints and the absence of social support.

Shared care and access to dietary experts were seen to facilitate patients’ understanding and acceptance of the renal diet and helped to develop and maintain motivation. Clinicians reported being significantly challenged and frustrated by patients’ perceived lack of motivation and resistance to dietary change.

Clinicians working in peritoneal dialysis and kidney transplantation have similarly reported they believe that poor dietary and lifestyle habits hinder effective treatment, while intrinsic motivation and support from social networks enabled behaviour change.

Developing motivation and engaging patients and their families are particularly important in HD as diet and fluid regimens are more restrictive than for other treatments. Renal clinicians in our study felt that comprehensive counselling with an experienced dietitian was an important element of care and helped to motivate patients to make appropriate dietary changes.