Supplemental Material
Appendix 1: Global Kidney Nutrition Care Atlas Questionnaire.
Supplemental Table 1: Detailed response rates to individual nutrition questions.
Supplemental Figure 1A: Availability of dietary counseling by a person trained in nutrition (this include renal dietitians, general dietitians, nutritionists, or nutrition technicians) for different ISN regions.
Supplemental Figure 1B: Kidney dietitian practice settings for different ISN regions.
Supplemental Figure 1C: Kidney nutrition care availability for nondialysis CKD versus dialysis patients for different ISN regions.
Supplemental Figure 1D: Personnel other than dietitians involved in kidney nutrition care across different ISN regions.
Supplemental Figure 2A: Doing formal assessment of nutrition status across ISN regions.
Supplemental Figure 2B – 2E: Use of different nutrition assessment tools across ISN regions:
(B) body weight, (C) serum albumin, (D) skinfold anthropometry, and (E) body mass index across ISN regions.
Supplemental Figure 3A – 3B: (A) Oral nutrition supplements availability, and (B) cost coverage in inpatient and outpatient setting across ISN regions.
Supplemental Figure 4A – 4C: Formal feedback to nephrologists on: (A) findings of nutrition
assessment, (B) dietary prescription to CKD patients, and (C) dietary adherence of CKD patients,
across ISN regions.
Appendix I
C3. Nutritional services
C3.1. Please indicate the availability of the following nutritional services for kidney care in your country, where 'Generally available' means: in 50% or more centres (hospitals or clinics) and 'Generally not available' means: in less than 50% of centres (hospitals or clinics)
Nutritional issues
Generally available
Generally not available
Never Unknown
C3.1.1 Dietary counselling by a person trained in nutrition (for example, a dietitian)
C3.1.2 Measurement of serum albumin
C3.1.3 Use of anthropometry for nutritional assessment (changes in body weight)
C3.1.4 Use of anthropometry for nutritional assessment (skin fold assessment)
C3.1.5 Use of anthropometry for nutritional assessment (body mass index)
C3.1.6 Oral nutrition supplements (for example, vitamins, oral meal supplements)
C3.2. Are dietitians or dietitians specialized in renal nutrition (renal dietitians) available for consultation in your country?
Yes No Unknown
C3.2.1 If there are dietitians/renal dietitians in your country, in which settings are they available for consultation? (please check all that apply)
• Inpatient setting
• Outpatient clinic/office setting
C3.2.2 If there are dietitians/renal dietitians in your country, which patients are eligible for consultation?
(please check all that apply)
• Non-dialysis CKD patients
• Dialysis patients
C3.2.3. If there are dietitians/renal dietitians in your country that offer services in inpatient settings, how much does it usually cost (USD) patients directly (out-of-pocket expenses) for each consultation (encounter)?
Textbox
C3.2.4 If there are dietitians/renal dietitians in your country that offer services in outpatient settings, how much does it usually cost (USD) patients directly (out-of-pocket expenses) for each consultation (encounter)?
Textbox
C3.2.6. How often is there formal communication between nutritional counsellors and nephrologists in your country that centre around these issues:
Always Often Sometimes Never Unknown
C3.2.6.1 Prescriptions to CKD patients C3.2.6.2 Dietary adherence and suggested changes
C3.2.7. Is there formal assessment of nutritional status in patients with CKD (including ESKD)?
Yes No Unknown
C3.2.7.1. If there is a nutritional assessment, how often are nephrologists informed of the findings of nutritional assessments?
1) Never 2) Sometimes 3) Often 4) Usually 5) Always
C3.3 Do personnel other than dietitians give dietary counselling to CKD patients in your country?
Yes
No Unknown
C3.3.1 If yes, who provides most of the dietary counselling to CKD patients? (please select the most appropriate response)
Nephrologists
Non-nephrologist physicians Nurses
Nutritional technicians Other
C3.5. In which settings are oral nutrition supplements (ONS) provided free of charge to patients?
• C3.5.1 Inpatient? Yes or no
• C3.5.2 Outpatient clinic/office? Yes or No
Supplemental Table 1. Detailed response rates to individual nutrition questions.
NIS, Newly Independent States; Data expressed as number (%) of countries responded to the survey.
C3.1 Availability nutritional services for kidney care
C3.2 dietitians/rena l dietitians availability
C3.2.1 dietitians practice setting
C3.2.2 dietitians care available for non-dialysis- CKD and dialysis patients
C3.2.6.1 prescriptions to CKD patients
C3.2.6.2 dietary adherence
C3.7 formal assessmen t of nutritional status
C3.7.1 feedback to nephrologist s
C3.3 personne l other than dietitians
C3.3.1 who provides most of the dietary counsellin g to CKD patients
C3.5.1 inpatient settings for oral nutrition supplement s (ONS)
C3.5.2 outpatient settings for oral nutrition supplement s (ONS)
Overall 155(96.9) 155(96.9) 155(96.9) 155(96.9) 74(98.7) 74(98.7) 155(96.9) 82(98.8) 155(96.9) 131(100) 155(96.9) 155(96.9)
ISN regions:
-Africa 41(97.6) 41(97.6) 41(97.6) 41(97.6) 8(100) 8(100) 41(97.6) 9(100) 41(97.6) 31(100) 41(97.6) 41(97.6)
-Eastern & Central
Europe 19(100) 19(100) 19(100) 19(100) 6(100) 6(100) 19(100) 13(100) 19(100) 17(100) 19(100) 19(100)
-Latin America & the
Caribbean 18(100) 18(100) 18(100) 18(100) 10(90.9) 10(90.9) 18(100) 10(100) 18(100) 15(100) 18(100) 18(100)
-Middle East 11(100) 11(100) 11(100) 11(100) 8(100) 8(100) 11(100) 10(100) 11(100) 11(100) 11(100) 11(100)
-NIS & Russia 7(70) 7(70) 7(70) 7(70) - - 7(70) 3(100) 7(70) 6(100) 7(70) 7(70)
-North American 9(90) 9(90) 9(90) 9(90) 5(100) 5(100) 9(90) 5(100) 9(90) 7(100) 9(90) 9(90)
-North and East Asia 7(100) 7(100) 7(100) 7(100) 5(100) 5(100) 7(100) 6(100) 7(100) 6(100) 7(100) 7(100)
-Oceania & South East
Asia 15(100) 15(100) 15(100) 15(100) 8(100) 8(100) 15(100) 8(100) 15(100) 13(100) 15(100) 15(100)
-South Asia 7(100) 7(100) 7(100) 7(100) 5(100) 5(100) 7(100) 4(100) 7(100) 7(100) 7(100) 7(100)
-Western Europe 21(100) 21(100) 21(100) 21(100) 19(100) 19(100) 21(100) 14(93.3) 21(100) 18(100) 21(100) 21(100)
World Bank Groups:
-Low income 22(95.7) 22(95.7) 22(95.7) 22(95.7) 2(100) 2(100) 22(95.7) 4(100) 22(95.7) 16(100) 22(95.7) 22(95.7)
-Lower-middle income 35(92.1) 35(92.1) 35(92.1) 35(92.1) 7(100) 7(100) 35(92.1) 14(100) 35(92.1) 33(100) 35(92.1) 35(92.1)
-Upper-middle income 41(100) 41(100) 41(100) 41(100) 21(95.5) 21(95.5) 41(100) 22(100) 41(100) 33(100) 41(100) 41(100)
-High income 57(98.3) 57(98.3) 57(98.3) 57(98.3) 44(100) 44(100) 57(98.3) 42(97.7) 57(98.3) 49(100) 57(98.3) 57(98.3)
Supplemental Figure 1A. Availability of dietary counseling by a person trained in nutrition (this include renal dietitians, general dietitians, nutritionists, or nutrition technicians) for different ISN regions.
Supplemental Figure 1B. Dietitians/renal dietitians practice settings for different ISN regions.
42
15
32
39
73
0
44
71
47
71
81
43
17 21
56 55
0
56 57
47
71
90
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall Africa E & C Europe
Latin America
Middle East
NIS &
Russia
North America
N & E Asia
OSEA South Asia
Western Europe Inpatient setting Outpatient clinic/office setting
59 29
37
67 82 29
100 71
67 71
95
37 61
63
33 9 57
29 33 14
5 3 10
14
14 1
9
0% 20% 40% 60% 80% 100%
Overall Africa E & C Europe Latin America Middle East N & E Asia NIS & Russia North America OSEA South Asia Western Europe
Generally available Generally not available Never Unknown
Supplemental Figure 1C. Nutrition care availability for nondialysis CKD versus dialysis patients in different ISN regions.
43
17
26
39
55
0
56
71
53
71
86
48
20
32
61
73
0
56
71
53
71
90
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Overall Africa E & C Europe
Latin America
Middle East
NIS &
Russia
North America
N & E Asia
OSEA South Asia
Western
Europe
Non-dialysis CKD patients Dialysis patients
Supplemental Figure 1D. Personnel other than dietitians involved in kidney nutrition care across different ISN
regions.
51
76 76 44
61 71 46
33 29
100 73
80 88 48
63
6 25
14 8
13
5
47
21 15 25 39
14 38
67 71
18 13
12 35
30
3 3 6 8
7 3
2
2 9
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
High income Upper middle income Lower middle income Low income Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa Overall
Nephrologists Non-nephrologist physicians Nurses Nutritional technicians Other
Supplemental Figure 2A. Doing formal assessment of nutrition status across different ISN regions.
Supplemental Figure 2B. Use of different nutrition assessment tools: body weight across different ISN regions.
71 57 53
86 56
43
91 56
68 22
14 43 47
14 33
57
9 39
32 71
14 11
6 7
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa
Yes No Unknown
90 71
80
100 67
86 73 72
84 66
5 29 7 11
14 18
28 16 27
13 22
7
5 9
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa
Generally available Generally not available Never Unknown
Supplemental Figure 2C. Use of serum albumin across different ISN regions.
Supplemental Figure 2D. Use of skinfold anthropometry across different ISN regions.
100 71
100 100 100 100 91 89
100 80
29 11 20
9
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa
Generally available Generally not available Unknown
62 29
33
71 11
43 18
44 42 39
33 57
47
29 56
43 64
56 47 46
14 13 33
14 9
15
5 7 9 11
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa
Generally available Generally not available Never Unknown
Supplemental Figure 2E. Use of body mass index across different ISN regions.
90 71
87 86
89 71
73 83 74 71
5 29
7 14 29
27 17 21 24
7 5
5 11
5
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa
Generally available Generally not available Never Unknown
Supplemental Figure 3A. Oral nutrition supplement availability across ISN regions.
95 100 80
86 100 29
100 83
89 66
81
5 13
14 71
17 11 29
17
7 5
2
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa Overall
Generally available Generally not available Never
Supplemental Figure 3B. Cost coverage in inpatient and outpatient setting across ISN regions.
Supplemental Figure 4A. Formal feedback to nephrologists on findings of nutrition assessment across different ISN regions.
Supplemental Figure 4B. Formal feedback to nephrologists on dietary prescriptions to CKD patients across different ISN regions.
33 13
10
40 8
13 25
13
80 20
10 15
11
33 75 50
83 40
20 31
67
13 25
17 20 100
30 30 46
22
7
0% 20% 40% 60% 80% 100%
Western Europe South Asia OSEA N & E Asia North America NIS & Russia Middle East Latin America E & C Europe Africa
Always Usually Often Sometimes Never Unknown
18
20
20 11
38
18 38
40 60 50
11
63 100
55 63
20 40 50 60
68
20 9
20 11
0% 20% 40% 60% 80% 100%
Africa E & C Europe Latin America Middle East N & E Asia NIS & Russia North America OSEA South Asia Western Europe
Always Often Sometimes Never Unknown
Supplemental Figure 4C. Formal feedback to nephrologists on dietary adherence of CKD patients across different ISN regions.
9
13 20 5
25
18 25
60 60
50 20 16
75 100
64 75
40 40 38 60
74
9
5
0% 20% 40% 60% 80% 100%
Africa E & C Europe Latin America Middle East N & E Asia NIS & Russia North America OSEA South Asia
Western…
Always Often Sometimes Never Unknown
