Time to revisit the role of renal dietitian in the dialysis unit.

THENOVEMBER 2013 issue of the journal published a very important and interesting study by Hand, Steiber, and Burrowes titled ‘‘Renal Dietitians Lack Time and Resources to Follow the NKF KDOQI Guidelines for Frequency and Method of Diet Assessment: Results of a Survey’’. The authors should be commended for executing an outstanding study on a very important but significantly overlooked subject—the roles and responsibilities of a renal dietitian in an outpatient dialysis unit. Although the dietitians cover a crucial aspect of care of chronic kidney disease (CKD) and end-stage renal disease (ESRD), there are only limited data regarding these issues. This well-conceived study provides very relevant data for the care of the ESRD patients in the outpatient dialysis setting, including but not limited to the characteristics of the dietitians and their workload, frequency and barriers to dietary intake data collection, and methods of dietary intake collection and analyses. Of those data, it is remarkable that the finding by Hand and colleagues suggests that over 25% of the practicing dietitians in the United States are assigned more than 150 ESRD patients at a given time. Accordingly, we are equally impressed, albeit not completely surprised, with the results showing that only 6.5% of dietitians follow the Kidney Disease Outcomes Quality Initiative recommendations for biannual dietary