A Systematic Review of Online Resources on Dietary Management of Hyperphosphatemia in People with Chronic Kidney Disease (CKD)

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Begum, Most Murshida

Issue Date

2022

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Thesis

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Chronic kidney disease , Dietary advice , Hyperphosphatemia , Inconsistent , Online resources , Phosphate-specific diet therapy

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Background: The internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent and conflicting advice online for managing diet-related complications such as hyperphosphatemia.Purpose of the study: To summarize and evaluate online resources for phosphate-specific diet therapy in people with chronic kidney disease. Methods: For this systematic review, patient-facing resources on phosphate-specific diet therapy were collected from Google and Yahoo search engines, and the social media website Facebook. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food sub-groups, and individual food items was categorized as “restricted”, “recommended”, “mixed” and “not mentioned”. Additional information on publication date, source, author, phosphorus bioavailability and demineralization were also collected for comparison to dietary advice. Resources that were not intended for people with CKD such as journal publications were excluded from analyses. Results: After removing duplicates, 199 online resources were available for review from Google and Yahoo, and 33 from Facebook. Dietary advice was primarily focused on restriction of foods high in phosphorus, and processed foods containing phosphorus-based food additives. Although there were notable overlaps in dietary advice, significant inconsistencies were found. Resources ranged from 2005 to 2021 and were primarily from healthcare providers and websites (29% and 39% respectively) and prepared by registered dietitians and medical doctors (65% and 31% respectively). Few resources mentioned phosphorus bioavailability as an important consideration (16%) or noted demineralization as a phosphorus-lowering strategy (8%). Similar findings were available from Facebook, but limited number of resources limited comparisons. Conclusion: Results of this study indicate that online resources for phosphate-specific diet therapy are highly restrictive and contain important inconsistencies despite coming from reputable sources. Given the widespread and growing use of online resources by people with CKD, and healthcare professionals to inform dietary choices affecting health outcomes, efforts are urgently needed to establish an evidence-based consensus for phosphate-specific diet therapy. Until then, the findings from this thesis project provide a basis for increasing awareness of the potential for confusion arising from online resources.

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