Guideline use: a survey of dietitians working with adult kidney transplant recipients.

Aim:   To establish current service provision as well as barriers and enablers to guideline implementation in the Nutritional Management of Adult Kidney Transplant Recipients (KTR).

Methods:   Fifteen primary renal transplant centres (15/17; 88% response rate) and 21 secondary renal transplant centres (21/24; 88% response rate) responded to an online survey addressing key questions investigating their current practice in the nutritional management of adult KTR.

Results:   Referral from primary to secondary sites was limited with only two sites (9%) routinely receiving referrals. Allocated funding for KTR at secondary sites was low (n = 4, 14%). Many primary sites received nil or <0.5 full-time equivalent (FTE) funding for inpatient (n = 8, 53%); and nil or ≤0.2 FTE funding for outpatient services (n = 9, 60%). In sites reporting FTE hours, the average dietitian-to-patient ratio was 1 FTE dietitian for every 383 (range 50-1280) annually transplanted patients. Major barriers identified in delivering nutrition services at primary sites included time/lack of resources and limitations with systems to identify or track transplant recipients.

Conclusion:   Dietitian-to-patient ratios in the management of KTR at primary sites are inconsistent and likely to be inadequate at secondary transplant sites to implement guideline recommendations, especially for weight management. Investigations into the effectiveness of innovative interventions such as groups or telehealth are warranted, which may assist practitioners to achieve guideline recommendations in an environment of limited resources.