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Kidney Nutrition in the Era of Social Media: Bridging the Gap of Nutrition Education and Kidney Health Literacy by Leveraging Resources of Social Networking

Published:September 13, 2022DOI:https://doi.org/10.1053/j.jrn.2022.09.002

      Introduction

      Social media has allowed our individual messages to reach broader audiences and transformed how we communicate academically, professionally, and personally. To support these diverse applications, multiple social media platforms exist with rapid growth in use among many kidney nutrition partners, as reviewed by Langham et al.,
      • Langham R.G.
      • Kalantar-Zadeh K.
      • Bonner A.
      • et al.
      Kidney health for all: Bridging the Gap in kidney health education and literacy.
      with a focus on health literacy in kidney care. Although social media has opened doors to communicate our professional expertise, it is important to remember the potential limitations and risks. The aim of this editorial is to illustrate the benefits, drawbacks, and potential best practices for social media use in the field of renal nutrition, referred to in this article as kidney nutrition.
      • Moore L.W.
      • Wang A.Y.M.
      • Kalantar-Zadeh K.
      Global kidney nutrition care and health literacy: Overcoming the Disparities in renal nutrition Service Capacity and education.
      ,
      • Proano G.V.
      • Papoutsakis C.
      • Lamers-Johnson E.
      • et al.
      Evaluating the Implementation of evidence-based kidney nutrition practice guidelines: the AUGmeNt study Protocol.

      Benefits of Social Media

      Different groups preferentially use individual social media platforms.
      • Langham R.G.
      • Kalantar-Zadeh K.
      • Bonner A.
      • et al.
      Kidney health for all: Bridging the Gap in kidney health education and literacy.
      ,
      • Dumas A.A.
      • Lapointe A.
      • Desroches S.
      Users, Uses, and Effects of social media in Dietetic practice: Scoping review of the Quantitative and Qualitative evidence.
      The field of Nephrology, including the Journal of Renal Nutrition, has led the utilization of Twitter for educational purposes, including sharing peer-reviewed publications, live-tweeting conferences, journal clubs, asking questions, and discussions of case studies.
      • Colbert G.B.
      • Topf J.
      • Jhaveri K.D.
      • et al.
      The social media Revolution in Nephrology education.
      These uses have improved article dissemination and citations,
      • Luc J.G.Y.
      • Archer M.A.
      • Arora R.C.
      • et al.
      Does tweeting Improve citations? One-year results from the TSSMN prospective randomized Trial.
      increased the reach and equitable access to information shared at conferences,
      • Colbert G.B.
      • Topf J.
      • Jhaveri K.D.
      • et al.
      The social media Revolution in Nephrology education.
      ,
      • Desai T.
      • Dhingra V.
      • Shariff A.
      • et al.
      Quantifying the Twitter Influence of Third party Commercial entities versus healthcare Providers in Thirteen medical conferences from 2011 - 2013.
      enhanced learning opportunities,
      • Topf J.M.
      • Sparks M.A.
      • Phelan P.J.
      • et al.
      The Evolution of the journal club: from Osler to Twitter.
      and improved networking opportunities,
      • Colbert G.B.
      • Topf J.
      • Jhaveri K.D.
      • et al.
      The social media Revolution in Nephrology education.
      which are particularly important for early career scientists. Although not the primary social media platform, nutrition professionals also use Twitter to communicate with colleagues (e.g., #RDChat). Overall, Twitter offers many benefits to kidney nutrition professionals, but use by patients and care partners is limited.
      • Yoon S.
      • Wee S.
      • Lee V.S.Y.
      • Lin J.
      • Thumboo J.
      Patterns of use and perceived value of social media for population health among population health stakeholders: a cross-sectional web-based survey.
      Many nutrition professionals, as well as patients and their care partners predominantly use Facebook and Instagram.
      • Helm J.
      • Jones R.M.
      Practice Paper of the Academy of nutrition and Dietetics: social media and the Dietetics practitioner: opportunities, Challenges, and best practices.
      ,
      DietitianConnection
      Trends in dietitians' social media habits.
      Nutrition professionals may easily share information about healthy eating, practical recommendations for chronic kidney disease (CKD), and share links to professional websites, including blogs. Facebook is commonly used as a forum in a diverse set of public and private groups, while Instagram is primarily used to share infographics, recipes, and short informational videos. Notably, kidney nutrition private Facebook groups, some of which are almost 3,000 members, are venues for renal nutrition professionals to engage in discussions and ask questions regarding patient care, new products, and recent and classic renal nutrition literature. Similarly, several kidney patient groups and renal support networks have over 20,000 members. Nutrition professional societies have taken advantage of the extensive use of Facebook and other social media platforms to disseminate evidence-based nutrition information showing high and growing engagement.
      • Mendoza-Herrera K.
      • Valero-Morales I.
      • Ocampo-Granados M.E.
      • Reyes-Morales H.
      • Arce-Amare F.
      • Barquera S.
      An Overview of social media Use in the field of public health nutrition: benefits, Scope, limitations, and a Latin American experience.
      Beyond Facebook and Instagram, LinkedIn is increasingly used for professional networking and Pinterest appears to be gaining popularity among dietitians.
      DietitianConnection
      Trends in dietitians' social media habits.
      These broad ways to utilize social media give practitioners options to find communication methods tailored to their skill and comfort level.

      Drawbacks, Risks, and Limitations of Social Media

      Social media use confers a myriad of benefits, but also has drawbacks including serious risks and limitations, some of which were noted during the COVID-19 pandemic era. Due to the novelty of COVID-19, it was important to provide rapid communication regarding treatments and best practices. Different social media platforms helped cover this need, as major health societies and organizations, such as the World Health Organization, the United States Centers for Disease Control and Prevention, as well as experts in the field, were able to reach practitioners and the general population. However, the ease of sharing information was also met with the ease of sharing incorrect or biased information, also known as misinformation. This was in part because some of the information or data was often communicated without proper due process, including no peer review, which may have led to the rise of misinformation and disinformation, the latter deliberately intended to mislead.
      • Venegas-Vera A.V.
      • Colbert G.B.
      • Lerma E.V.
      Positive and negative impact of social media in the COVID-19 era.
      Careless social media postings, including unprofessional language or breaking the privacy of a person and entities, are serious violations than can affect relationships, reputation, and careers. Therefore, it is important that the kidney nutrition community avoids sharing information that is not evidence-based or biased by personal and professional conflicts of interest. Professional societies provide useful guidance on this point (Fig. 1).
      • Klemm S.
      Guidance for professional Use of social media in nutrition and Dietetics practice.
      ,
      Professionalism in the Use of social media. AMA Principals of medical Ethics: I, II, IV web site.
      Figure thumbnail gr1
      Figure 1A roadmap for best practices in social media for kidney nutrition professionals.

      Summarizing the Use of Social Media for Kidney Nutrition

      Widespread interest exists among nutrition professionals, patients, and their care partners for information about kidney nutrition and lifestyle. To meet this desire for information, kidney nutrition partners are turning to social media. Whether or not we as professionals are making our voices heard, members of the kidney nutrition community will find information on social media. As kidney nutrition professionals, we have expertise and experience we should share to help fill this space and ensure the information that kidney nutrition partners are finding is evidence-based. We encourage readers to responsibly use their social media platforms for kidney nutrition, provide their handle for Twitter, Facebook, LinkedIn, and so on, to promote the evidence, and avoid misinformation.

      Elsewhere in This Issue of the Journal of Renal Nutrition

      In this last issue for 2022, the Journal brings readers an editorial on health literacy,
      • Langham R.G.
      • Kalantar-Zadeh K.
      • Bonner A.
      • et al.
      Kidney health for all: Bridging the Gap in kidney health education and literacy.
      3 review articles (one of which is a systematic review with meta-analysis),
      • Babich J.S.
      • Kalantar-Zadeh K.
      • Joshi S.
      Taking the Kale out of hyperkalemia: plant foods and serum potassium in patients with kidney disease.
      • Takahashi A.
      Role of zinc and copper in erythropoiesis in patients on hemodialysis.
      • Vijay V.
      • Kaur Kang H.
      The worldwide prevalence of nonadherence to diet and fluid restrictions among hemodialysis patients: a systematic review and meta-analysis.
      11 reports on original research,
      • Di Sessa A.
      • Russo M.C.
      • Arienzo M.R.
      • et al.
      PNPLA3 I148M Polymorphism Influences renal function in children with obesity and prediabetes.
      • Yasar E.
      • Tek N.A.
      • Tekbudak M.Y.
      • et al.
      The relationship between myostatin, Inflammatory Markers, and sarcopenia in patients with chronic kidney disease.
      • Alvarenga L.
      • Cardozo L.F.M.F.
      • Leal VdO.
      • et al.
      Can resveratrol supplementation reduce uremic toxin Plasma levels from the Gut Microbiota in Nondialyzed patients with chronic kidney disease?.
      • Ould Setti M.
      • Kacimi S.E.O.
      • Niskanen L.
      • Virtanen J.
      • Tuomainen T.-P.
      Synergic Interaction of Vitamin D deficiency and renal hyperfiltration on mortality in middle-aged men.
      • Mao D.
      • Cheng Jingmin
      Two dietary patterns from China Might benefit kidney function, as Indicated by latent profile Analysis.
      • Xiong J.
      • Peng H.
      • Yu Z.
      • et al.
      Daily walking dose and health-related quality of life in patients with chronic kidney disease.
      • Chan S.
      • Hawley C.M.
      • Pascoe E.M.
      • et al.
      Prebiotic supplementation in kidney transplant recipients for preventing infections and gastrointestinal Upset: a randomized controlled feasibility study.
      • Sualeheen A.
      • Khor B.-H.
      • Balasubramanian G.V.
      • et al.
      Benchmarking diet quality to assess nutritional risk in hemodialysis patients: Applying Adequacy and moderation Metrics of the hemodialysis-healthy eating index.
      • Xavier J.S.
      • Góes C.R.d.
      • Borges M.C.C.
      • Caramori J.C.T.
      • Vogt B.P.
      Handgrip strength thresholds are associated with malnutrition Inflammation Score (MIS) in maintenance hemodialysis patients.
      • Wang S.
      • Tang W.
      • Zhou J.
      • et al.
      Combination of Quantitative Computed Tomography and blood Biochemistry for Evaluating the relationship between nutrition and bone mineral density in patients on maintenance hemodialysis.
      • Machiba Y.
      • Mori K.
      • Shoji T.
      • et al.
      Nutritional Disorder Evaluated by the Geriatric nutritional risk index Predicts death after hospitalization for infection in patients Undergoing maintenance hemodialysis.
      • Blumberg Benyamini S.
      • Barnea Z.
      • Cernes R.
      • et al.
      Association of nutrition status at dialysis Start with Long-Term Survival: a 10-Year retrospective study.
      a case study,
      • Budd J.
      • Mafrici B.
      Renal dietary Management of a patient with a high-output ileostomy and kidney disease: a case study.
      a research brief,
      • Friedman A.N.
      • Petry T.B.Z.
      • Aboud C.M.
      • Mendonca dos Santos T.
      • Roux C.W.l.
      • Cohen R.V.
      State-of-the-art medical therapy versus roux-en-Y gastric Bypass Alone for treatment of early diabetic kidney disease.
      and a letter.
      • Yajima T.
      Is the Modified creatinine index Really Superior to the Geriatric nutritional risk index for predicting malnutrition and Clinical outcomes in hemodialysis patients?.
      Langham et al.
      • Langham R.G.
      • Kalantar-Zadeh K.
      • Bonner A.
      • et al.
      Kidney health for all: Bridging the Gap in kidney health education and literacy.
      highlight the importance of assessing kidney health literacy (KHL) of patients with kidney disease. The article was highlighted for World Kidney Day 2022 and focuses on the need to promote KHL for people with CKD, their care partners, and patient advocacy groups but also governments, policy makers, and healthcare providers. As our lead discussion in this issue of the Journal, promotion of kidney disease information is critical for improving care for patients with CKD and developing tools for preventing kidney disease. Relatedly, in adults without a diagnosis of CKD, Ould Setti et al.
      • Ould Setti M.
      • Kacimi S.E.O.
      • Niskanen L.
      • Virtanen J.
      • Tuomainen T.-P.
      Synergic Interaction of Vitamin D deficiency and renal hyperfiltration on mortality in middle-aged men.
      provide a fascinating examination of the synergy between Vitamin D deficiency and renal hyperfiltration with the incidence of mortality in middle-aged men. The Journal also shares findings on dietary patterns and dietary quality that impact CKD and hemodialysis in China (Mao et al.)
      • Mao D.
      • Cheng Jingmin
      Two dietary patterns from China Might benefit kidney function, as Indicated by latent profile Analysis.
      and Malaysia (Sualeheen et al.),
      • Sualeheen A.
      • Khor B.-H.
      • Balasubramanian G.V.
      • et al.
      Benchmarking diet quality to assess nutritional risk in hemodialysis patients: Applying Adequacy and moderation Metrics of the hemodialysis-healthy eating index.
      which have implications for all patients with CKD. Diet quality is associated with nutrition status (Sualeheen et al.)
      • Sualeheen A.
      • Khor B.-H.
      • Balasubramanian G.V.
      • et al.
      Benchmarking diet quality to assess nutritional risk in hemodialysis patients: Applying Adequacy and moderation Metrics of the hemodialysis-healthy eating index.
      and a higher plant-based, lower animal foods diet was associated with lower serum uric acid and creatinine levels in adults without CKD.
      • Mao D.
      • Cheng Jingmin
      Two dietary patterns from China Might benefit kidney function, as Indicated by latent profile Analysis.
      This finding corresponds to the review by Babich et al.,
      • Babich J.S.
      • Kalantar-Zadeh K.
      • Joshi S.
      Taking the Kale out of hyperkalemia: plant foods and serum potassium in patients with kidney disease.
      who question the practice, adopted in recent decades, of a universal potassium restriction for all patients with kidney disease. They discuss the guidelines promoting potassium restriction, the paucity of data to support the restriction of this nutrient, and the foods known to contain moderate or higher levels of potassium. They review the few articles that test the association of dietary potassium and hyperkalemia and focus on the recommendation of a higher plant-based diet in kidney disease care.
      KHL could also be beneficial in improving adherence to diet and fluid restrictions. Vijay and Kaur Kang
      • Vijay V.
      • Kaur Kang H.
      The worldwide prevalence of nonadherence to diet and fluid restrictions among hemodialysis patients: a systematic review and meta-analysis.
      determined that nonadherence is common in patients requiring hemodialysis. The studies in their meta-analysis demonstrated that the worldwide prevalence of nonadherence to diet was 60.2% and fluid restrictions was 60.6% in patients with kidney disease receiving maintenance hemodialysis. Improved knowledge of the diet by patients and by healthcare team members may reduce these high values and a less restrictive diet may contribute to improved adherence. KHL should also include guidance on the benefits of physical activity for patients with kidney disease. Two of the 4 factors inhibiting physical activity in a recent study were related to poor KHL (fear of complications and inadequate support from care partners).
      • Hannan M.
      • Bronas U.G.
      Barriers to exercise for patients with renal disease: an integrative review.
      In a study by Xiong et al.,
      • Xiong J.
      • Peng H.
      • Yu Z.
      • et al.
      Daily walking dose and health-related quality of life in patients with chronic kidney disease.
      patients with CKD 1-5 without dialysis, demonstrated that walking in range of 7,000-12,000 steps per day was associated with improved health-related quality of life.
      Using the combination of hand-grip strength (HGS) and low appendicular skeletal muscle index, sarcopenia was identified by Yasar et al.
      • Yasar E.
      • Tek N.A.
      • Tekbudak M.Y.
      • et al.
      The relationship between myostatin, Inflammatory Markers, and sarcopenia in patients with chronic kidney disease.
      in patients with nondialysis CKD, receiving hemodialysis, peritoneal dialysis, or kidney transplant. They demonstrated that serum myostatin concentration was significantly, albeit mildly, associated with sarcopenia and that kidney transplant recipients had the lowest proportion of sarcopenia. Xavier et al.
      • Xavier J.S.
      • Góes C.R.d.
      • Borges M.C.C.
      • Caramori J.C.T.
      • Vogt B.P.
      Handgrip strength thresholds are associated with malnutrition Inflammation Score (MIS) in maintenance hemodialysis patients.
      examined the relationship of HGS cut points in hemodialysis patients with the presence of malnutrition (assessed by Malnutrition Inflammation Score [MIS]). HGS below the threshold for sarcopenia (27 kg for males, 16 kg for females) was significantly associated with worse MIS, being male, older, and having diabetes. Similarly, HGS below the threshold for mortality (22 kg for males, 7 kg for females) was significantly associated with worse MIS, being older, and having diabetes, but was worse for women than men. Nutrition status assessed by the Geriatric Nutrition Risk Index was predictive of all-cause mortality and mortality after hospitalization for infection in a study by Machiba et al.
      • Machiba Y.
      • Mori K.
      • Shoji T.
      • et al.
      Nutritional Disorder Evaluated by the Geriatric nutritional risk index Predicts death after hospitalization for infection in patients Undergoing maintenance hemodialysis.
      of patients requiring maintenance hemodialysis. Nutrition status was associated with osteopenia in a study by Wang et al.
      • Wang S.
      • Tang W.
      • Zhou J.
      • et al.
      Combination of Quantitative Computed Tomography and blood Biochemistry for Evaluating the relationship between nutrition and bone mineral density in patients on maintenance hemodialysis.
      These investigators examined the relationship among serum albumin, fat mass, and fat-to-muscle mass with bone mineral density, finding that osteopenia was associated with lower serum albumin, higher fat mass, and a higher ratio of fat-to-muscle mass in a group of patients receiving maintenance hemodialysis.
      Two reports of biotics are included in this issue of the Journal of Renal Nutrition. Alvarenga et al.
      • Alvarenga L.
      • Cardozo L.F.M.F.
      • Leal VdO.
      • et al.
      Can resveratrol supplementation reduce uremic toxin Plasma levels from the Gut Microbiota in Nondialyzed patients with chronic kidney disease?.
      provide a report of a randomized placebo-controlled crossover study in patients with nondialysis CKD who received 500 mg of trans-resveratrol supplementation or placebo. No impact was observed on the concentration of uremic toxin levels using this dose of resveratrol. In a feasibility study, performed to test both the study design and the outcome of gastrointestinal symptoms, Chan et al.
      • Chan S.
      • Hawley C.M.
      • Pascoe E.M.
      • et al.
      Prebiotic supplementation in kidney transplant recipients for preventing infections and gastrointestinal Upset: a randomized controlled feasibility study.
      performed a randomized, double-blind, placebo-controlled study of prebiotics (green banana–resistant starch) or control (waxy maize) in kidney transplant recipients. They found that participants who were administered the prebiotic had significantly fewer gastrointestinal symptoms.
      The research brief by Friedman et al.
      • Friedman A.N.
      • Petry T.B.Z.
      • Aboud C.M.
      • Mendonca dos Santos T.
      • Roux C.W.l.
      • Cohen R.V.
      State-of-the-art medical therapy versus roux-en-Y gastric Bypass Alone for treatment of early diabetic kidney disease.
      provides insight on the ability of medications for treating diabetic kidney disease on outcomes after 2 years of therapy compared to having metabolic surgery (Roux-en-Y gastric bypass). The medications included renin-angiotensin-aldosterone system blockers, sodium-glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists; each known to reduce albuminuria in diabetic kidney disease. The study was retrospective, finding that metabolic surgery resulted in significantly improved regression of microalbuminuria and more weight loss than observed in the medication managed group. Even more medications will soon be marketed for treatment or prevention of CKD and for treatment of obesity. As recommended by Friedman et al., prospective studies need to be performed in this area to delineate the risks and benefits of either (or both) approaches. In a study of children with obesity and prediabetes, Di Sessa et al.
      • Di Sessa A.
      • Russo M.C.
      • Arienzo M.R.
      • et al.
      PNPLA3 I148M Polymorphism Influences renal function in children with obesity and prediabetes.
      correlated 2 important findings: the presence of prediabetes is associated with lower estimated glomerular filtration rate in obese children and that the association is stronger in children with the PNPLA3 148M allele.
      Elsewhere in this issue, Takahashi
      • Takahashi A.
      Role of zinc and copper in erythropoiesis in patients on hemodialysis.
      reports on a review of the function of zinc and copper on erythropoiesis in hemodialysis patients and the importance of monitoring blood concentration of these minerals during supplementation to prevent copper deficiency. Benyamini et al
      • Blumberg Benyamini S.
      • Barnea Z.
      • Cernes R.
      • et al.
      Association of nutrition status at dialysis Start with Long-Term Survival: a 10-Year retrospective study.
      report that nutrition status deterioration during the first 3 months of hemodialysis is associated with death in the first 3 years of treatment. Budd and Mafrici
      • Budd J.
      • Mafrici B.
      Renal dietary Management of a patient with a high-output ileostomy and kidney disease: a case study.
      report on a case of high-output ileostomy in a patient with CKD and cancer. In this case, the renal dietitian was able to guide the patient to safely manage her intestinal losses and continue cancer treatment—another case of KHL where someone recognized that this patient would benefit from a renal dietitian consult.
      The content of this issue of the Journal of Renal Nutrition is varied and connected. We emphasize the importance of KHL, the use of quality research as evidence, and the importance of remaining current in the literature to provide patients with options for optimizing their care. Social media will continue to be important in disseminating information, yet kidney nutrition professionals need to carry the torch for accuracy in information.

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