We just published a scoping review on personalised nutrition in haemodialysis (CKJ, 2026) — here are the key findings and what they mean for practice

​

Hi r/Nephrology,

I'm José Francisco Rojas-Pérez, first author of a scoping review just published in the **Clinical Kidney Journal** (Oxford University Press / European Renal Association), and I wanted to share the findings here and open a discussion.

**The paper:** *"Personalised Nutrition in Haemodialysis: A Scoping Review of Studies Published Between 2015 and 2025"*

🔗 https://academic.oup.com/ckj/advance-article/doi/10.1093/ckj/sfag117/8655904

---

**Why we did this**

The term "personalised nutrition" is everywhere in the HD literature — but nobody had actually defined it operationally. Studies use "individualised," "tailored," and "personalised" interchangeably, which creates massive heterogeneity and makes comparison across trials almost impossible. We wanted to map the evidence and propose a working framework.

---

**What we found (30 studies, 2015–2025)**

**On dietary non-adherence:**

- ~60% of HD patients don't follow dietary recommendations globally

- The evidence strongly suggests this is a **structural problem, not a behavioural one** — prescriptions are perceived as overly restrictive, culturally misaligned, and disconnected from everyday life

- Non-adherence should be read as a marker of vulnerability, not wilful non-compliance

**On the renal dietitian gap:**

- Only **36% of HD centres worldwide** employ permanent renal dietitians

- Clinical nutrition is not formally recognised as a regulated discipline within nephrology in **>40% of countries**

- This is arguably the biggest single modifiable barrier to improving nutritional outcomes in HD

**On nutritional assessment:**

- Serum albumin and BMI consistently **underestimate nutritional risk** in HD — fluid shifts, inflammation, and sarcopenic obesity all confound them

- Muscle ultrasonography (sensitivity 83%, specificity 78% for sarcopenia), MF-BIA phase angle, handgrip dynamometry, and MIS perform significantly better

- These tools are accessible, non-invasive, and feasible in routine HD units

**On dietary strategies:**

- Individualised oral supplementation → improvements in albumin, prealbumin, MIS, and QoL

- Supervised plant-forward diets → compatible with stable potassium, improvements in FGF-23 and phosphorus metabolism

- Probiotics/prebiotics/synbiotics → reduced CRP, IL-6, and uraemic toxins

- Omega-3 and antioxidant interventions → cardiometabolic and inflammatory benefits

- Oral creatine → promising for muscle mass and functional capacity

---

**Our proposed definition of personalised nutrition in HD**

> *"The tailoring of dietary strategies to an individual's clinical phenotype, morphofunctional status, metabolic profile, and personal preferences, integrating nutritional intervention, functional assessment, and behavioural dimensions within a patient-centred framework."*

Five core dimensions: clinical profile, morphofunctional assessment, dietary factors, psychosocial determinants, and contextual factors.

---

**Honest limitations**

- Most interventional studies: <100 participants, 6–16 weeks follow-up

- Surrogate biochemical outcomes dominate — hard endpoints (mortality, hospitalisation) are underreported

- The framework is evidence-grounded but not yet prospectively validated

- "Personalisation" risks becoming rhetorical without structural investment in dietitian integration and standardised assessment protocols

---

**Questions for the community:**

1. How many of your HD units have a permanent renal dietitian integrated into the multidisciplinary team?

2. Are you using morphofunctional tools (BIA, muscle ultrasound, MIS) routinely, or still relying primarily on albumin?

3. Do you think the shift away from the "universal renal diet" toward more flexible models is realistic in your setting?

Full open-access paper available at the link above. Happy to discuss any aspect of the methodology or findings.

---

*Rojas-Pérez JF et al. Clinical Kidney Journal, 2026. DOI: 10.1093/ckj/sfag117*

-