There are several critical needs for improving dietary intake assessment in CKD (26,35,82,83). They include finding simple ways for patients to record their intakes frequently and easily so that "usual" intakes can better be assessed. It is difficult for patients not to change their intake, at least for the first few days while they are keeping food records; multiple records are likely to be more representative of true intake. Additionally, in CKD, especially in the later stages of the disorder, intakes vary considerably from day to day and they are only assessed occasionally. Thus, a true picture of actual intake over the long term is very difficult to obtain. Also, true intake is more likely to be lower than recorded intakes as patients seldom record their food intakes when they are critically ill and often forget some items that they ate.
A second challenge is to find better ways to document underreporting of intake, which occurs strikingly in obese patients, but in all patients. Over-reporting is also a problem among patients who are frequently ill because they fail to report intakes on such days.
It is also important to develop better ways to report intake of dietary supplements commonly used in CKD. The field needs more validated and better nutrition-related QOL instruments, better automated recording methods, and better dietary analysis software for both medical foods and dietary supplements commonly consumed by those with kidney disease.
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