A qualitative study to investigate the nutrition perspectives and experiences of Veterans with CKD

Background: CKD affects susceptible populations at higher rates than the general public. Dietary adherence, quality, and behaviors play a crucial role in CKD and chronic disease management. However, individuals with CKD, including Veterans and those with mission-driven occupations and cultures, face unique challenges navigating dietary recommendations and kidney-health promoting diets. Understanding factors such as military or occupational experiences, comorbidities, and dietary barriers may lead to developing effective, patient-centered dietary interventions. Methods: We conducted a qualitative descriptive study and semistructured interviews with 32 veterans with CKD (stages 3b–5; including dialysis), with a mean age of 71 years, 54% were White, and 16% were women, receiving care at the Veterans Affairs Eastern Colorado Health Care System, from June 2023 to July of 2024. Interview constructs included healthy eating, CKD management, food preferences, and decision making. We conducted thematic analyses using an inductive approach to understand participants' perspectives and experiences. Results: Three overarching domains emerged: (1) moments that matter, shaping dietary behaviors by themes such as health crises, diagnoses, and the perceived mortal consequences of food choices; (2) chronic disease perceptions, management, and adaptation, capturing the burden of rigid dietary restrictions, conflicting recommendations, and dichotomies between strict rules versus flexible healthy diet principles; and (3) contextual factors that influence health, nutrition, and adaptation, highlighting the effect of social support, military culture, and environmental influences on food behaviors. Conclusions: Veterans' experiences with CKD nutrition and management are shaped by pivotal health events, rigid dietary frameworks, military-influenced eating habits, and other social-emotional contextual factors. Nutrition and health care approaches should focus on personalized, flexible approaches and leveraging existing veterans affairs–based principles that emphasize patient-centered care and experience. These include supporting individuals by acknowledging urgency in dietary decision making, capitalizing on key moments for intervention, and increasing awareness of nutrition's role in health without reinforcing restrictive, unsustainable dietary patterns.