J BASTOW1, H MACLAUGHLIN1,2, K MORGAN2, J BRODRICK2, B MASON2, J MUSIAL2
1Queensland University Of Technology, Kelvin Grove, Australia, 2Royal Brisbane and Women’s Hospital, Herston, Australia
Aim: To determine if following evidence-based practice recommendations is associated with positive outcomes for body mass index (BMI) and nutritional status in maintenance haemodialysis patients.
Background: Evidence-based practice guidelines include regular nutrition assessment and high- energy and -protein diets as integral in nutritional management of patients requiring haemodialysis for kidney failure. An investigation into the long-term impact of dietetic care on patient nutritional status and BMI has not been undertaken.
Methods: A retrospective evaluation of prospectively collected data was conducted on maintenance haemodialysis patients at the Royal Brisbane and Women’s Hospital from 2004 to 2019 inclusive. Biannual dietetic assessments measured BMI (categorised underweight <22.9kg/m², normal 23-26kg/m², overweight 26.1-29.9kg/m² and obese >30kg/m²) and nutritional status (according to subjective global assessment A=well-nourished, B&C=malnourished). Repeated-measures ANOVA and Pearson’s chi-square assessed change in each measure over time after grouping years into quartiles.
Results: In a cohort of 664 patients (median [interquartile range] observations: 3 [1 to 6]; data missing: BMI 2.5%, nutritional status 3.8%), BMI significantly increased from median [interquartile range] 24.4kg/m² [21.6kg/m² to 28kg/m²] in 2004 to 29.5kg/m² [24.4kg/m² to 35.4kg/m²] in 2019 (p<0.001). BMI categories significantly differed throughout the study period, with a decrease in underweight patients (31.6% to 18.1%), normal weight patients (26.7% to 16.3%) and overweight patients (20.2% to 18.6%); and increase in obese patients (21.5% to 47%) (χ² 142.9, df=12, p<0.001). The proportion of malnourished patients significantly decreased over time, from 14.5% to 9.3% (χ² 12.3, df=4, p=0.015).
Conclusions: Trends in data showed that whilst adhering to evidence-based practice guidelines is associated with improvements in nutritional status in this cohort, obesity prevalence doubled, thus prompting consideration of future practice implications and redirecting dietetic care.
A final year Nutrition and Dietetics student at Queensland University of Technology with a passion for public health promotion and early intervention. I am currently completing honours in conjunction with the Royal Brisbane and Women’s hospital and investigating trends in body mass index and nutritional status of maintenance haemodialysis patients over the last 15 years.