A RANDALL1,2, B BOSE2,3, K SUD2,3
1Department of Nutrition & Dietetics , Nepean Hospital, Kingswood, Australia, 2Department of Renal Medicine , Nepean Hospital, Kingswood, Australia, 3Nepean Clinical School, The University of Sydney, Kingswood, Australia
Aim: To evaluate change in nutritional status after six months of individualised dietetic intervention and counselling in patients receiving dialysis.
Background: Malnutrition is a strong and independent predictor of morbidity and mortality and is common in patients on dialysis. Clinical guidelines consistently recommend multi-parameter nutritional assessments and interventions as an essential component of care for dialysis patients.
Methods: We assessed nutritional status in maintenance haemodialysis and peritoneal dialysis patients at a single centre who had not received any dietetic intervention for over 3 years. Based on this initial assessment, patients were provided individualised dietetic intervention and counselling and the effect of this intervention was assessed prospectively after 6 months. Data collected included demographics; nutritional assessment including the Patient-Generated Subjective Global Assessment (SGA) and handgrip strength (HGS); anthropometric and biochemical parameters.
Results: One-hundred and three patients were studied (male, 60.2%; age, 62.9±15.1 years; diabetic, 51.5%; haemodialysis, 75.7%). Prevalence of malnutrition (SGA B and C) at baseline was 35%. Eighty-three patients (80.5%) were followed-up 6 months after nutritional intervention. Forty-nine patients (59%) had an improved SGA score; 25 (30.1%) remained nutritionally stable with no change to SGA score; while 9 (10.8%) had a decline in SGA score. Thirty-five (50.7%) patients had an improved HGS; 19 (27.5%) remained stable and maintained HGS; 15 (21.7%) had a decline in HGS. In those who were underweight on initial assessment, 60% had an increase and 9% maintained dry body weight.
Conclusions: One third of patients on maintenance dialysis were malnourished at baseline. Implementation of nutrition interventions by a dietitian was associated with improvement or maintenance of nutritional status and handgrip strength, with 60% of underweight patients gaining weight within 6 months.
Ann-Maree is currently working as the Senior Dietitian for Renal and Renal Supportive Care at Nepean Hospital. She has worked as a dietitian for 8 years with the past 4 years specialising in renal nutrition and has experience in working with patients across all stages of CKD.