Improving albumin levels in peritoneal dialysis patients☆☆☆★

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Peritoneal dialysis patients with low albumin levels have been known to have an increased mortality risk.¹ At the Renal Institute of the Pacific, Honolulu, Hawaii, low albumin levels among peritoneal dialysis patients are prevalent and a concern for renal dietitians. Nutrition intervention is needed in improving albumin levels and assisting peritoneal dialysis patients in optimizing their nutritional status.

Renal dietitians at the Renal Institute of the Pacific have tailored nutrition education to specifically address the challenges of a multi-ethnic patient population that exists in Hawaii. The patient population is mainly comprised of Asian and Polynesian ethnicity with a local cuisine that reflects a unique blend of cultures. Dialysis patients, like many island residents, tend to eat more starchy foods, such as rice, noodles, and locally grown vegetables rather than protein foods. Canned and processed meat products, such as luncheon meat, corned beef, and sausage are commonly eaten in many households rather than fresh meat products because they are available and more economical. These convenience foods tend to contain less protein and are high in sodium and fat.

An additional concern is that diabetic nephropathy is the leading cause of renal failure in Hawaii, with rates exceeding 52% among dialysis patients.² Diabetic patients on continuous ambulatory peritoneal dialysis have been shown to have a higher incidence of mild to moderate malnutrition than nondiabetic patients.³ Because of this, renal dietitians are faced with the need to create innovative educational materials.

The Peritoneal Dialysis Nutrition, Improving Your Albumin Level handout was developed and used in combination with verbal instructions during the counseling session. The handout defines albumin and emphasizes the importance of adequate protein consumption and ways to stay well. It was individualized to meet each patient's own nutrient needs.

Following the counseling session, knowledge and understanding of the patient was evaluated using Albumin Quiz! It consisted of questions on albumin and on the identification of local foods high in protein. Patients were also asked to demonstrate their daily protein serving requirements using food models that depicted local protein foods.

When these educational materials were presented to 32 peritoneal dialysis patients with low and marginal albumin levels, intervention seemed to be effective. In the following 2 months, average albumin levels using the bromcresol purple method improved from 2.98 g/dL to 3.08 g/dL and nutrition knowledge increased. The protein serving size demonstration was also found to be beneficial in reinforcing appropriate servings to meet individual daily needs.

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Acknowledgements 

The authors would like to thank Roberta Lovely, RN, MPH, Administrative Director, and the dietitians at the Renal Institute of the Pacific, Honolulu, Hawaii.

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References 

1. Spiegel DM, Breyer JA. Serum albumin: A predictor of long-term outcome in peritoneal dialysis patients. Am J Kidney Dis. 1994;23:283–285
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2. Transpacific Renal Network: Selected Demographics 1999. San Rafael, CA, pp 21
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3. Young GA, Kopple JD, Lindholm B, et al.  Nutritional assessment of continuous ambulatory peritoneal dialysis patients: An international study. Am J Kidney Dis. 1991;17:462–471
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