Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status

Campbell, Katrina L.; Ash, Susan; Zabel, Rachel; McFarlane, Catherine; Juffs, Philip; Bauer, Judith D.

doi:10.1053/j.jrn.2008.11.002

« Previous Next »Journal of Renal Nutrition
Volume 19, Issue 2 , Pages 136-144, March 2009

Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status

Katrina L. Campbell, BHlth Sci (Hons), PhD
- Institute of Health and Biomedical Innovation, Queensland University of Technology, and Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; and Nutritional Sciences Division, King's College London, London, United Kingdom
Susan Ash, BSc, Dip Nut Diet, MHealth Planning, PhD
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Address reprint requests to Susan Ash, PhD, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland 4001, Australia.
Rachel Zabel, B Hlth Sci (Hons)
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
Catherine McFarlane, BSc, M Nutr Diet
- Renal Dietitian, Wesley Hospital, Brisbane, Queensland, Australia
Philip Juffs, BSc, Grad Dip Nutr Diet
- Renal Dietitian, Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
Judith D. Bauer, BSc, Grad Dip Nut Diet, M Hlth Sc, PhD
- Department of Nutrition Services, Nutrition Services Manager, Wesley Hospital, Brisbane, Queensland, Australia; and Adjunct Associate Professor, School of Public Health; Queensland University of Technology, Brisbane, Queensland, Australia

Objective

Standardized nutrition guidelines that focus on a nutrition care process have been used by dietitians treating renal patients in Australia for over 3 years. We show the impact of this implementation on the nutritional status of a cohort of hemodialysis patients.

Design

We conducted a retrospective observational study, investigating a cohort of maintenance hemodialysis patients after the implementation of a systematic approach to the patient's nutritional care.

Setting

This study took place in public and private in-center hemodialysis units.

Patients

Patients included a cohort of 65 maintenance hemodialysis patients (mean age ± SD, 64 ± 15 years; 58% male; dialysis vintage median [interquartile range], 22 [10 to 46] months).

Interventions

All participants were provided with a dietary interview at least every 6 months, with intensive follow-up where required, and were monitored monthly regarding weight and biochemistry. Outcomes were assessed annually between May 2004 and December 2006, after the implementation of this model of care.

Main Outcome Measure

Energy and protein intake according to dietary interview, nutritional status according to subjective global assessment, and data regarding dry weight and biochemistry (including albumin, potassium, and phosphate) were collected by the dietitian at each facility. Change in each outcome measure over time was assessed using repeated-measures analysis.

Results

The proportion of patients with malnutrition (subjective global assessment B or C) decreased from 14% at baseline to 3% after 2 years. Serum albumin, potassium, and dry weight remained stable throughout the study period, and there was a significant decrease in serum phosphate over time (mean ± SD,1.8 ± 0.5 to 1.5 ± 0.5 mmol/L, P = .004). Dietary energy and protein intake changed significantly over the study period (P = .001 and P = .022, respectively), with the highest mean intake recorded during the final follow-up assessment.

Conclusions

The implementation of a systematic approach to patient care, in line with nutrition management guideline recommendations, was associated with an improvement in nutritional status and dietary intake in this cohort of maintenance hemodialysis patients, without the need for increased resources or dietitian time.