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Objective: To determine the effect of a tailored intervention on albumin levels among hemodialysis
patients.
Design: Randomized controlled trial.
Setting: Eight freestanding chronic hemodialysis units in northeast Ohio.
Subjects: Eighty-three randomly selected adult patients who had been on dialysis for at least
6 months and had a mean albumin <3.7 g/dL (bromcresol green method) or <3.4 g/dL (bromcresol
purple method) for the last 3 months. To better elucidate the feasibility and outcomes
of the intervention, we selected more intervention than control patients.
Intervention: Dietitians of the 52 intervention patients determined whether any of the following
potential barriers to adequate protein nutrition were present for each patient: (1)
poor knowledge of protein-containing foods, (2) poor appetite, (3) needing help shopping
or cooking, (4) low fluid intake, and (5) inadequate dialysis. Depending on the specific
barriers present, the dietitians (1) educated patients on protein-containing foods,
(2) recommended snacks for which patients had preserved appetite, (3) helped set up
social supports, (4) provided recommendations on fluid intake, and/or (5) arranged
for improved dialysis. Dietitians of the 31 control patients continued to provide
usual care.
Main outcome measures: Change in albumin after 6 months, stratified as minimal change (less than .25 g/dL
increase or decrease), moderate improvement (.25 to .49 g/dL increase), and large
improvement (increase of .50 g/dL or more). To examine the role of inflammatory states,
we also determined serum C-reactive protein levels at the beginning and end of the
trial.
Results: Among intervention patients, 29% had a minimal change in albumin, 44% had a moderate
improvement, and 27% had a large improvement. Among control patients, 74% had a minimal
change in albumin, 19% had a moderate improvement, and 6% had a large improvement
(P < .001 for comparison of intervention and control subjects). About 60% of subjects
had high baseline C-reactive protein levels (>10 mg/L). However, there was little
relationship between change in albumin and either baseline C-reactive protein levels
or changes in C-reactive protein levels (P = .83).
Conclusion: A nutrition intervention tailored to patient-specific barriers resulted in improved
albumin levels even among patients with high C-reactive protein levels. Further work
is needed to refine and test this intervention on a larger sample.
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Article info
Footnotes
Supported by grant number DK51472 and DK54178 from the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda. MD, and the Leonard C. Rosenberg Renal Research Fonndation, Cleveland, OH.
Identification
Copyright
© 2001 National Kidney Foundation, Inc. Published by Elsevier Inc.
