Abstract
Proper nutrition may reverse the malnutrition and can modulate renal function in hemodialysis patients. In majority of the dialysis units in Pakistan, nutritional advice is given by health professionals working in dialysis. We compared the impact of dietary counseling by a renal dietitian, on nutritional status with that by health professionals working in dialysis units in patients undergoing maintenance hemodialysis. Nutritional assessments were made using subjective global assessment (SGA) scale, which combines assessment of intake, physical findings, and functional status. Two hundred and seventy‑seven patients undergoing hemodialysis from two renal care units in Hayatabad Medical Complex Peshawar and Lahore Gernal Hospital Lahore Pakistan, were enrolled (138 patients in control group, 139 in experimental group). In the experimental group, patients were given repeated dietary counseling by a renal dietician, whereas control group patients were provided with the necessary nutritional information by another health professional. Detailed nutritional, biochemical, and SGA assessment were done on all of them at the beginning and completion of study after 6 months. Patients were categorized as well‑nourished (WN) (SGA = 1–14), mild to moderate malnourishment (MMM) (SGA = 15–35), and severe malnutrition (SM) (SGA = 36–49). In the present study, the overall malnutrition rate at baseline was 95.3%, and it dropped down to 91.7% after 6 months after nutritional counseling. In the experimental group, malnutrition status decreased from 97.2% to 89.8%, whereas in the control group, malnutrition situation remained same. Compared to baseline, in the control group, there was no improvement in the WN group. However, a shift has been observed from MMM group to SM group suggesting more number of patients are becoming malnourished. Contrarily, in the experimental group, an improvement of +7.2% in WN group and +14.3% in MMM group and a drop of −21.6% in severe malnourished group suggesting more number of patients gaining nutrition. The present study observed a significant improvement in nutritional status of patients who received counseling by the renal dietician. The reduction in SGA score was independent of reductions in serum creatinine and blood urea levels Keywords : Dietary Counselling, Nutritional Status, Hemodialysis Patients DOI : 10.7176/JMPB/55-16 Publication date :May 31 st 2019
Highlights
End‐stage renal disease (ESRD) is a major public health problem, and its incidence and prevalence are increasing worldwide.[1,2] Malnutrition was regarded as the late complication of chronic renal failure
Protein intake between these groups was statistically similar 0.7 g/kg/day in the control group versus 0.78 g/kg/day in the experimental group.It can be seen from Table 3 that, six months after diet counseling, patients in the experimental group had a substantial increase in energy and protein intake compared with control group (2125.14 ± 302.19 vs. 1330.17 ± 238.46;P < 0.0001) and (1.2 vs. 0.7 g/kg/day, P < 0.0001), respectively
subjective global assessment (SGA) score a composite marker of nutritional status significantly improved in the experimental group, whereas it remained more or less same in the control group
Summary
End‐stage renal disease (ESRD) is a major public health problem, and its incidence and prevalence are increasing worldwide.[1,2] Malnutrition was regarded as the late complication of chronic renal failure. Nutritional education and dietary counseling for patients with renal disease play a significant role in the preservation of renal function and overall well‐being of the renal patient since dietary protein intake can modulate renal function.[11] In the majority of the dialysis units in Pakistan, nutritional information is given by health professionals rather than renal dietician. We compared the impact of dietary counseling by a renal dietitian under the close monitoring of nephrologists’ versus health professionals working in dialysis units on nutritional status in patients undergoing hemodialysis
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