PP167-MON RELATIONSHIP OF NUTRITION STATES AND BODY CONDITION OF ELDERLY HEMODIALYSIS PATIENTS LIVING NURSING HOME

Abstract

Rationale: Our enteral feeding audit (2011) highlighted variation in dietetic management of patients at risk of refeeding syndrome (RS). We aimed to investigate this further and improve uniformity of practice. Methods: A questionnaire, based on a similar UK study [1] was completed (2012) by all dietitians (n = 17), including case scenarios to elicit RS risk and recommendations for caloric, micronutrient and electrolyte provision. Results were presented to the department. A medical audit highlighted poor awareness of RS and an interdisciplinary working group was formed. A hospital RS policy was developed and dietetic practice was re-audited in 2013 (n = 15). Results: Substantial variation was seen in perceived risk of RS with 53% of respondents correctly identifying high RS risk as per NICE2. Extreme and moderate risk were identified in 71% and 64% of respondents respectively. Identification of RS risk improved at all levels on re-audit, with 87%, 80% and 67% of dietitians identifying high, extreme and moderate risk respectively. Recommendations for initial caloric provision improved; 80% correctly prescribing 10 kcal /kg in high risk and 50% giving 5 kcal /kg in extreme risk, compared to 47% and 35% respectively on initial audit. Some overfeeding at extreme risk was still evident on re-audit, while underfeeding in high risk ceased. Recommendations for appropriate route and dose of thiamine and multivitamin supplementation markedly improved (80% vs 24%). Provision of full electrolyte requirements on feed initiation, as per NICE2 was deemed unsafe. Conclusion: Dietetic identification of RS risk, caloric provision and micronutrient recommendations improved at all levels of risk, with some scope for increased uniformity.