Prise en charge pratique de la dénutrition des patients hémodialysés en France : enquête nationale

Abstract

Protein energy wasting (PEW) is frequent among hemodialysis patients. Published international recommendations in this field are sometimes difficult to implement in daily practices. We evaluated daily practices of PEW screening and treatment in French hemodialysis centers using an online computerized questionnaire sent by email (1 answer required per center). Eighty-six centers returned the questionnaire filled by a nephrologist (43%), nurse (14%) or dietician (43%). The mean number of patients per center was 112±64 patients. PEW screening was performed at least once/month in 56% of centers, once/3 months in 36%, and less frequently in 8%. PEW screening frequency and tools were in agreement with recommendations. Regarding treatment, dietitian interviews were proposed in 98% of units. Hundred percent of units prescribed home oral nutrition supplements (ONS), and 90% ONS during hemodialysis. Ninety-seven percent of centers practiced intradialytic parenteral nutrition, 34% enteral nutrition with feeding tube and 41% with gastrostomy. 14% of centers had no dietician or only on call. A dietician was present≤1 day per week in 44% of centers, 1 to 2.5 days per week in 27%, and>2.5 days per week in 15%. After adjustment for the number of patients, private practice units had significantly less time of presence of the dietician than nonprofit associations or public healthcare centers. In all, 36% of centers offered physical activity during hemodialysis sessions – cycling in almost all centers – and only 12.8% proposed physical activity programs apart from dialysis sessions. In summary, in majority of French hemodialysis centers, PEW screening was consistent with recommendations but the dietician time was insufficient to screen for PEW causes and elaborate a treatment program. Only one third of centers perform enteral nutrition, the most recommended artificial nutrition therapy. Nutritional treatment could be improved in hemodialysis centers in France.