Strategies to identify and correct malnutrition in hemodialysis patients

Abstract

• ■ Objective: To assess the efficacy of an inhouse patient review form for identifying patients at risk of malnutrition and hence increased mortality and to assess the impact of dietary and medical intervention of the patients identified as being malnourished. • ■ Design: A retrospective audit of a cohort of patients monitored at baseline and regularly for 7 months. • ■ Setting: The hemodialysis unit at the Royal London Hospital, Whitechapel, London, England. • ■ Patients: Fifty-seven of 63 patients dialyzing during the day at this tertiary renal referral center. • ■ Intervention: Reiteration of dietary advice regarding meeting nutritional requirements, the use of dietary supplements, and medical intervention to improve anemia and adequacy of dialysis. • ■ Main outcome measures: The following parameters were obtained at baseline and reviewed within 7 months: daily protein intake, albumin levels, hemoglobin, dialysis hours per week, body weight, ideal body weight, body mass index, protein catabolic weight, Kt/V, bicarbonate, length of time on renal replacement therapy. • ■ Results: The relative risk of death was 6.8 times higher in the group with risk factors for malnutrition. Significant improvements in the nutrition intervention group with respect to percent change in weight (−4.41 ± 5.43 to +2.48 ± 5.92), dry weight (57.19 ± 12.92 to 59.16 ± 13.93), daily protein intake (49.1 ± 12.75 to 58.2 ± 15.21) were found. • ■ Conclusion: A simple protocol can identify patients at risk of malnutrition and mortality and in need of dietetic and medical intervention. Appropriate intervention can improve the nutritional status of these patients.