SUN-102 NUTRITION-IMPACT SYMPTOM BURDEN IN PATIENTS ATTENDING RENAL SUPPORTIVE CARE

Abstract

End-stage kidney disease is associated with high symptom burden resulting in increased morbidity and mortality. Renal Supportive Care (RSC) is a multi-disciplinary approach to the management of patients with end-stage kidney disease who have chosen a conservative (non-dialysis) pathway or receiving renal replacement therapies (RRT) (eg. haemodialysis, peritoneal dialysis and transplantation) and suffering a significant symptom burden. Nutritional counselling plays an important role in the management of symptoms affecting a patient’s ability to eat well and prevent or treat malnutrition. Currently, no Australian data exists to describe the nutrition-impact symptom burden suffered by this group and the change in this symptom burden with nutritional counselling. This study aimed to describe the burden of nutrition-impact symptoms suffered by patients attending RSC and to describe the change in number and severity of nutrition-impact symptoms with dietetic intervention. A prospective audit was conducted from August 2015 to December 2017 for patients attending RSC across NSW. The presence and severity of nutrition-impact symptoms (poor appetite, sore or dry mouth, constipation, nausea, vomiting, diarrhoea) was assessed using the Palliative Care Outcome Scale-Renal (IPOS-Renal). Nutrition symptoms were scored from mild (1) to overwhelming (4). Nutrition-impact symptom severity scores were calculated by dividing the total symptom score by the number of nutrition symptoms. In NSW, patients on dialysis attending RSC services suffered from a higher rate of nutrition-impact symptoms than those being conservatively managed. The most frequently reported nutrition-impact symptoms were sore or dry mouth, poor appetite and constipation in both dialysis and conservatively managed patients. Sore or dry mouth was the most frequent symptom (63% of dialysis patients and 59% of conservatively managed patients), followed by poor appetite (54% in both dialysis and conservatively managed patients) and constipation (47% of dialysis patients and 37% of conservatively managed patients). Among dialysis patients, there was a decrease in total number of nutrition-impact symptoms between initial and follow-up nutritional assessments, 2.58 to 2.39 respectively. However, there was no change in the total number of nutrition-impact symptoms among conservative care patients with an average of 2.10 nutrition-related symptoms. The nutrition-impact symptom severity score of patients receiving dialysis (n=59) was 0.85 compared with 0.65 in conservatively managed patients (n=109). In both the dialysis (n=117) and conservative groups (n=251), nutrition-impact symptom severity improved between initial and follow-up dietitian interventions (0.76 and 0.59 respectively). Patients receiving dialysis attending RSC services suffer the highest nutrition-impact symptom burden. The three most common nutrition-impact symptoms experienced in both dialysis and conservatively managed patients being a sore or dry mouth, poor appetite and constipation. This study demonstrated that interventions by a dietitian were associated with reduced total number of nutrition-impact symptoms in dialysis patients and a decrease in nutrition-impact symptom severity in both dialysis and conservatively managed patients.