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Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status.

Abstract

OBJECTIVE

Standardized nutrition guidelines that focus on a nutrition care process have been used by dietitians treating renal patients in Australia for over 3 years. We show the impact of this implementation on the nutritional status of a cohort of hemodialysis patients.

DESIGN

We conducted a retrospective observational study, investigating a cohort of maintenance hemodialysis patients after the implementation of a systematic approach to the patient's nutritional care.

SETTING

This study took place in public and private in-center hemodialysis units.

PATIENTS

Patients included a cohort of 65 maintenance hemodialysis patients (mean age +/- SD, 64 +/- 15 years; 58% male; dialysis vintage median [interquartile range], 22 [10 to 46] months).

INTERVENTIONS

All participants were provided with a dietary interview at least every 6 months, with intensive follow-up where required, and were monitored monthly regarding weight and biochemistry. Outcomes were assessed annually between May 2004 and December 2006, after the implementation of this model of care.

MAIN OUTCOME MEASURE

Energy and protein intake according to dietary interview, nutritional status according to subjective global assessment, and data regarding dry weight and biochemistry (including albumin, potassium, and phosphate) were collected by the dietitian at each facility. Change in each outcome measure over time was assessed using repeated-measures analysis.

RESULTS

The proportion of patients with malnutrition (subjective global assessment B or C) decreased from 14% at baseline to 3% after 2 years. Serum albumin, potassium, and dry weight remained stable throughout the study period, and there was a significant decrease in serum phosphate over time (mean +/- SD,1.8 +/- 0.5 to 1.5 +/- 0.5 mmol/L, P = .004). Dietary energy and protein intake changed significantly over the study period (P = .001 and P = .022, respectively), with the highest mean intake recorded during the final follow-up assessment.

CONCLUSIONS

The implementation of a systematic approach to patient care, in line with nutrition management guideline recommendations, was associated with an improvement in nutritional status and dietary intake in this cohort of maintenance hemodialysis patients, without the need for increased resources or dietitian time.

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  • Authors+Show Affiliations

    ,

    Department of Nutrition and Dietetics, Institute of Health and Biomedical Innovation, Queensland University of Technology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.

    , , , ,

    Source

    MeSH

    Aged
    Analysis of Variance
    Australia
    Cohort Studies
    Dietary Proteins
    Dietetics
    Energy Intake
    Female
    Humans
    Kidney Failure, Chronic
    Male
    Malnutrition
    Middle Aged
    Nutrition Assessment
    Nutritional Status
    Phosphates
    Potassium
    Practice Guidelines as Topic
    Renal Dialysis
    Retrospective Studies
    Serum Albumin
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    19218040

    Citation

    Campbell, Katrina L., et al. "Implementation of Standardized Nutrition Guidelines By Renal Dietitians Is Associated With Improved Nutrition Status." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 19, no. 2, 2009, pp. 136-44.
    Campbell KL, Ash S, Zabel R, et al. Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status. J Ren Nutr. 2009;19(2):136-44.
    Campbell, K. L., Ash, S., Zabel, R., McFarlane, C., Juffs, P., & Bauer, J. D. (2009). Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 19(2), pp. 136-44. doi:10.1053/j.jrn.2008.11.002.
    Campbell KL, et al. Implementation of Standardized Nutrition Guidelines By Renal Dietitians Is Associated With Improved Nutrition Status. J Ren Nutr. 2009;19(2):136-44. PubMed PMID: 19218040.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status. AU - Campbell,Katrina L, AU - Ash,Susan, AU - Zabel,Rachel, AU - McFarlane,Catherine, AU - Juffs,Philip, AU - Bauer,Judith D, PY - 2007/10/02/received PY - 2009/2/17/entrez PY - 2009/2/17/pubmed PY - 2009/6/2/medline SP - 136 EP - 44 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 19 IS - 2 N2 - OBJECTIVE: Standardized nutrition guidelines that focus on a nutrition care process have been used by dietitians treating renal patients in Australia for over 3 years. We show the impact of this implementation on the nutritional status of a cohort of hemodialysis patients. DESIGN: We conducted a retrospective observational study, investigating a cohort of maintenance hemodialysis patients after the implementation of a systematic approach to the patient's nutritional care. SETTING: This study took place in public and private in-center hemodialysis units. PATIENTS: Patients included a cohort of 65 maintenance hemodialysis patients (mean age +/- SD, 64 +/- 15 years; 58% male; dialysis vintage median [interquartile range], 22 [10 to 46] months). INTERVENTIONS: All participants were provided with a dietary interview at least every 6 months, with intensive follow-up where required, and were monitored monthly regarding weight and biochemistry. Outcomes were assessed annually between May 2004 and December 2006, after the implementation of this model of care. MAIN OUTCOME MEASURE: Energy and protein intake according to dietary interview, nutritional status according to subjective global assessment, and data regarding dry weight and biochemistry (including albumin, potassium, and phosphate) were collected by the dietitian at each facility. Change in each outcome measure over time was assessed using repeated-measures analysis. RESULTS: The proportion of patients with malnutrition (subjective global assessment B or C) decreased from 14% at baseline to 3% after 2 years. Serum albumin, potassium, and dry weight remained stable throughout the study period, and there was a significant decrease in serum phosphate over time (mean +/- SD,1.8 +/- 0.5 to 1.5 +/- 0.5 mmol/L, P = .004). Dietary energy and protein intake changed significantly over the study period (P = .001 and P = .022, respectively), with the highest mean intake recorded during the final follow-up assessment. CONCLUSIONS: The implementation of a systematic approach to patient care, in line with nutrition management guideline recommendations, was associated with an improvement in nutritional status and dietary intake in this cohort of maintenance hemodialysis patients, without the need for increased resources or dietitian time. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/19218040/Implementation_of_standardized_nutrition_guidelines_by_renal_dietitians_is_associated_with_improved_nutrition_status_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(08)00459-7 DB - PRIME DP - Unbound Medicine ER -