Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status

Katrina L. Campbell, Susan Ash, Rachel Zabel, Catherine McFarlane, Philip Juffs, Judith D Bauer

Research output: Contribution to journalArticleResearchpeer-review

34 Citations (Scopus)

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. Crown

Original languageEnglish
Pages (from-to)136-144
Number of pages9
JournalJournal of Renal Nutrition
Volume19
Issue number2
DOIs
Publication statusPublished - Mar 2009
Externally publishedYes

Fingerprint

Nutrition Policy
Nutritionists
Nutritional Status
Kidney
Renal Dialysis
Maintenance
Energy Intake
Weights and Measures
Biochemistry
Patient Care
Nutritional Physiological Phenomena
Outcome Assessment (Health Care)
Interviews
Dietary Proteins
Crowns
Serum Albumin
Malnutrition
Observational Studies
Dialysis
Albumins

Cite this

Campbell, Katrina L. ; Ash, Susan ; Zabel, Rachel ; McFarlane, Catherine ; Juffs, Philip ; Bauer, Judith D. / Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status. In: Journal of Renal Nutrition. 2009 ; Vol. 19, No. 2. pp. 136-144.
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title = "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. Crown",
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Implementation of Standardized Nutrition Guidelines by Renal Dietitians Is Associated With Improved Nutrition Status. / Campbell, Katrina L.; Ash, Susan; Zabel, Rachel; McFarlane, Catherine; Juffs, Philip; Bauer, Judith D.

In: Journal of Renal Nutrition, Vol. 19, No. 2, 03.2009, p. 136-144.

Research output: Contribution to journalArticleResearchpeer-review

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