PREVALENCE OF MALNUTRITION AS CLINICAL TARGET IN MAINTENANCE HAEMODIALYSIS, IS IT A GOOD INDICATOR?

M CHAN1,2,3
1The St. George Hospital, Kogarah, Australia, 2University of New South Wales, Kensington, Australia, 3University of Wollongong, Wollongong, Australia

Aim: To examine the cause of persistent high prevalence of malnutrition categorised by Subjective Global Assessment (SGA) score B/C in a tertiary haemodialysis (HD) centre.
Background: Clinical practice guidelines recommend routine six-monthly nutrition review using SGA, and set clinical target on “percentage of malnutrition (SGA score B/C)”. Our data revealed a persistent high prevalence of malnutrition ~35%. Therefore, it is important to identify the cause(s) to minimise malnutrition which is associated with increased mortality and other adverse outcomes.
Methods: Retrospective audit of routine nutritional assessment records was performed at month 0 (T-0mth) and sixth (T-6mth). Data collected were patient-flow (e.g. hospital admission, transfer etc.), SGA and patient’s response to nutrition interventions. Descriptive analyses were performed.
Results: 108 patients (T-0mth) and 109 patients (T-6mth) were studied. Prevalence of malnutrition was 39.8% and 32.1% respectively. Approximately 64.6% of patients received repeated measures at both time points; those only received one measure were transplanted (3.5%), deceased (6.3%), AKI/temporary patients (9.7%), transferred to and from other units (7.6%) and new patients (8.3%) at T-6mth, with ~50% of new or AKI/temporary patients were rated as malnourished. Of the 43 malnourished patients at T-0mth, 58% responded to nutrition intervention, and improved (39.5%) or stabilised (18.6%) by the T-6mth. The rest deteriorated due to hospitalisation; or deceased or transferred. These results reflect the general nature of patient-flow that consists of new, unstable, recent hospitalised patients entering and leaving the program.
Conclusions: Routine six-monthly SGA is effective in monitoring nutritional status. However, using “prevalence of malnutrition” as clinical target was not found to be a useful global indictor of the unit’s performance. Intrapersonal improvement should be a feasible nutrition indicator to adopt.


Biography:
Dr. Maria Chan is the Lead renal dietitian at the St. George Hospital, Kogarah, Conjoint Associate Lecturer, University of New South Wales, Kensington, and Honorary Clinical Principal Fellow University of Wollongong, Australia. Her research interest is nutrition, exercise and metabolism in renal disease

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