S NOTARAS1,2,4, L GALEA1,3, P LEE1, V BRITOS4, B YIP4, A MAKRIS1,2,3,4
1Dietetics Department, Liverpool Hospital, Liverpool, Australia, 2Western Sydney University, , Australia, 3University of New South Wales, , Australia, 4Renal Department, South Western Sydney Local Health District, , Australia
Aim: Investigate the impact of medical nutrition therapy (MNT) on time to dialysis for patients attending a pre-dialysis service.
Background: MNT is a key component of Chronic Kidney Disease (CKD) treatment. A multidisciplinary approach, including dietetics, has been reported as the most optimal model of care for dialysis preparation, focusing on symptom management and nutrition changes to delay dialysis. Delaying dialysis is a significant motivator for patients to change dietary behaviours. Evidence on the impact of MNT on delaying time to dialysis is limited.
Methods: A retrospective, multi-centre observational cohort study of patients attending pre-dialysis clinics within a metropolitan renal service. Demographic/medical data, MNT received and time to dialysis were collected from electronic medical records and letters. Patients who received MNT were compared to those who did not receive MNT over a 4-year period. Primary endpoint was time to dialysis. Patients excluded: under 18 years, those who received transplant prior to dialysis, commenced dialysis within three months of initial pre-dialysis visit or managed conservatively.
Results: A cohort of 259 patients was identified. Mean eGFR was 17ml/min (95%CI 16.2-17.7) at initial pre-dialysis clinic visit. Diabetic nephropathy was the cause of CKD in 53% of patients, 66% were English-speaking, 62% commenced dialysis. Only 42% of patients received MNT. There were significantly fewer patients needing to commence dialysis in those undergoing MNT compared to no-MNT HR 0.56 (95%CI 0.40-0.78;p=0.001 Cox proportion hazard). The MNT and no-MNT group commenced dialysis on average 960 days (95%CI 863-1058) and 710 days (95%CI 628-792) respectively after dialysis education.
Conclusions: Patients who received MNT had a slower progression to dialysis. Standardised referral pathways are needed to optimise patient access to pre-dialysis dietetic services.
Stephanie Notaras is a Senior Renal Dietitian at Liverpool Hospital and an Accredited Practicing Dietitian. She has 9 years of work experience in both acute inpatient and outpatient settings. She has completed a Master of Social Health and Counselling with a research focus on the experiences of patients with chronic kidney disease and eating behaviour change. Stephanie is guest lecturer and OSCE examiner at the University of Wollongong and is also undertaking a PhD in renal nutrition.