title: Impact of a high-dependency care area on the nutritional management of patients with acute uremia.
abstract: At this institution, all non-intensive care unit (ICU)-based patients with acute uremia were previously managed on the general nephrology ward, and there were concerns that these patients may not have been benefiting from optimal management, particularly with regard to nutrition. In 1998, a renal high-dependency care (RHDC) unit was established within the ward, providing opportunity to compare the clinical management and outcomes of acutely uremic patients in 2 annual cohorts that were admitted both before and after implementation of the RHDC unit. Retrospective case reviews complemented data collected prospectively on the unit since 1995. There were 108 patients included from 1995 to 1996 and 86 patients included from 1998 to 1999; no patients were excluded, but a few case records were unobtainable. Both patient groups were demographically similar (median age, 68 years pre-RHDC, 62.5 years with the RHDC unit), and initial illness severity/comorbidity showed no significant differences. Nutritional support increased significantly (P <.05) from 22.4% in 1995 to 1996 to 38.4% of patients in 1998 to 1999, reflecting increased oral supplementation. Dialysis requirements were similar (60.2% v 63.5%). The proportion of patients requiring admission to the ICU (17.6% v 8.1%) and the total number of ICU bed days used (195 v 86) was reduced in 1998 to 1999. Cost analysis showed little overall difference between the 2 cohorts; the actual cost of improved nutritional management was negligible. The RHDC area and its nurse-based protocols have increased nutritional support for acutely uremic patients, allowing a reduction in ICU usage without any worsening in outcomes.
authors.affiliation: Department of Renal Medicine, Hope Hospital, Salford, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Maredia
authors.forename: Diane
authors.initials: D
authors.lastname: Green
authors.forename: Heather
authors.initials: H
authors.lastname: Jayasekera
authors.forename: Hilary
authors.initials: H
authors.lastname: Robinson
authors.forename: Anne
authors.initials: A
authors.lastname: Jones
authors.forename: Julian
authors.initials: J
authors.lastname: Wright
authors.forename: Donal J
authors.initials: DJ
authors.lastname: O'Donoghue
authors.forename: Stephen
authors.initials: S
authors.lastname: Waldek
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D008297:Male; D015596:Nutrition Assessment; D018529:Nutritional Support; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D014511:Uremia / Q000191:economics / Q000628:therapy*