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.
  
  
  METHODS
  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.
  
  
  METHODS
  This study took place in public and private in-center hemodialysis units.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Nutrition and Dietetics, Institute of Health and Biomedical Innovation, Queensland University of Technology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Campbell
authors.forename: Susan
authors.initials: S
authors.lastname: Ash
authors.forename: Rachel
authors.initials: R
authors.lastname: Zabel
authors.forename: Catherine
authors.initials: C
authors.lastname: McFarlane
authors.forename: Philip
authors.initials: P
authors.lastname: Juffs
authors.forename: Judith D
authors.initials: JD
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D004044:Dietary Proteins / Q000008:administration & dosage; D004046:Dietetics / Q000592:standards*; D002149:Energy Intake / Q000502:physiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010710:Phosphates / Q000097:blood; D011188:Potassium / Q000097:blood; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins; D010710:Phosphates; D012709:Serum Albumin; D011188:Potassium