title: [Nutritional care and clinical improvement in a renal ward: a pilot multimodal approach].
abstract: Malnutrition is an independent factor associated with morbi-mortality in chronic kidney disease. It is particularly common and may increase during hospitalization.
  
  
  OBJECTIVE
  To measure nutritional and physical performance evolution as well as patients' physical autonomy during a hospitalization in a university hospital renal ward. Treatments were adjusted according to different diagnoses (nutritional care, body composition, physical activity) along with a multidisciplinary approach. In this way, it can show the impact of this care on nutritional status of the patient.
  
  
  METHODS
  Regardless of their nutritional status and kidney disease (acute or chronic kidney disease, chronic hemodialysis), patients were included at day 0, within 2 days from admission; nutritional interventions and measurements were assessed on day 7, day 14 and day 21. The study was run from December 2011 till June 2012, and 48 patients were included.
  
  
  RESULTS
  On admission, patients had a low energy intake (20.9±8.6 kcal/kg/day). This intake was improved by means of a dietetic intervention (28.1±6.5 kcal/kg/day after two weeks of hospitalization, 29±6.1 kcal/kg/day after three weeks and 29±8.4 kcal/kg/day after four weeks). Seventy-three percent of the hospitalized patients were malnourished, among them 91% had a decreased serum albumin (26.8±6.6 g/L). Weight and muscle mass (measured by impedancemetry) were maintained, prealbumin increased by 16.5 mg/L after two weeks (n=48; P=0.61), 27.8 mg/L after three weeks (n=31; P=0.018), 52.3 mg/L after four weeks (n=13; P=0.002) and albuminemia by 1.8 g/L (n=13 patients monitoring four weeks; P=0.13). Both physical autonomy (assessed with Test moteur minimum) and muscle strength (Hand Grip Test) were significantly improved.
  
  
  CONCLUSIONS
  A systematic screening of wasting and a multidisciplinary care improved nutritional status and physical ability of patients hospitalized in a renal ward.
authors.affiliation: Service de néphrologie-hypertension-dialyse, hôpital Édouard-Herriot, 69437 Lyon, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Pasian
authors.affiliation: Service de néphrologie-hypertension-dialyse, hôpital Édouard-Herriot, 69437 Lyon, France; Carmen, Inserm 1060, université de Lyon, 69495 Pierre Bénite, France.
authors.forename: Fitsum
authors.initials: F
authors.lastname: Guebre-Egziabher
authors.affiliation: Service de néphrologie-hypertension-dialyse, hôpital Édouard-Herriot, 69437 Lyon, France; Carmen, Inserm 1060, université de Lyon, 69495 Pierre Bénite, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Kalbacher
authors.affiliation: Service de néphrologie-hypertension-dialyse, hôpital Édouard-Herriot, 69437 Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Pommerol
authors.affiliation: Carmen, Inserm 1060, université de Lyon, 69495 Pierre Bénite, France; Service de néphrologie-dialyse-nutrition, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: denis.fouque@chu-lyon.fr.
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
mesh_terms: D000368:Aged; D004045:Dietary Services; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D009752:Nutritional Status; D010348:Patient Care Team; D010865:Pilot Projects; D051437:Renal Insufficiency / Q000453:epidemiology*; D012709:Serum Albumin
chemical_list: D012709:Serum Albumin
keywords: Apports protéino-énergétiques; Artificial nutrition; Body composition; Capacité physique; Composition corporelle; Dénutrition; Insuffisance rénale; Kidney disease; Nutrition artificielle; Physical capacity; Protein-energy intake; Refeeding; Renutrition; Wasting