‘On dialysis’ food provision can improve dietary intake on dialysis days

SL Jorgensen, RC Wolfenden, LM Wells,

York District Hospital

Problem: Malnutrition is a common finding among haemodialysis patients. It is well recognised that the development of such malnutrition is often multi-factorial and is associated with poor outcomes. In an audit undertaken in 2002, patients reported to frequently miss meals or eat less on dialysis days (DD) compared to non-dialysis days (NDD) and it was apparent that there was a link between this and nutritional risk.

Purpose: Following the audit, patients were routinely counselled on how to manage the potential impact of dialysis treatment on meal patterns. Food provision was also formalised and food is offered to those patients identified by a renal dietitian as having an increased nutritional risk. As a result we decided to compare food intake on both DD and NDD and identify any differences between place and time of dialysis, along with other social factors.

Design: As part of routine nutritional assessment, patients were asked to complete a three day food diary. Diaries returned over a 12 month period were analysed by experienced renal dietitians to determine average daily calorie and protein intake on both DD and NDD. Information regarding the time and place of dialysis, age, social circumstances and food intake on haemodialysis was also collected.

Findings: 44 chronic haemodialysis patients (mean age 70.2 ± 13.2 years) returned food diaries (31 main unit (MU) and 13 satellite unit SU)). 40 patients (90%) consumed food on dialysis which was provided by the renal unit. Such ‘on dialysis’ food provision contributed 26% of calories and 23% of protein to an average DD intake. Both MU and SU patients consumed significantly more calories (p=0.003) and protein (p=0.013) on DD compared to NDD. On DD patients dialysing at the SU ate significantly more calories (p=0.018) than those at the MU. There was no significant difference between age or social circumstances. Although not significantly different, patients dialyzing on an afternoon shift ate less than those on a morning or twilight shift, which confirms findings of the 2002 audit.

Conclusion: Increased consumption of calories and protein on DD may be the result of the changes that have been implemented since the 2002 audit. ‘On dialysis’ nutritional intervention can contribute a significant amount of protein and calories to a DD intake. Addressing the problem of patients missing meals or eating less when attending for dialysis can lead to a significant increase in protein and calorie consumption on DD.

Relevance: Food provision on haemodialysis may be beneficial in helping to address malnutrition but with the knowledge that some patients experience less intra-dialytic complications when food is avoided, it is important that tolerance and symptoms should be monitored. In addition, the requirement for such food provision should be regularly assessed by a dietitian on an individual patient basis.