REGIONAL AUDIT OF NUTRITION AND RENAL BONE DISEASE IN HAEMODIALYSIS PATIENTS IN NORTHERN IRELAND

K Magee, C Mackin, T Moffitt, J McKee, H Mathieson, S Macafee

Belfast City Hospital

PROBLEM: Maintaining or improving nutritional status and controlling bone biochemistry are continual challenges for renal dietitians and now occupy the majority of our patient contact time in the haemodialysis (HD) unit.

PURPOSE: To audit how dialysis units in Northern Ireland (NI) compare with each other and with the Renal Association (RA) Standards (2002). To review and improve current management strategies.

DESIGN: Each dialysis unit collated data on their own maintenance HD patients who had been on HD for > 90 days. The data was presented and discussed at a regional audit meeting in June 2004 and at an All Ireland Renal Nutrition Study Day in November 2004.

MAIN FINDINGS: 479 HD patients were included in the audit. Overall 72% achieved the RA target for phosphate (range 66-84%) with Sevelamer being the most commonly used binder. 83% met the target for calcium levels (range 81-93%). These results compared favourably with the England and Wales Renal Registry Results (2003). 41% had a Body Mass Index (BMI) within the healthy weight range (range 39-48%). 85% met the RA target for albumin with 10-30% requiring oral nutritional supplements.

CONCLUSION: There is a wide variation between units in NI when comparing markers of nutrition and renal bone disease. NI compares favourably with England and Wales for some results but still falls short of the RA standards. There is a high incidence of overweight and obesity in HD patients and also a large number requiring nutritional support.

RELEVANCE: Nutritional status and bone disease both influence clinical outcomes and quality of life in HD patients and all members of the Multidisciplinary Team (MDT) need to work together to ensure best practice. Renal Dietitians have a key role to play in tackling these issues and need to continually review their practice to ensure the best patient outcomes.