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NUTRITION PRACTICES AND PATIENT OUTCOMES IN MALAYSIAN HEMODIALYSIS CENTERS
Khor Ban Hock1, Sharmela Sahathevan1, Abdul Halim Gafor2, Lee Day Guat3, Zulfitri Azuan Mat Daud4,Tilakavati Karupaiah1
1Program Dietetics, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
2Nephrology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia
3National Renal Registry, Malaysian Society of Nephrology, Malaysia
4Nutrition and Dietetics Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
BACKGROUND: We assessed the availability of dietetic services and nutrition practices in Malaysian hemodialysis (HD) centers through a national cross-sectional survey. Centers were identified through the National Renal Registry (NRR) Malaysia A 17-item survey administered through telephonic interview to dialysis managers, elicited information on dietetic services, nutrition assessment, nutrition education, use of oral nutrition supplementation (ONS), and provision of in-center meals. The NRR database was also accessed for clinical data.
RESULTS: Of 150 participating HD centers, access to a dietitian was absent in 67.3%, while 18.0 % had in-house dietitians and 14.7 % had limited access as per visiting or shared services. Serum albumin was the most common nutrition parameter monitored (100 %), followed by normalized protein catabolic rate (32.0 %), BMI (28.7 %) and dietary intake (6.0 %). Renal specific ONS was recommended for malnourished patients in 102/150 HD centers, but only 10 centers supplied ONS free to patients. Poor appetite (37.9 %) and low albumin (28.4 %) were the common indications to recommend ONS to HD patients. Provision of in-center meals was reported in 92/150 HD centers. In a sub-group analyses (n=5274), patients in HD centers with an in-house dietitian were likely to achieve serum albumin >40g/L compared to patients without dietitian access (47.2% vs 40.5%, P<0.001). However, BMI and serum phosphate were not significantly different between groups (both P>0.05).
CONCLUSION: Clear discrepancies in nutrition management in Malaysian HD centers may translate into outcome disparities for HD patients.