Newsletter

[ Vol. 11 No. 3 ] (September - December 2010 )
Oral nutritional support in renal failure

Maria Chan
Department of Nutrition & Dietetics, The St George Hospital, New South Wales, Australia

Malnutrition is common in Chronic Kidney Disease (CKD). It could occur at any stages of CKD even well before dialysis is required. It predicts hospitalisation rate, mortality and morbidity and is associated with poor quality of life (QOL). Clinical practice guidelines recommend nutrition interventions by dietitians for optimal management of metabolism and catabolism. Prevention is the key. As soon as malnutrition is identified, the first line of management is oral nutritional support. It is both a science and an art; the dietitian must address all aspects of dietary modifications as well as any psychosocial issues specific to CKD. Cost effective oral nutritional support requires the dietitians to adopt a structured nutritional care process, known as Medical Nutrition Therapy (MNT). System and clinical management must go hand in hand to provide quality care. Effective screening and timely referral are important, they allow the patients at risk to be identified and treated early. With MNT, a skilled dietitian must be able to provide a structured nutrition care plan including assessment, education, diet prescription, counseling and a diet plan with realistic goals for the patients. Food fortifications and oral nutrition supplements are often used to manage malnourished patients. Continuous evaluation and monitoring are vital to achieving the desirable outcomes. As part of the multi-disciplinary renal team, the dietitian must work closely with other health professionals to address clinical and psychosocial issues such as the use of medications / appetite stimulants, dialysis dosage, exercise training, food budgeting and behavioural modifications. All of these could affect the outcomes of nutritional care. Quality improvement and research activities should also form part of the routine to ensure performance targets are met and to improve outcomes. In conclusion, oral nutritional support is an integral part of medical management of malnourished renal patients and its success depends on a total management approach of MNT and the collaborative care of the multi-disciplinary renal team.

From  
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 58