Nutrition workout Advisory for ongoing Hemodialysis (HD) Patient

 

The prevalence of Chronic Kidney Disease is increasing day by day as per latest statistics and there is need to introduce appropriate measures to hamper the progression of kidney function deterioration. In spite of dietary guidelines available for CKD management, which gets updated every now and then, but still issue remains unresolved. Every time there are studies done to see nutritional status of renal patient but still no decrease in the rate of mortality. At present majority of patients on dialysis fall under all age group category. As age increases risk of several other diseases also increases along with poor nutritional intake, because of long-term dialysis. The nutritional disturbances due to dialysis, compounds to the problem and the patients become more susceptible to malnutrition.

·   Methodology: Basic demographic data were collected from all participating patients. Charlson Co morbidity Index (CCI) scores, using standard methods, were calculated by a detailed review of the medical records. For process of collecting data, a diet home recall was taken from each patient. A descriptive research was used to evaluate malnutrition status using CCI index to understand co- morbidity risk of patients on dialysis along with SGA and biochemical parameters like hemoglobin, creatinine and potassium. Use of convenience sampling settings was used to choose patients on dialysis. All the dialysis patients willing to participate were eligible to be part of the study. 108 patient’s biochemical parameters were collected through medical file to evaluate the nutritional status along with their CCI index.

·   Findings: The study predicts nutritional risk like anemia, dehydration, micronutrient deficiency and loss of muscle mass that leads to malnutrition in elderly. Age, a component of CCI, is a strong risk factor for morbidity and mortality in chronic diseases and correlates with co morbidities. 

  The graph towards right side  shows participants and their hemoglobin levels. X axis depicts class interval and Y axis depicts frequency. 

The graph towards right side shows participants and their potassium levels. X axis depicts class interval and Y axis depicts frequency. 






 The graph towards left side  shows participants and their creatine levels. X axis depicts class interval and Y axis depicts frequency. 

The CCI independent of age is a robust and linear predictor of mortality in hemodialysis patients. The mortality rate of patients with advanced chronic kidney disease (CKD) is unacceptably high. These patients have a high prevalence of co-morbid conditions, which in itself is one of the major risk factors for high mortality.


Category

No. of patients

CCI score

%

HD

49

0

45%

HD+HTN

26

1

24.07%

HD+DM

7

1

0.06%

HD+DM+HTN

22

2

20.37%

HD+DM+HTN+
other co-morbidities

4

2

0.037

Recommendation:  As researcher, strongly feel that there is some X factor need to get discovered to improve nutritional status of dialysis patient. To overcome this scenario of malnutrition risk need new advisory workout for renal patient and up gradation of all macro and micro nutrients. This study is mini effort to develop advisory workout in long term dialysis patients.

Special Note:  There are oral nutritional supplements available in the diet markets. But dialysis patient are not able to take required doses and appetite also gets affected. So needs more practical testing of nutritional supplements before they introduce in market. Even cost needs to lower as it is used by them every day.


By:

Ushakiran Sisodia R.D Msc Gold medallist, PGDBM ,CDE; A.N Radha winner (Best Practicing dietician three consecutive years )

Neha Sawant M.sc Food processing and preservation Assistant Manager Nutrition and dietetics

Manjiri hankare PG Nutrition dietetics  Junior Dietician 

Sanjana Rao M.sc Dietetics and applied nutrition (MNT)

Shruti Nair M.sc Dietetics and applied nutrition (Pediatric)

Nanavati Max super Speciality hospital Mumbai India (Diet &Nutrition Dept)

 

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