THE DIETITIANS ROLE IN THE MANAGEMENT OF MALNUTRITION IN CHRONIC-RENAL-FAILURE

A questionnaire-based survey of the practice of renal dietitians in the UK has been undertaken. The questionnaire was designed to examine three areas: nutritional practice, nutritional assessment and nutritional support. There was a response rate of 86% (61/71). Staffing levels ranged from 0 to 3.0 (median 1.0) whole time equivalents (WTE). The ratio of dialysis patients to dietitians ranged from 39 to 244 per WTE (median 134). Nutrition was perceived to be of low priority in four units, of medium priority in 25 and of high priority in 32. Dietary prescription was specified in three ways: by medical staff (33/61), as per unit policy (16/61) and as decided by the dietitian (54/61). Dietary protein prescription ranged from 0.5 to 1.0 g/kg/day (mean 0.71) in pre-dialysis patients, from 1.0 to 1.4 g/kg/day (mean 1.08) in haemodialysis (HD) patients and from 1.0 to 1.5 g/kg/day (mean 1.3) in CAPD. The prevalence of malnutrition in all three groups of patients was estimated to be less than 30% by the majority of dietitians. Weight and height (56/61), body mass index (53/61) and serum albumin (58/61) were used most frequently to assess nutritional status. Urea kinetic modelling was used infrequently (HD 21, CAPD 4, pre-dialysis 1). Nutritional audit was performed in only 14 units. This study suggests that the identification and treatment of malnutrition in UK renal units is of a low priority at present. This needs to be reversed and dietitian's should be responsible for this role.