Predialysis Nutrition Linked to Lower Mortality

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NEW YORK— Some of the serious complications which arise during the first year of dialysis can be minimized with predialysis care by a dietitian, according to new data published in the October issue of the American Journal of Kidney Diseases.

These issues include insufficient protein and caloric intake and protein-energy malnutrition.

The researchers, led by Dr. Yelena Slinin of the VA Medical Center in Minneapolis, found an independent association between more than 12 months of predialysis care by a dietitian and increased chances of survival during the first year of dialysis. 

They reported that predialysis care by a dietitian is associated with lower total cholesterol levels and normal albumin levels at the onset of dialysis.  Hemodialysis patients who had the advantage of dietitian counsel were more likely to maintain appropriate nutrition.

Researchers noted that even though Medicare has been paying for medical nutrition therapy for patients within six months of a kidney transplant and for those with a GFR of 15-50 since 2002, only 10.5 percent of the patients beginning dialysis in 2005 had received dietary counsel before commencing ESRD therapy.       

According to the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative, patients with Chronic Kidney Disease (CKD) stages four or five should have  their nutritional status monitored at one to three month intervals, and patients at stage three  CKD should be monitored every six to twelve months. 

“Our guidelines suggest that nutritional monitoring be provided by a registered dietitian, trained and experienced in CKD nutrition and this study’s results certainly support that,” said Dr. Kerry Willis, Senior Vice President, Medical and Scientific Activities. 

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