Evolution of Nutritional Status in Patients on Hemodialysis after 1 Year of Intervention by a Team of Kidney Dietitian-Nutritionists: Is It Possible to Correct Malnutrition from More Severe Stages?

Background: Given the complexity of protein energy wasting (PED) in hemodialysis (HD), prevention and treatment options are complex. There is no single treatment approach. Objective: To retrospectively evaluate the evolution of the nutritional status of HD patients. Methods: Descriptive, retrospective and multicenter study of 130 HD patients. We performed individualized nutritional intervention by Dietitians-Nutritionists (DN) integrated in a multidisciplinary team. We collected demographic, clinical, nutritional and nutritional screening variables, MIS1 and DPE2, at baseline and one-year follow-up. Parametric and non-parametric statistics for related groups. Results: Median age 75.77 years [65.43-83.83], time on HD 33.91 months [23.06-57.26], Charlson index 7 [5-9], BMI 24kg/m2 [21-27], LVEF 54.6%, DM 45.4%, diabetic nephropathy 22.3%, history of previous RF 30.8%, men 64.6%, non-EU origin 15.4%. In the annual follow-up, 82.3% of the patients remain active. A total of 5.4% were transplanted, 9.2% died and 3.1% were discharged. All patients receive dietary education (DE). Patients with moderate-severe malnutrition without improvement only with DE were added: 33.7% Oral nutritional supplementation (ONS) through hospital coordination, 16.8% intradialytic phosphosoda, 9.3% appetite stimulants, 7.5% food support by social services in coordination with the social work unit. An improvement in MIS screening scores was observed (baseline 7 [5-10] vs follow-up 5 [5-7]), especially those who received ONS (baseline 10 [7-13] vs follow-up 7 [6-9]). Even more evident in patients who received ONS during the entire period evaluated (baseline 12 [9-13] vs follow-up 7 [5-9]). A progression of malnutrition was observed and, likewise, a decrease in severe malnutrition (p ≤ 0.05). Conclusion: Individualized dietary advice in combination with different nutritional strategies from a multidisciplinary approach contributes to improve MIS scores and reverse malnutrition in more severe stages. Funding: Private Foundation Support