Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status

Campbell, Katrina L., Ash, Susan, Zabel, Rachel, Mortimer, Catherine, Juffs, Philip, & Bauer, Judith D. (2009) Implementation of standardized nutrition guidelines by renal dietitians is associated with improved nutrition status. Journal of Renal Nutrition, 19(2), 136 -144.

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Standardized nutrition guidelines that focus on a nutrition care process have been used by dietitians treating renal patients in Australia for over 3 years. We show the impact of this implementation on the nutritional status of a cohort of hemodialysis patients.


We conducted a retrospective observational study, investigating a cohort of maintenance hemodialysis patients after the implementation of a systematic approach to the patient's nutritional care.


This study took place in public and private in-center hemodialysis units.


Patients included a cohort of 65 maintenance hemodialysis patients (mean age ± SD, 64 ± 15 years; 58% male; dialysis vintage median [interquartile range], 22 [10 to 46] months).


All participants were provided with a dietary interview at least every 6 months, with intensive follow-up where required, and were monitored monthly regarding weight and biochemistry. Outcomes were assessed annually between May 2004 and December 2006, after the implementation of this model of care.

Main Outcome Measure

Energy and protein intake according to dietary interview, nutritional status according to subjective global assessment, and data regarding dry weight and biochemistry (including albumin, potassium, and phosphate) were collected by the dietitian at each facility. Change in each outcome measure over time was assessed using repeated-measures analysis.


The proportion of patients with malnutrition (subjective global assessment B or C) decreased from 14% at baseline to 3% after 2 years. Serum albumin, potassium, and dry weight remained stable throughout the study period, and there was a significant decrease in serum phosphate over time (mean ± SD,1.8 ± 0.5 to 1.5 ± 0.5 mmol/L, P = .004). Dietary energy and protein intake changed significantly over the study period (P = .001 and P = .022, respectively), with the highest mean intake recorded during the final follow-up assessment.


The implementation of a systematic approach to patient care, in line with nutrition management guideline recommendations, was associated with an improvement in nutritional status and dietary intake in this cohort of maintenance hemodialysis patients, without the need for increased resources or dietitian time.

Impact and interest:

25 citations in Scopus
23 citations in Web of Science®
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ID Code: 17389
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Nutrition guidelines, Renal Dietitians, Nutrition Status
DOI: 10.1053/j.jrn.2008.11.002
ISSN: 1051-2276
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NUTRITION AND DIETETICS (111100)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NUTRITION AND DIETETICS (111100) > Nutrition and Dietetics not elsewhere classified (111199)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2009 Elsevier
Copyright Statement: This is the author’s version of a work that was accepted for publication in Journal of Renal Nutrition. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Renal Nutrition, [VOL 19, ISSUE 2, (2009)] DOI: 10.1053/j.jrn.2008.11.002
Deposited On: 19 May 2009 22:38
Last Modified: 27 Jun 2017 19:46

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