MALNUTRITION SCREENING IN AN IN-CENTRE HAEMODIALYSIS UNIT: APPETITE FOR CHANGE?

Best Practice Guidelines recommend regular nutrition assessment of patients receiving haemodialysis, with priority to those with poorly controlled co-morbidities or malnutrition. On a nurse-led monthly care plan, serum albumin is currently being used to identify patients requiring referral to a dietitian. It is well documented that the specificity of serum albumin as a nutritional marker is limited by the presence of inflammation. The purpose was to compare albumin with an alternative screening tool. An annual malnutrition audit was conducted with 100 patients attending in-centre Haemodialysis across two centres. Each were assessed using the PG-SGA or SGA, and asked to rate their appetite on a five point scale (very poor, poor, fair, good or very good). Pre dialysis serum albumin levels were noted. Of the 100 patients assessed, 28% were classified as malnourished. 61% of all patients had a serum albumin of 35 g/L or less. 31% of all patients rated their appetite as being fair, poor or very poor. The sensitivity, specificity, positive predictive values and negative predictive values of albumin and appetite as a screening tool for malnutrition can be seen in the table. Albumin (≤35 g/L) Appetite (≤fair) Sensitivity 0.86 0.78 Specificity 0.49 0.86 Positive Predictive Value 0.39 0.68 Negative Predictive Value 0.90 0.91 If albumin is used as a screen for malnutrition and referral to a dietitian, 61% of those referrals will be assessed by the dietitian as well nourished, and 14% of malnourished patients would be missed. If appetite was used as a screen for malnutrition, 32% of those referrals will be assessed by the dietitian as well nourished, and 22% of malnourished patients would be missed. Asking patients to rate their appetite on a five point scale appears to be an effective way to screen for malnutrition in the haemodialysis population. In centres with limited dietitian support, this may be preferable to screening with albumin due to the reduced number of inappropriate referrals and therefore enabling the priority to lie with the patients with malnutrition.