Can malnutrition in predialysis patients be prevented by dietetic intervention?

Objective: This study aimed to discover if the documented decline in nutritional status in predialysis patients could be prevented by dietetic intervention. Design: Longitudinal prospective interventional study. Setting: General hospital nephrology clinic. Patients: Eleven patients with progressive chronic renal failure not yet requiring dialysis, all with creatinine clearance below 25mL/min were studied. Mean age was 63.9 ± 14.5 years. Intervention: Patients received nutritional counseling from a renal dietitian on at least 3 occasions over a period of 6 months. Following assessment, patients were advised on dietary changes according to individual need, aiming for adequate energy intake to achieve or maintain a body mass index of 20 to 25 and protein intake of 0.8 to 1.0 g/kg/d. Dietary supplements were prescribed when necessary. Outcome measures: Changes in nutritional status were assessed by Subjective Global Assessment, anthropometric measures (weight, triceps skinfold thickness, mid arm muscle circumference, and grip strength), and biochemical markers (serum albumin, serum transferrin, and insulin-like growth factor-1). Results: None of the patients showed decline in Subjective Global Assesment category, and 2 of the patients improved. All anthropometric and biochemical measures of nutritional status were stable or increased over the course of the study, and mid arm muscle circumference increased significantly ( P < .05), contrasting with published data showing a decline in these measures in patients not receiving dietetic intervention. Conclusion: With dietetic intervention, it may be possible to maintain or improve nutritional status in this group. © 2001 by the National Kidney Foundation, Inc.