S 34 Plenary Session

Programme of the Session:

GS: Martina Susenj (Spain)
The spectrum of malnutrition in ESRD

O 64
Evaluation of the Nutritional Status of Haemodialysis Patients
Mukadder Mollaoğlu (Turkey)

O 65
Relationship between body mass change and survival of dialyzed patients
Erzsebet Molnar (Hungary)

O 66
A nurse-led multifactorial intervention to improve phosphate binder adherence: a one-year clinical trial
Yoleen Van Camp (Belgium)

Abstracts:

GUEST SPEAKER
The Spectrum of Malnutrition in End Stage Renal Disease
M. Susenj^1
1Diaverum, Barcelona, Spain

Objectives: This presentation considers the assessment and treatment of malnutrition status of patients with End Stage Renal Disease (ESRD). According to recent studies this is a relatively common condition with a prevalence between 18 and 75% depending on dialysis modality, nutritional assessment tool, origin of patient population and other demographics. Malnutrition in ESRD patients cannot be just attributed to inadequate food intake, as the concept ambiguously implies. Malnutrition in ESRD patients has been found to have overlapping etiological factors with chronic inflammation that may result in arteriosclerosis (i.e., malnutrition inflammation arteriosclerosis syndrome). Research studies also suggest the importance of underlying metabolic and endocrine alterations as the driving force of malnutrition, identifying the following risk factors: hyperparathyroidism, metabolic acidosis, systemic inflammation, and catabolism associated with dialysis treatment and underlying comorbid conditions. Due to its etiologic complexity, those studies suggest the need of combining different nutritional assessment tools to predict their nutritional status, such as dietary anamnesis, body composition measurements, various scoring systems, and laboratory indicators. In addition, once diagnosed, the most effective way to address malnutrition in ESRD patients consists of implementing nutritional therapies such as nutrient supplementation (e.g., protein, calories, micronutrients), anabolic strategies (e.g., use of recombinant human growth hormone, anabolic steroids), appetite stimulants (e.g., ghrelin, megestrol acetate) and anti-inflammatory intervention (e.g., omega 3). The ultimate goal of these interventions is the preservation of lean body mass, which low levels are associated to increased risk of morbidity and mortality.

BIOGRAPHY OF THE GUEST SPEAKER

O 64
Evaluation of the Nutritional Status of Hemodialysis Patients
Mukadder Mollaoglu¹, Mansur Kayataş¹, Ferhan Candan¹, Birsen Yürügen^2
1Cumhuriyet University, Sivas, Turkey; ²Okan University, Istanbul, Turkey

Background: Uremic malnutrition is a common phenomenon in maintenance hemodialysis patients and a risk factor for poor clinical outcomes including reduced quality of life and increased hospitalization.
Objectives:The purpose of the this study was to determine the frequency and severity of malnutrition in dialysis patients.
Methods: In a cross sectional, descriptive study, 218 hemodialysis patients were assessed for malnutrition. Data was collected by using a personal information form, Mini Nutritional Assessment (MNA). We analyzed MNA scores, biochemical nutritional markers and anthropometric composition in 218 patients (120 male, age 53.4±13.2). Monthly assessed biochemical parameters including albumin, CRP, lipid profile and creatinin of the last 6 months were respectively collected.
Results:Patients were grouped according to MNA scores; well-nourished (n:56, score≥24), moderate PEW or risk group (n:116, score 17-23.5) and PEW group (n:46, score<17). Biochemical findings of these groups were compared. A correlation analysis revealed that MNA scores were correlated with hemoglobin, albumin, Tricep Skinfold Thickness (TSF), Mid-Arm Muscle Circumference (MAMC)] and BMI. Conclusion/Application to practice: The results indicate that the prevalence of malnutrition is high in these hemodialysis patients. Regular assessment of nutritional status of patients undergoing maintenance hemodialysis, to identify patients at risk of malnutrition, and allow for early nutritional intervention. A consistent nutritional assessment protocol is warranted and should be implemented to decrease malnutrition in Turkish hemodialysis patients.

Disclosure: No conflict of interest declared

O 65
Relationship between body mass change and survival of dialyzed patients
E. Molnar^1,2, I. Szakacs¹, I. Kulcsar^1,3
1B. Braun Avitum Hungary cPlc. Dialysis Centre No. 6, Szombathely, Hungary; ²Markusovszky Teaching Hospital, Szombathely, Hungary; ³1st Department of Medicine , Markusovszky Teaching Hospital, Szombathely, Hungary

Background: The appearance of observations in favour of (reverse epidemiology) and against the higher survival rate of overweight dialysis patients has long been an exciting issue in nephrology.
Objectives: To analyse the correlation between body mass and survival as well as between body mass change and survival.
Methods: Data for 238 patients included in a chronic haemodialysis (HD) programme was collected and followed up retrospectively.  The average body mass values of patients at the commencement of HD, on day 91, at the end of the period of observation and the body mass change values per unit of time were compared.  The correlation of these values with survival was analysed (Cox-models, Kaplan-Meier and endpoint analysis).
Results:The follow-up period was 5.5 years on average.  The body mass reduction was 2.3 ±3.2 kg for women and 1.6 ±3.1 kg for men/year.  It was more pronounced in patients over 65 years of age and for those with diabetes.
We did not find a significant correlation between body mass measured at the commencement of HD and survival.
Patients were divided into 3 groups depending on the change of their body mass.  The analyses clearly showed that the highest survival rate occurred in the patient group where body weight loss per unit of time was the lowest.
Conclusion/Application to practice: Although these observations were made on a small number of patients, the follow-up period was long.  We hope that our observations will help resolve the still existing controversies of the issue studied.

Disclosure: No conflict of interest declared

O 66
A nurse-led multifactorial intervention to improve phosphate binder adherence: a one-year clinical trial
Y. Van Camp¹, B. Van Rompaey¹, B. Vrijens^{2, 3}, P. Arnouts⁴, M. Elseviers^1
1Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Wilrijk, Belgium; ²Department of Biostatistics and Medical Informatics, Université de Liège, Liège, Belgium; ³MWV Healthcare, Visé, Belgium; ⁴Department of Nephrology and Hypertension, General Hospital Turhoutse ZiekenhuisAssociatie (TAZ), Campus Sint-Jozef, Turnhout, Belgium

Background: Despite the development of effective phosphate binders, phosphatemia control has not improved significantly. Phosphate binder nonadherence – not taking phosphate binders as prescribed – is an important contributing factor.
Objectives: We aimed to test a one-year nurse-led multifactorial intervention to enhance phosphate binder adherence.
Methods:In a quasi-experimental clinical trial, phosphate binder adherence was measured electronically in 135 hemodialysis patients for one year and phosphatemia measured monthly. For all patients, months 1-2 were baseline (no interventions).
Intervention patients received 1 "preparatory" intervention aimed at "prerequisites" for adherence (knowledge/education), social support and skills(e.g. cue-dose training). Then they received 8 “maintenance” individualized management sessions, based on the adherence data and phosphatemia:
• Good adherence and phosphatemia: positive feedback.
• Poor adherence or uncontrolled phosphatemia: encouragement to idenfity causes and to propose solutions. A special intervention tool, listing the most prevalent problems and according solutions was used to guide the management sessions.
Control patients received standard care.
Results: Mean adherence in month 1 was 6% lower in intervention patients (76 vs. 82% in control patients). Over 12 months, mean adherence had a significantly rising trend in intervention patients (slope +0.08 (95%CI +0.17;+1.54)), which was non-significantly decreasing in control patients (slope –0.05 (95%CI –1.50;+0.46)). The more sessions received, the better adherence. Poor adherence was mostly unintentional (forgetfulness) (72%), rather than intentional (28%).
Mean phosphatemia decreased –0,5mg/dL (p=0.01) in intervention patients and increased +0,3mg/dL (p=0.50) in control patients after 12 months.
Conclusion/Application to practice:The interventions enhanced adherence and phosphatemia control and should be adopted into daily, clinical practice.

Disclosure: No conflict of interest declared