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Indian J Nephrol. 2019 May-Jun;29(3):179-185. doi: 10.4103/ijn.IJN_272_16.

Dietary Counseling by Renal Dietician Improves the Nutritional Status of Hemodialysis Patients.

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Department of Nutrition, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India.
Department of Home Science, Sri Padmavati Mahila University, Tirupati, Andhra Pradesh, India.
Aravind Kidney Centre, Narayana Medical College, Nellore, Andhra Pradesh, India.
Department of Pharmacology, Narayana Medical College, Nellore, Andhra Pradesh, India.


Proper nutrition may reverse the malnutrition and can modulate renal function in hemodialysis patients. In majority of the dialysis units in India, nutritional advice is given by health professionals working in dialysis. We compared the impact of dietary counseling by a renal dietitian, on nutritional status with that by health professionals working in dialysis units in patients undergoing maintenance hemodialysis. Nutritional assessments were made using subjective global assessment (SGA) scale, which combines assessment of intake, physical findings, and functional status. Two hundred and seventy-seven patients undergoing hemodialysis from two renal care units in Nellore, Andhra Pradesh, South India, were enrolled (138 patients in control group, 139 in experimental group). In the experimental group, patients were given repeated dietary counseling by a renal dietician, whereas control group patients were provided with the necessary nutritional information by another health professional. Detailed nutritional, biochemical, and SGA assessment were done on all of them at the beginning and completion of study after 6 months. Patients were categorized as well-nourished (WN) (SGA = 1-14), mild to moderate malnourishment (MMM) (SGA = 15-35), and severe malnutrition (SM) (SGA = 36-49). In the present study, the overall malnutrition rate at baseline was 95.3%, and it dropped down to 91.7% after 6 months after nutritional counseling. In the experimental group, malnutrition status decreased from 97.2% to 89.8%, whereas in the control group, malnutrition situation remained same. Compared to baseline, in the control group, there was no improvement in the WN group. However, a shift has been observed from MMM group to SM group suggesting more number of patients are becoming malnourished. Contrarily, in the experimental group, an improvement of +7.2% in WN group and +14.3% in MMM group and a drop of -21.6% in severe malnourished group suggesting more number of patients gaining nutrition. The present study observed a significant improvement in nutritional status of patients who received counseling by the renal dietician. The reduction in SGA score was independent of reductions in serum creatinine and blood urea levels.


Dietary counseling; hemodialysis; high-protein diet; renal dietician; subjective global assessment scale

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