Masters Degrees (Nutrition and Dietetics)

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Browsing Masters Degrees (Nutrition and Dietetics) by Author "Botha, Angelique"

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    Assessing risk of malnutrition in adult patients on hemodialysis in Port Elizabeth
    (University of the Free State, 2016-04) Botha, Angelique; Meko, Lucia
    English: There are currently 737 patients on renal replacement therapy (RRT) in the Eastern Cape (EC) of South Africa (SA) alone. Diseases of lifestyle are major risk factors for the development and/or progression of chronic kidney disease (CKD). CKD is a growing problem in SA, as diseases of lifestyle are becoming more prevalent. The kidneys play a vital role in the body. The kidneys’ functions include: waste removal through the urine; reabsorption of water, glucose and amino-acids; production of hormones such as calcitriol and erythropoietin; production of the enzyme renin; regulation of homeostasis by regulating electrolytes, the acid-base balance and blood pressure. CKD is present when there are abnormalities in the kidneys prevent these functions. The reduced ability of the kidneys to carry out these functions, leads to the need for renal replacement therapy (RRT), such as hemodialysis (HD). The main objective of this study was to determine the risk for malnutrition amongst adults with CKD receiving HD in Port Elizabeth (PE). A total of 68 patients took part in the study. Only 68, 7% (n = 44) patients were from the National Renal Care Dialysis unit, 20.6% (n = 14) patients from the Mercantile Life Dialysis unit and 14.7% (n = 10) from Fresenius Medical Care dialysis unit. These three centres were included for logistical reasons as well as familiarity with the staff and patients. A structured researcher-administered questionnaire was presented to the HD patients. The information collected included socio-demographics, a short-form mini nutrition assessment (SF-MNA) and anthropometrical data. There were 57.4% (n=39) male patients and 42.7% (n= 29) female patients. The majority of patients were married (58.8%); 47.1% had finished high school and an equal percentage of patients had a tertiary education. The largest percentage of patients (63.2%) was older than 50 years with a median age of 54.5 years. Half of the patients were black (n=34), 22.1% (n=15) were coloured, 4.4% (n=3) were Asian/ Indian and 22.1% (n=15) were white. Most patients spoke isiXhosa (41.3%) while only 23.5% spoke English. Just under a third (29.4%) of the patients was unemployed, while just over a quarter (26.5%) was employed on a full time basis. Pensioners made up 32.4% of the sample and only 2 patients were students. Most patients (94.1%) attend the unit 3 times per week and 5.9% (n= 4) attend the unit only twice per week. The majority of patients have been on HD for more than a year, half (48.9%) had been on HD for 1 to 5 years, and 26.5% had been on HD for more than 5 years. Patients who came from areas outside PE, were from Somerset East, Alexandria, Cradock, Port Alfred or Grahamstown. Most of the patients live within PE. Five patients (7.4%) live within 5 km of their dialysis unit, 39.7% within 5 – 10 km from the unit, and six 8.8% (n= 6) more than 50 km from the unit. Patients were classified as at risk for malnutrition if their SF-MNA scores were ≤ 11, and a score of ≥ 12 was considered acceptable. Of the 68 patients, 52.9% (n = 36) were identified as at risk for malnutrition. Significant associations between the risk of malnutrition, and HD duration, loss of appetite (p-value < 0.0001), weight loss (p-value < 0.0001) and psychological stress and/or acute disease (p-value < 0.0001) were found. In conclusion, a large number (52.9%) of patients that were receiving HD in PE at the time of the study, were at risk for malnutrition. Ongoing monitoring of such at-risk patients is therefore important. Detection of loss of appetite, weight loss and psychological stress and/or acute disease should be reason to suspect a risk for malnutrition. Early dietary and psychosocial intervention may improve the nutritional status and thus improve the patient’s quality of life. Psychological, nutritional and medical support during the first few months after HD is started, is important, as a higher risk for malnutrition is seen amongst patients on HD for 0 – 6 months. It is recommended that appropriate supplementation becomes standard practice and form part of the National Therapeutic Programme (NTP) during the first 6 months of HD.