Nutritional management of chronic renal failure by dietitians - the South African experience

ABSTRACT

Objective: The objective of this descriptive study was to assess the practices of South African dietitians regarding the dietary treatment of patients with chronic renal failure. Subjects and design: A questionnaire was mailed to 600 randomly selected dietitians registered with the Health Professions Council of South Africa. Practices were compared to international standards for pre-dialysis; haemodialysis (HD) and peritoneal dialysis (PD) patients. Results: A 26 response rate was obtained; with only 28 of these dietitians indicating that they counsel renal patients. The majority of dietitians met the international dietary recommendations; but a substantial number deviated from them. This was especially evident in PD patients; where the deviation ranged from 20 (4 dietitians) in the case of energy and phosphate; to 55 (11 dietitians) in the case of calcium. Parameters used for the assessment of nutritional status included body mass index (45of dietitians); serum albumin (44); clinical examinations (43); bioelectrical impedance (37) and diet history (36). Methods used to monitor dietary compliance included biochemistry; dietary history; anthropometric measurements and clinical investigation. The most frequently used approaches in the management of protein-energy malnutrition included supplemental drinks (86) and dietary enrichment at household level (76). Conclusion: Although the majority of dietitians met international standards for most nutrients; there was some variation and uncertainty. Ongoing education will enable South African dietitians to treat renal patients competently and with confidence