Effectiveness of a Nutrition Education Program for the Prevention and Treatment of Malnutrition in End-stage Renal Disease

Objective: In end-stage renal disease (ESRD) patients, malnutrition is mainly addressed from a pharmacological but not educational point of view. Therefore, the objective of this study was to implement a nutritional education program (NEP) and to evaluate and compare its effectiveness in the treatment and prevention of malnutrition with oral supplementation (OS)-the standard treatment in these patients.

Design: This study was a longitudinal, 4-month prospective study.

Settings: The study was conducted from January to May 2012 in the Hemodialysis Fresenius Medical Care Clinic of Murcia.

Subjects: One hundred twenty patients with ESRD undergoing hemodialysis were randomly assigned to a NEP or to OS.

Intervention: Patients assigned to the NEP group followed an educational program for 4 months that aimed to improve general nutritional knowledge and included culinary recommendations and an elaboration of balanced menus. The OS group received a nutritional supplement during the hemodialysis procedure.

Main Outcome Measure: The main outcome measure was certain biochemical markers of nutritional and metabolic status. Nutrition knowledge was also evaluated.

Results: After 4 months of intervention, nutritional knowledge was increased in all patients (P < .050) after the NEP, which was reflected in a decrease in the prevalence of malnutrition, especially in this group. Creatinine clearance, total protein serum values, and other biochemical parameters improved significantly in both groups (P < .050 in all cases), although other parameters such as C-reactive protein were impaired only in the NEP group.

Conclusion: The NEP was at least as effective as OS for preventing and even treating malnutrition in patients with chronic renal failure on hemodialysis, improving their nutritional status, which may result in a long-term decrease in the mortality and morbidity of these patients.