2264
A STUDY OF PATIENTS’ DIETARY HABITS AND MEAL PATTERNS ON HAEMODIALYSIS: A COMPARISON BETWEEN DIALYSIS AND NON-DIALYSIS DAYS
Stevens M, Ives A, White A, Munday J.
Basildon and Thurrock University Trust Hospital
BACKGROUND: Protein energy malnutrition is common in patients undergoing haemodialysis and is associated with negative outcomes. Increased nutritional requirements and physical and psychosocial factors associated with dialysis increase the likelihood of malnutrition in this patient group. It is common practice to advise against routine eating during dialysis due to perceived increased risks, such as hypotension, aspiration, impaired glycaemic control and infection control but there is no substantial evidence to support this. Currently on our dialysis unit, 2-4 plain biscuits (Digestive™, Rich Tea™) and one small cup of tea (180ml) are provided. Patients are permitted to consume their own foods on the dialysis unit but this is at the discretion of the medical team and dependent upon their individual tolerance and clinical condition. A study was conducted to evaluate whether patients’ meal patterns/dietary habits differ between dialysis and non-dialysis days, and to assess whether a patient felt well enough to eat during dialysis. The adequacy of the current snack provision was also investigated.
DESIGN: A Patient Questionnaire was completed between November 2013 and February 2014. 97 patients out of 120 (81%) dialysis patients agreed to participate. A dietitian or dietetic assistant completed the questionnaire at chair side during a dialysis session.
FINDINGS: 20% of patients on haemodialysis did not have a main meal on dialysis days compared to 5% on non-dialysis days. (Main meal defined as a portion of meat, fish, or pulse with potatoes, rice, bread, or pasta). More patients ate 1 (29% compared to 22%) or 3 light meals (7% compared to 3%) on dialysis days compared to on non-dialysis days. (Light meal defined as cereal, toast or sandwich). All patients increased their snacking on dialysis days whilst decreasing main meal frequency (Snacks defined as biscuits, chocolate, fruit, crisps). 43% of patients only consume the biscuits provided by the hospital during dialysis. 47% bring a light meal such as a sandwich to dialysis. However, 63% of all patients felt they would be able to eat something more substantial such as a sandwich if it was available. At present there is no facility at our dialysis unitto purchase light meals/snacks/drinks.
Table 1 Illustrates the nutritional breakdown of different meal/snack options available as an inpatient atour hospital.
Steamplicity™ Nutritional information / Energy (kcal) / Protein (g)Roast Chicken Dinner / 328 / 28
Chicken and sweetcorn mayo sandwich / 350 / 12
2 McVities Digestive™ biscuits / 140 / 2
CONCLUSION: The study suggests that meal patterns differ on dialysis and non-dialysis days for patients’dialysing at our dialysis unit. The impact of regular hospital haemodialysis treatment appears to affect the quality and quantity of meals consumed in the majority of patients. Currently the food and drink provision provided on our dialysis unit does not provide an adequate amount of energy or protein to be a suitable substitute for a main meal/sandwich, as illustrated in table 1. The hospital canteen/sandwich shop is not in close proximity to the dialysis unit for patients to easily obtain food/drinks. Providing an alternative energy and protein rich supplement/snack/light meal during dialysis should be considered. Having a snack trolley service and/or vending machine to provide suitable snacks close to the dialysis unit could improve access to food.