Nephrology and Dialysis Unit, A Landolfi Hospital, Solofra, Italy.
J Ren Nutr. 2010 Mar;20(2):82-90. doi: 10.1053/j.jrn.2009.05.001. Epub 2009 Jul 17.
The prevention of malnutrition in patients with progressive chronic kidney disease (CKD) presents a challenge to nephrologists. We evaluated nutritional practice and routines, at a national level, related to the nutritional management of nondialyzed CKD patients.
A questionnaire-based survey (32 open and 9 multiple-choice questions) was used to assess the evaluation of nutritional status in nondialyzed CKD outpatients at baseline and during follow-up. Data were obtained for 230 Italian public nephrology centers (63% of the total number of Italian public nephrology centers).
There was a dedicated dietitian at only 19% of the centers. At baseline, body weight, body mass index, and serum albumin were determined in almost all centers, nutrient intakes and bioimpedance analysis in half the centers, and subjective global assessment and skinfold thickness in a small proportion of centers. During follow-up, the rate of assessments decreased by 8% for weight, 14% for nutrient intake, and 29% for subjective global assessment and skinfold thickness. Overall, the K/DOQI minimum criteria for nutritional assessment were fulfilled in only two thirds and half of the clinics at baseline and during follow-up, respectively. Multivariate analysis showed that the number of nutritional variables evaluated was significantly related to the size of the CKD clinic and the presence of a dietitian at baseline, but only with the presence of dietitian during follow-up. Daily urinary output was collected at 90% of the centers, but urea and sodium excretions were determined in only 59% and 57% of cases, respectively. The rate of assessment for urinary solutes during follow-up was higher at centers where a very low protein diet was prescribed.
The indications about nutritional assessment for CKD patients are poorly translated into practice patterns, especially with respect to the evaluation of nutrient intakes and additional but simple variables such as skinfold-thickness measurement and bioimpedance analysis. The presence of a dedicated dietitian appears to improve the quality of nutritional assessment in CKD.
预防进展性慢性肾脏病（CKD）患者的营养不良对肾病学家提出了挑战。我们评估了全国范围内与非透析 CKD 患者营养管理相关的营养实践和常规。
采用基于问卷的调查（32 个开放问题和 9 个多项选择问题）评估基线和随访时非透析 CKD 门诊患者的营养状况评估。共获得 230 家意大利公立肾脏科中心的数据（占意大利公立肾脏科中心总数的 63%）。
只有 19%的中心有专门的营养师。在基线时，几乎所有中心都测定了体重、体重指数和血清白蛋白，一半中心测定了营养素摄入量和生物电阻抗分析，一小部分中心测定了主观整体评估和皮褶厚度。在随访期间，体重评估率下降了 8%，营养素摄入量下降了 14%，主观整体评估和皮褶厚度下降了 29%。总体而言，仅三分之二和一半的诊所分别在基线和随访期间满足 K/DOQI 营养评估的最低标准。多变量分析显示，评估的营养变量数量与 CKD 诊所的规模和基线时营养师的存在显著相关，但仅与随访时营养师的存在相关。90%的中心收集了每日尿输出量，但只有 59%和 57%的情况下分别测定了尿素和钠排泄量。在开具低蛋白饮食的中心，随访期间评估尿溶质的比例较高。
CKD 患者的营养评估指标很少转化为实践模式，特别是在评估营养素摄入量和其他简单变量（如皮褶厚度测量和生物电阻抗分析）方面。专门营养师的存在似乎可以提高 CKD 患者营养评估的质量。
