At the time of submission, Department of Nutrition, Case Western Reserve University, Cleveland, Ohio; At the time of publication, Clinical Dietitian, Banner Health, Phoenix, Arizona.
Department of Medicine and Institute for H.O.P.E, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio.
J Ren Nutr. 2022 Jan;32(1):112-119. doi: 10.1053/j.jrn.2021.07.006. Epub 2021 Jul 27.
This study described the job responsibilities and modalities of care among dialysis dietitians in the United States and their observations regarding the nutrition needs of their patients, during the COVID-19 pandemic.
Cross-sectional online survey captures dietitian characteristics and responsibilities, dialysis facility characteristics, and patient needs. We recruited US dialysis dietitians. We used chi-square tests to compare respondent stress and facility-level policies regarding eating/drinking and oral nutrition supplements based on facility ownership type.
We received 191 complete or partial survey responses. Sixty-three percent of respondents stated that their center banned eating/drinking during dialysis due to COVID-19 masking policies. DaVita and non-profit facilities were significantly more likely to still allow eating/drinking during dialysis (31% and 29%, respectively) compared to Fresenius facilities (7%). A common theme in open-ended responses regarding nutrition care for COVID-19-positive patients was providing less care to these patients. A majority of respondents admitted to stress from working in healthcare during COVID-19. The majority of respondents indicated that patients were taking precautions such as having a family member or friend grocery shop for them (69%) or going to the store less often (60%). Just over a quarter of respondents indicated that affordability of food was a concern among patients. Seventy-two percent reported that patients were cooking at home more often, 60% had observed an increase in serum phosphorus, and 72% an increase in interdialytic weight gain.
Due to the increased risk of malnutrition and symptoms that can affect dietary intake in COVID-positive patients, and the economic conditions leading to increased rates of food insecurity, dietitians must be proactive in preventing and/or treating malnutrition through adequate protein and energy intake. Eating/drinking bans should not become permanent and dialysis centers should take precautions to allow intradialytic meals and oral nutrition supplement protocols to continue during the pandemic.
本研究描述了美国透析营养师在 COVID-19 大流行期间的工作职责和护理模式，以及他们对患者营养需求的观察。
横断面在线调查收集营养师的特征和职责、透析机构的特征以及患者的需求。我们招募了美国透析营养师。我们使用卡方检验比较了基于机构所有权类型的受访者压力和机构层面关于进食/饮水和口服营养补充剂的政策。
我们收到了 191 份完整或部分调查回复。63%的受访者表示，他们的中心因 COVID-19 掩蔽政策而禁止在透析期间进食/饮水。与 Fresenius 设施（7%）相比，DaVita 和非营利性设施更有可能仍然允许在透析期间进食/饮水（分别为 31%和 29%）。COVID-19 阳性患者营养护理的开放性回复中的一个共同主题是为这些患者提供较少的护理。大多数受访者承认在 COVID-19 期间在医疗保健领域工作带来的压力。大多数受访者表示，患者采取了一些预防措施，例如让家人或朋友为他们购买杂货（69%）或减少去商店的次数（60%）。略多于四分之一的受访者表示，患者对食物的负担能力感到担忧。72%的受访者报告说患者在家做饭的次数更多，60%的受访者观察到血清磷升高，72%的受访者观察到透析间体重增加。
由于 COVID-19 阳性患者营养不良风险增加和可能影响饮食摄入的症状，以及导致食物不安全发生率增加的经济状况，营养师必须积极通过充足的蛋白质和能量摄入预防和/或治疗营养不良。进食/饮水禁令不应成为永久性的，透析中心应采取预防措施，允许在大流行期间继续进行透析期间的进餐和口服营养补充协议。
