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The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey
BACKGROUND: This study aimed to assess the situational capacity for nutrition care delivery in the outpatient hemodialysis (HD) setting in Malaysia by evaluating dietitian accessibility, nutrition practices and patients’ outcomes. METHODS: A 17-item questionnaire was developed to assess nutrition pr...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280465/ https://www.ncbi.nlm.nih.gov/pubmed/30514284 http://dx.doi.org/10.1186/s12913-018-3702-9 |
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author | Khor, Ban-Hock Chinna, Karuthan Abdul Gafor, Abdul Halim Morad, Zaki Ahmad, Ghazali Bavanandam, Sunita Visvanathan, Ravindran Yahya, Rosnawati Goh, Bak-Leong Bee, Boon-Cheak Karupaiah, Tilakavati |
author_facet | Khor, Ban-Hock Chinna, Karuthan Abdul Gafor, Abdul Halim Morad, Zaki Ahmad, Ghazali Bavanandam, Sunita Visvanathan, Ravindran Yahya, Rosnawati Goh, Bak-Leong Bee, Boon-Cheak Karupaiah, Tilakavati |
author_sort | Khor, Ban-Hock |
collection | PubMed |
description | BACKGROUND: This study aimed to assess the situational capacity for nutrition care delivery in the outpatient hemodialysis (HD) setting in Malaysia by evaluating dietitian accessibility, nutrition practices and patients’ outcomes. METHODS: A 17-item questionnaire was developed to assess nutrition practices and administered to dialysis managers of 150 HD centers, identified through the National Renal Registry. Nutritional outcomes of 4362 patients enabled crosscutting comparisons as per dietitian accessibility and center sector. RESULTS: Dedicated dietitian (18%) and visiting/shared dietitian (14.7%) service availability was limited, with greatest accessibility at government centers (82.4%) > non-governmental organization (NGO) centers (26.7%) > private centers (15.1%). Nutritional monitoring varied across HD centers as per albumin (100%) > normalized protein catabolic rate (32.7%) > body mass index (BMI, 30.7%) > dietary intake (6.0%). Both sector and dietitian accessibility was not associated with achieving albumin ≥40 g/L. However, NGO centers were 36% more likely (p = 0.030) to achieve pre-dialysis serum creatinine ≥884 μmol/L compared to government centers, whilst centers with dedicated dietitian service were 29% less likely (p = 0.017) to achieve pre-dialysis serum creatinine ≥884 μmol/L. In terms of BMI, private centers were 32% more likely (p = 0.022) to achieve BMI ≥ 25.0 kg/m(2) compared to government centers. Private centers were 62% less likely (p < 0.001) while NGO centers were 56% less likely (p < 0.001) to achieve serum phosphorus control compared to government centers. Patients from centers with a shared/visiting dietitian had 35% lower probability (p < 0.001) to achieve serum phosphorus levels below 1.78 mmol/L compared to centers without access to a dietitian. CONCLUSIONS: There were clear discrepancies in nutritional care in Malaysian HD centers. Changes in stakeholder policy are required to ensure that dietitian service is available in Malaysian HD centers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3702-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6280465 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62804652018-12-10 The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey Khor, Ban-Hock Chinna, Karuthan Abdul Gafor, Abdul Halim Morad, Zaki Ahmad, Ghazali Bavanandam, Sunita Visvanathan, Ravindran Yahya, Rosnawati Goh, Bak-Leong Bee, Boon-Cheak Karupaiah, Tilakavati BMC Health Serv Res Research Article BACKGROUND: This study aimed to assess the situational capacity for nutrition care delivery in the outpatient hemodialysis (HD) setting in Malaysia by evaluating dietitian accessibility, nutrition practices and patients’ outcomes. METHODS: A 17-item questionnaire was developed to assess nutrition practices and administered to dialysis managers of 150 HD centers, identified through the National Renal Registry. Nutritional outcomes of 4362 patients enabled crosscutting comparisons as per dietitian accessibility and center sector. RESULTS: Dedicated dietitian (18%) and visiting/shared dietitian (14.7%) service availability was limited, with greatest accessibility at government centers (82.4%) > non-governmental organization (NGO) centers (26.7%) > private centers (15.1%). Nutritional monitoring varied across HD centers as per albumin (100%) > normalized protein catabolic rate (32.7%) > body mass index (BMI, 30.7%) > dietary intake (6.0%). Both sector and dietitian accessibility was not associated with achieving albumin ≥40 g/L. However, NGO centers were 36% more likely (p = 0.030) to achieve pre-dialysis serum creatinine ≥884 μmol/L compared to government centers, whilst centers with dedicated dietitian service were 29% less likely (p = 0.017) to achieve pre-dialysis serum creatinine ≥884 μmol/L. In terms of BMI, private centers were 32% more likely (p = 0.022) to achieve BMI ≥ 25.0 kg/m(2) compared to government centers. Private centers were 62% less likely (p < 0.001) while NGO centers were 56% less likely (p < 0.001) to achieve serum phosphorus control compared to government centers. Patients from centers with a shared/visiting dietitian had 35% lower probability (p < 0.001) to achieve serum phosphorus levels below 1.78 mmol/L compared to centers without access to a dietitian. CONCLUSIONS: There were clear discrepancies in nutritional care in Malaysian HD centers. Changes in stakeholder policy are required to ensure that dietitian service is available in Malaysian HD centers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3702-9) contains supplementary material, which is available to authorized users. BioMed Central 2018-12-04 /pmc/articles/PMC6280465/ /pubmed/30514284 http://dx.doi.org/10.1186/s12913-018-3702-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Khor, Ban-Hock Chinna, Karuthan Abdul Gafor, Abdul Halim Morad, Zaki Ahmad, Ghazali Bavanandam, Sunita Visvanathan, Ravindran Yahya, Rosnawati Goh, Bak-Leong Bee, Boon-Cheak Karupaiah, Tilakavati The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey |
title | The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey |
title_full | The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey |
title_fullStr | The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey |
title_full_unstemmed | The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey |
title_short | The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey |
title_sort | state of nutrition care in outpatient hemodialysis settings in malaysia: a nationwide survey |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280465/ https://www.ncbi.nlm.nih.gov/pubmed/30514284 http://dx.doi.org/10.1186/s12913-018-3702-9 |
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