Kidney Week

Abstract: SA-PO1065

Adequate Protein Supplementation for Hospitalized Dialysis Patients

Session Information

• Diet and Nutrition: Clinical
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

• Agarwal, Adhish, University of Utah, Salt Lake City, Utah, United States

Adhish Agarwal,

• Schmidt, Jennifer E., University of Utah Hospital, Salt Lake City, Utah, United States

Jennifer E. Schmidt,

• Ahmed, Faris A., University of Utah, Salt Lake City, Utah, United States

Faris A. Ahmed,

• Christensen, Carissa, University of Utah HEALTH, Salt Lake City, Utah, United States

Carissa Christensen,

Background

A high protein diet (1.2 gm/kg/day) is recommended for dialysis patients¹. It is important for hospitalized dialysis patients to receive a high protein diet since inadequate protein intake worsens outcomes in hospitalized dialysis patients^2,3. However, chronic kidney disease (CKD) patients who are not on dialysis may benefit from a protein restricted ‘renal diet’⁴. Hospitalized dialysis patients could inadvertently receive a protein-restricted diet if placed on a ‘renal diet’ intended for CKD patients.

Methods

At the University of Utah Hospital, patients with CKD, including dialysis patients, were commonly placed on a ‘Renal diet’ that consisted of a 60 gm per day protein-restriction. The University of Utah uses EPIC software that has a template for ‘Renal diet’. In order to provide dialysis patients with adequate protein, we approached the Nutrition Care Services Department with recommendations to modify this template, to allow for the option of either increasing protein supplementation for dialysis patients, or restricting protein to 60 g/day for patients with CKD but not on dialysis.

Results

In collaboration with the EPIC software team at the University of Utah Hospital, the ‘Renal diet’ template was modified. When placing this diet order, providers still choose a ‘Renal diet’ but now are required to select a modifier of either ‘Dialysis’ or ‘Non-Dialysis’. Choosing the ‘Dialysis’ option provides the patient with a higher protein diet. In the 12 months preceding this template modification, providers ordered a ‘Renal diet’ 1594 times at our hospital. In the week following the modification, half of the ‘Renal diet’ orders (13 out of 26) had the ‘Dialysis’ modifier resulting in an appropriate higher protein diet given to dialysis patients. Modifying the EPIC template for ‘Renal diet’ has helped the dialysis patients admitted to our facility receive an appropriate higher protein diet.

Conclusion

We recommend that all acute care hospitals around the country examine their ‘Renal diet’ order templates; and modify renal diet templates, when necessary, to ensure an adequate protein diet for hospitalized dialysis patients.