P55
AN AUDIT EXPLORING MALNUTRITION IN ACUTE KIDNEY INJURY (AKI)
Bourke, N 1, Mafrici, B 1, Livesey, L 1, Peacock, V 1, Roe, S 2
1
Dietetic and Nutrition Department, Therapy Services, 2 Renal and Transplant Unit,
Nottingham University Hospital NHS Trust
PROBLEM: The UK Renal Association (RA) guidelines recommends that all patients
diagnosed with Acute Kidney Injury (AKI) receiving renal replacement therapy (RRT) should
be seen by a dietitian within 24 hours of admission and should be prescribed the recommended
nutritional support.
PURPOSE:
 To identify the percentage of patients with AKI who required RRT, seen by a renal dietitian
within 24 hours of their admission on our renal wards (as per RA standard).
 To indentify the percentage of patients who were able to meet at least 70% of their energy
requirements.
 To compare the Malnutrition Universal Screening tool (MUST) score with the ability of
patients to meet their estimated energy requirements.
DESIGN: A prospective audit was conducted between October 2011 and January 2012, on all
new patient admissions (longer than 48 hours) on our renal wards (bed capacity 32) in our
hospital (critical care patients were excluded). All patients had they MUST score recorded by
the nursing staff and were assessed individually by a renal dietitian who estimated the patient’s
nutritional requirements and their actual intake.
FINDINGS: There were 476 admissions to the renal wards with an in-patient stay greater than
48 hours. Forty-six (10%) patients had AKI who required RRT. Thirty-five (76%) of these
patients were seen within 24 hours of admission to the renal wards by a renal dietitian. Twentysix patients were able to meet more than 70% of their estimated energy requirements. Five out
of 20 patients who were meeting less than 70% of their energy requirements were identified at
risk of malnutrition by using MUST (as summarised in table 1).Statistical analysis was not
carried out due to the small sample size.
Table 1. MUST and estimated kcal intake of patients with AKI on RRT (n = 46).
Number of patients meeting 70% or above Number of patients meeting less than 70%
of their estimated energy requirements
of their estimated energy requirements
MUST 0-1
25
15
MUST > 2
1
5
CONCLUSION: Current dietetic cover on the renal wards failed to meet the RA standard.
Forty-three per cent of patients with AKI requiring RRT were meeting less than 70% of their
estimated energy requirements, which mirrors current national trends for hospital related
malnutrition. MUST appeared to underestimate malnutrition in AKI patients requiring RRT,
although these conclusions are based on a small sample size.
RELEVANCE: Malnutrition is a problem in AKI patients who require RRT and the use of
MUST may underestimate the number of patients who would benefit from dietetic input.
More research is needed to establish if meeting at least 70% of patients estimated energy
requirements in AKI requiring RRT affects clinical outcomes, length of hospital stay and
mortality.
References: Lewington, A, Kanagasundaram, S (2011). Acute Kidney Injury, Clinical Practice
Guideline, 5th Edition. Accessed online: www.renal.org/guidelines