ESRD NETWORK #14 - MEDICAL REVIEW BOARD
2004 STANDARDS OF NUTRITION CARE IN ESRD FACILITIES
Standard I: Professional Qualifications for the Renal Dietitian in All ESRD Settings
The renal dietitian will be qualified to perform in the capacity assigned.
Measurement Criteria
A. Currently licensed under the laws of Texas to use the title of licensed dietitian (L.D.), and
B. Eligible to be a registered dietitian (R.D.), and
C. One year (minimum of 1440 hrs, based on 30-hrs/48 wks/yr) of approved experience in clinical
dietetics after becoming eligible to be a registered dietitian, as per federal regulations.
Standard II: Quality of Nutrition Care Adult or Pediatric ESRD Patients
Receiving Chronic Hemodialysis or Peritoneal Dialysis Therapy
A qualified dietitian will provide nutrition services to all patients admitted to the facility.
Measurement Criteria
A. Identification of patients new to the facility and initial introduction within 2 weeks or 7 treatments) of
admission for hemodialysis (HD); and during the initial training period for peritoneal dialysis (PD).
B. Assessment of the nutritional status of the patient within 1 month of admission (13
treatments for HD patients) based on the following data (objective and subjective):
1. Height, weight, body mass index (BMI) and statement of weight stability.
Growth charts and standard deviation score in pediatric practices, and head circumference if < 36
months of age.
2. Previous diet modifications and/or counseling (nutrition supplements, diabetes and/or
dyslipidemias management, etc). Pediatric: formula intake, additives, and/or supplements.
3. Evaluation of nutrition risk factors: appetite, GI symptoms, functional capacity, biochemical
abnormalities and decreased somatic protein stores and energy reserves.
4. Pertinent medical history, current diagnoses and treatments:
diabetes, hypertension, dyslipidemias, GI complications, cancer, pregnancy etc.)
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The End Stage Renal Disease Network of Texas, Inc (#14) www.esrdnetwork.org 972-503-3215
14114 Dallas Parkway #660, Dallas, Texas, 75254
5. Medications (prescribed, OTC, herbal/nutraceutical) with potentially adverse nutrient
interactions, or affecting nutritional status.
6. Urine output: estimated or measured to assist in establishing guidelines for fluid intake, blood
pressure control, assessment of residual kidney function and calculations of dialysis adequacy.
7. Volume status: excessive interdialytic weight gains (HD) or fluid retention (PD) per facility
guidelines.
8. Pertinent psycho/social, economic, religious and cultural factors affecting nutritional status.
9. Past and present pica practices.
10. Blood chemistries beyond acceptable limits per facility guidelines.
11. ESRD treatment modality (renal replacement therapy).
12. Adequacy of dialysis per published guidelines.
C. Identification of current nutrition needs and formulation of nutrition care plan based on
above information and evaluation.
D. Education of the patient and/or caregiver(s) concerning the current nutrition needs.
Evidence of use of appropriate educational approaches (such as an interpreter) when needed.
E. Identification of special problems, discussion with health care team and initiation of
appropriate referrals.
F. Reassessment of patients annually, or more often in high risk patients (i.e., pediatric,
pregnancy, severe malnutrition, etc.).
G. Review, evaluation and initiation of appropriate actions per patient’s monthly or other periodic lab
data or established facility protocols and procedures.
H. Participation in multidisciplinary patient care planning meetings.
I. Participation in team management meetings and continuous quality improvement activities.
J. Participation in implementation of medical protocols per facility policies and procedures.
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The End Stage Renal Disease Network of Texas, Inc (#14) www.esrdnetwork.org 972-503-3215
14114 Dallas Parkway #660, Dallas, Texas, 75254
Standard III: Quality of Nutrition Care Adult or Pediatric Kidney Transplant Recipients in Outpatient Clinics
A qualified dietitian will provide nutrition services to all patients admitted to an outpatient clinic.
Measurement Criteria
A. Assessment of the nutritional status of the patient within two months of admission based on the
following objective and subjective data. (Exceptions: re-hospitalization, receipt of post transplant
nutrition assessment from a referring or transfer hospital.)
1. Height, weight, body mass index (BMI) based on estimated dry weight, and statement of weight
stability. Growth charts and standard deviation score in pediatric practices, and head
circumference if < 36 months of age.
2. Previous diet modifications and/or counseling (nutrition supplements, diabetes and/or
dyslipidemias management, etc.). Pediatric: formula intake, additives, and/or supplements.
3. Current nutrition counseling needs based on side-effects of immunosuppressants, level
of graft function and concomitant conditions.
4. Evaluation of nutrition risk factors, such as appetite, GI symptoms, functional capacity,
biochemical abnormalities, decreased somatic protein and energy reserves, etc.
5. Pertinent medical history, current diagnosis and treatments: diabetes, hypertension, dyslipidemias,
GI complications, cancers, pregnancy, cardiovascular disease and risk factors, etc.
6. Medications (prescribed, OTC, herbal/nutraceutical) with potentially adverse nutrient interactions,
or affecting nutritional status (such as side effects of immunosuppressants).
7. Volume status: excessive fluid retention or dehydration.
8. Pertinent psycho/social, economic, religious and cultural factors affecting nutritional status.
9. Food safety issues in an immunosuppressed population.
B. Education/counseling of the patient/caregiver(s) concerning identified needs.
Evidence of use of appropriate educational approaches (such as an interpreter) when needed.
C. Identification of special problems, discussion with health care team and initiation of appropriate
referrals.
D. Follow-up as ordered by physician or per Medical Nutrition Therapy guidelines.
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The End Stage Renal Disease Network of Texas, Inc (#14) www.esrdnetwork.org 972-503-3215
14114 Dallas Parkway #660, Dallas, Texas, 75254