Renal Dietitians' Perceptions of the Value of Subjective Global Assessment: A Mixed Methods Study.

OBJECTIVE: The objective of this study is to assess how renal registered dietitians (RDs) in Canada perceive the value of Subjective Global Assessment (SGA) to assess protein-energy wasting for clients with chronic kidney disease. DESIGN AND METHODS: A sequential exploratory mixed method approach included 2 focus groups (n = 6 and 8) and a national survey (n = 54). Two online focus groups were conducted 1 month apart followed by an online survey. Participants included renal RDs working with Stage 5 chronic kidney disease (dialysis and non-dialysis) patients. RESULTS: Five main themes (consistency, organizational/environment, confidence, interpretation, and education) emerged. Renal RDs support using a tool to provide a standardized process for nutrition assessment and feel SGA is an effective educational tool; however, barriers such as time, privacy, confidence in the tool, as well as ability to perform physical assessment, interpretation, and subjectivity limit the use of SGA. Renal RDs feel that it is important to examine nutrition interventions in conjunction with SGA results. CONCLUSION: The main results of the study describing the limitations to the clinical use of the SGA tool revolve around RDs' time, confidence, ability to interpret the SGA tool, and how SGA is used by administration. The results support the need for educators and administrators to communicate the use of SGA results and provide education opportunities focusing on the use of validated, reliable, responsive tools to assess nutrition status as well as hands-on physical assessment. In some situations, an alternative validated version of SGA or screening tool may be appropriate.

Evaluation of a mineral metabolism protocol in peritoneal dialysis patients.

OBJECTIVES: To determine if there is an improvement in the number of peritoneal dialysis (PD) patients who meet target goals for serum phosphorus and parathyroid hormone (iPTH) after the implementation of a dietitian led mineral metabolism protocol. DESIGN: Retrospective, comparative, analytic study. SETTING: Fraser Health Authority PD units in Abbotsford and New Westminster, British Columbia. SUBJECTS: One hundred fourty patients from 2009 and 139 patients from 2011 stable on PD for a minimum of 3 months. MAIN OUTCOME MEASURE: Change in number of patients meeting target goals for serum phosphorus and iPTH after the implementation of a mineral metabolism protocol for 6 months. RESULTS: After 6 months of the protocol being initiated, there was no significant difference in number of patients meeting serum phosphorus targets (82.0% vs. 74.5%, P = .126); however, a significant increase in the number of patients who met target iPTH range (60.4% vs. 48.5%, P = .048) was shown. CONCLUSIONS: Use of a mineral metabolism protocol by dietitians in PD units supports an improvement in iPTH targets.