Khor Ban Hock, Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
Tilakavati Karupaiah, School of BioSciences, Faculty of Health and Medical Sciences, Taylor’s University
Medical nutrition therapy plays a pivotal role in the management of patients undergoing maintenance hemodialysis (HD) and should ideally be provided by dietitians practicing in nephrology care. In the United States of America, it is mandatory to have a dietitian member in the multidisciplinary team for patient care. However, dietitian accessibility is known to be limited in Asian countries. We, therefore, undertook a needs assessment approach to evaluate the current state of dietitian accessibility and nutrition practices in Malaysian outpatient HD centers.
We sampled 150 HD centers representative of 13 states in Malaysia through the National Renal Registry (NRR) database. Sampling reflected sector distribution of dialysis services in Malaysia with 50% from private centers and 25% each from government and non-governmental organiza-tion (NGO) centers, respectively. A 17-item questionnaire was administered to the dialysis managers.
From the survey, 18.0% of centers reported access to a dedicated dietitian and 14.7% had access to a visiting or shared dietitian. The remaining HD centers (67.3%) had no access to a dietitian. Most government centers had access to either dedicated, visiting or shared dietitians contrasting with poor access to a dietitian in both private (84.9%) and NGO (73.3%) HD centers. This clearly indicated that dietitian accessibility is lacking in the largest sector of dialysis provision in Malaysia.
We went on to compare the nutritional parameters of patients in HD centers with a dedicated dietitian, a shared or visiting dietitian, or without a dietitian. Patients’ nutritional data was retrieved from the annual submission of each center to the NRR. However, the nutritional outcomes of HD patients from centers with dedicated dietitian were no better compared to those from centers with a shared or visiting dietitian or without dietitian. One possible explanation for this observation is that dietitians are not routinely involved in the clinical practice at HD centers and only attend to selected patients based on physician referral. Therefore, it is essential for dietitians to be more proactive in routine nutrition management in HD centers.
The survey’s findings are leading to the creation of an advocacy group with nephrologists and dietitians as stakeholders, to inform the Malaysian Society of Nephrology on improving dietitian accessibility at all HD centers in Malaysia. Hopefully, this approach will improve the nutritional outcomes of HD centers as well as increase the job scope for dietitians. Concurrently, competency development and credentialing for dietitians in dietetic skills related to renal patient management is also critical.
Reference: Khor BH, Chinna K, Gafor AHA, Morad Z, Ahmad G. Bavanan-dam S, Visvanathan R, Yahya R, Goh BL, Bee BC and Karupaiah T. 2018. BMC Health Services Research 18:939. https://-doi.org/10.1186/s12913-018-3702-9