Clinical indicators associated with poor oral intake of patients with chronic renal failure.

Objective: The purpose of this study was twofold: (1) to determine the incidence of patients with chronic renal failure (CRF) who consume less than 75% of their estimated nutritional needs, and (2) to identify factors associated with an oral intake less than 75% of the estimated nutritional needs of patients with CRF.

Design: Prospective, descriptive, correlational study of data obtained from patients with a diagnosis of CRF.

Setting: BryanLGH Medical Center East Campus, Lincoln, NE.

Patients: Sixty-six patients included on this study met the following criteria: (1) a primary or secondary underlying diagnosis of CRF and (2) not receiving parenteral or enteral (tube feeding) nutritional support on admission.

Intervention: Admission data (age, sex, percentage of ideal body weight, weight loss/time, type of dialysis, gastrointestinal history, blood urea nitrogen and creatinine levels, and diet) were collected from the patients' medical records and 2-day kilocalorie (kcal)/protein counts were conducted on consecutive patients admitted to the hospital. The kcal/protein counts were initiated within 24 hours of admission and consisted of six meals and all snacks the patient received.

Main Outcome Measure: Only 15% of the patients met 75% or greater of their estimated kcal needs, and 12% met 75% or greater of their estimated protein needs. The mean kcal/kg intake was 11 kcal/kg, with a range of 0 to 27 kcal/kg, and the mean protein/kg intake was 0.42 g of protein/kg, with a range of 0 to 10 g of protein/kg. Of the variables studied for associations with decreased nutrient intake, only emesis mildly correlated with kcal intake.

Conclusion: Less than one quarter of the patients on this study met 75% or greater of their kcal and protein needs. The average kcal and protein intakes found in this study were far less than current recommendations for hemodialysis, continuous ambulatory peritoneal dialysis, and predialysis patients. However, the results of this study could lead to earlier and more aggressive interventions in patients with CRF at risk for poor oral intake.