Zayed University, Dubai
M Karavetian earned her PhD in “Health Promotion” from Maastricht University, Netherlands and her Dietetics degree from American University of Beirut, Lebanon. She has extensive experience in nutrition management of the chronically and critically ill patients. She shares her experience in conferences and workshops locally and regionally in the aim of training health care professionals for better health care. She also is trained and specialized in health care quality (setting policies and procedures and training staff on the new set of rules in health care settings). Her research is focused on identifying effective strategies to change dietary behavior in chronically ill patients. Her publications focus on dietary management of hemodialysis patients and finding the optimal dietitian-to-patient ratio needed in the hemodialysis unit in the Arab world for optimal clinical outcomes. She has shared her experience in national and international conferences. She currently is an Assistant Professor in the Department of Natural Sciences in Public Health, College of Sustainable Sciences and Humanities, Zayed University, Dubai.
Background: Osteodystrophy management includes a dietary phosphorus restriction, which limits protein intake, exacerbating the malnutrition-inflammation syndrome and mortality among hemodialysis patients.
Methods: A multi-center randomized controlled trial was conducted to test the hypothesis that intensive nutrition education focused on phosphorus-to-protein balance will improve patient outcomes. Six hemodialysis units were randomly assigned to the Trained Hospital Dietitian (THD) protocol (210 patients). Six others (184 patients) were divided equally according to the patients' dialysis shifts and were assigned to Dedicated Dietitian (DD) and Control protocols. Patients in the THD group received nutrition education from hospital dietitians who were trained by the study team on renal dietetics, but who had limited time for hemodialysis patients. Patients in the DD group received individualized nutritional education on dietary phosphorus and protein management for 6 months (2-hour/patient/month) from study renal dietitians. Patients in the control group continued receiving routine care from hospital dietitians who had limited time for these patients and were blinded to the study. Serum phosphorus (mmol/L), malnutrition-inflammation score (MIS), 8-domain health-related quality of life (HRQOL) index and length of hospital stay (LOS) were assessed at T0 (baseline), T1 (post-intervention) and T2 (post-6 month follow up).
Results: Only the DD protocol significantly improved serum phosphorus (T0:1.78±0.5, T1:1.63±0.46, T2:1.69±0.53) and 3 domains of the HRQOL index and maintained MIS at T1, but this protective effect resolved at T2. The LOS significantly dropped for all groups by T2.
Conclusion: The presence of competent renal dietitians fully dedicated to hemodialysis units was superior over the other protocols in improving patient outcomes.