Dialysis and nutrition practices in Korean hemodialysis centers

Survey the dialysis practices and nutritional status-related patient characteristics.

Cross-sectional survey.

Twenty-eight randomly selected Korean hemodialysis facilities.

Medical record review of 140 randomly selected patients in 28 Korean dialysis facilities. The Student t test and chi-square tests were used to compare facility types and locations.

The mean number of dialysis treatments per week was 2.7 +/- 0.4. Mean dialysis treatment length was 253 +/- 27.5 minutes. Rural dialysis centers reported fewer treatments per week and shorter dialysis treatment times than did urban centers but, otherwise, there were few differences by either location (urban v rural) or by facility type (hospital affiliated v freestanding facility). The mean age of the patients surveyed by record review was 51 +/- 14 years, and 59% of the patients were men. The primary causes of end-stage renal disease were chronic glomerulonephritis, hypertension, and diabetes. Average vintage of dialysis was 53 +/- 46 months. Adequacy of dialysis was usually assessed by using clinical judgment; urea kinetic modeling and urea reduction ratios were used less frequently. Patients' mean body mass index was 20.7 +/- 2.3, which was at the lower end of the healthy range of 18.5 to 25, and most (93%) of their weights had been stable over the previous 6 months. Their mean serum albumin level was 4.0 +/- 0.4 g/dL. Forty-two percent of patients used iron supplements and 68% of them received erythropoietin treatment. However, their mean hematocrit levels were only 25.9% +/- 4.2%, suggesting that iron supplements were underused or erythropoietin doses were lower than optimal. Virtually all patients (94%) had received initial diet instruction but few (6%) received follow-up nutrition counseling.

Greater attention to dialysis adequacy, hematocrit levels, nutrition assessment, weight monitoring, and diet therapy are recommended.