Malnutrition; Can the Leeds screening tool identify haemodialysis patients at risk?
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AbstractThere is global recognition of the need for early identification of those at risk of malnutrition. Nutritional screening has been advocated for systematically detecting and managing those at nutritional risk, triggering a dietetic referral where indicated. Dietetic assessment aims to minimise progression to overt malnutrition and ultimately, curtail the associated clinical and financial consequences. Patients receiving haemodialysis treatment are at increased risk of malnutrition. Generic nutritional screening tools are inherently limited in this population due to the observed variances in fluid status. There is currently no validated nutritional screening tool that is effective in this population. The present study aimed to test the effectiveness of the Leeds Nutritional Screening Tool (developed through pilot studies) in 140 representative haemodialysis patients. By means of a clinical audit, the clinical support worker tested the Leeds tool and the dietitian provided the criterion measure. A distinct feature was the inclusion of patients that were unable to fully complete answers, due to dementia, learning difficulties and a language barrier. Risk of malnutrition was evident in 49% of the Leeds sample. The Leeds tool showed good diagnostic accuracy (95%) with sensitivity and specificity comparable with other National Health Service tests. In turn, these results suggest that patients would be appropriately signposted for dietetic assessment, without wasting finite resources. Component analysis showed that the tool was well-balanced with a combination of objective and subjective measures and that it could be simplified by removal of a question on appetite, without affecting performance. Reliability testing was achieved by patient self-completion and by a nurse, both of whom produced consistent results with the clinical support worker. The tool was evaluated to have good practical acceptability amongst users. This research suggests that the Leeds tool can identify patients at risk of malnutrition, fulfilling the requirements needed to consider local implementation, alongside appropriate staff education. This research provide a sound framework for the development and testing of nutritional screening tools, in a field of variable study quality. It is hoped that the results will contribute to the wider audience, with further research needed to assess tool transferability amongst dialysis units.
PublisherUniversity of Chester
TypeThesis or dissertation
SponsorsLeeds Teaching Hospitals
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