Malnutrition is a very common concomitant condition in patients with Chronic Kidney Disease (CKD). Therefore dietary support is of high importance for these patients. Malnutrition is a general term that indicates a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function, and clinical outcome1. The first and most important type is protein-energy malnutrition (PEM) or protein-energy wasting (PEW), which is defined as a lack in supply of sufficient energy or protein to meet the body’s metabolic demands2.

The causes for malnutrition are: 

  • An inadequate food intake secondary to anorexia caused by uremia and altered taste sensation
  • Renal patients although they usualy do not have increased energy expenditure, their energy needs may increase due to the effect of disease or acute illness
  • Impaired ability to prepare food
  • Unpalatable prescribed diets (low salt, fluid restriction, low potassium, low phosphorus)
  • The dialysis procedure itself due to nutrient losses (amino acids, peptides, proteins, glucose, water soluble vitamins etc)
  • Hypermetabolism due to chronic inflammation
  • Endocrine disorders due to uremia3,4

Therefore, an early detection of malnutrition risk and a detailed nutritional assessment is of paramount importance in providing optimal nutritional care to individuals with CKD of all disease stages, improving quality of life and improving the outcome of dialysis for the ones on hemo or peritoneal dialysis.


How can we improve skills, in order to combine the right assessment with the right nutritional care, based on patients individual needs?

EDTNA/ERCA identified the gap and lack of knowledge and education about Malnutrition and approached B. Braun to start up a Collaboration Programme. The Educational Programme is about how to address the concerns to support successful development of Educational Material.

Project name - Exploring Nutrition Support Practices in Haemodialysis Units - A Guide to Implementing Best Practice


Investigate common practices of nutritional screening and support
The intent is to provide insight and education about Malnutrition and to increase the awareness of Dietary intervention which is of high importance for patients with Chronic Kidney Disease (CKD)

Identify educational gaps and need for further provision of knowledge in nutrition for renal nurses
To be able to early identify and treat malnutrition, a nutritional screening is necessary, followed by a detailed nutritional assessment in order to provide optimal care to individuals with CKD

Collaboration with EDTNA/ERCA – the multi-disciplinary experts.

Q4 2016 – Q4 2019

The Collaboration Programme was split into four Phases. 
Phase 1 - Survey
Phase 2 - The analysis of the Survey presented at the 46th EDTNA/ERCA International Conference, Krakow, Poland, September 9 -12 , 2017
Phase 3 - Based on the analysis of the Survey - Development of an Application which was launched at the 47th EDTNA/ERCA International Conference, Genoa, Italy, September 15 - 18, 2018

Exploring Nutrition Support Practices in Haemodialysis Units - A Guide to Implementing Best Practice

The objectives of this tool are: 

  • To increase healthcare professionals’ awareness about malnutrition
  • Provide information on the benefits of Nutritional support
  • To provide an educational tool which can support the provision of nutritional support
  • To implement this knowledge into practice and to improve the patient quality of life
  • To encourage the Patient to take an informative and active part on his treatment
Application Presentation
Phase 4 - Application - additional languages to be implemented

*Malnutrition is a burden in dialysis patients, affecting more than 30 % of dialysis patients.
  1. Nefrologia. 2013;33(4):495-505. doi: 10.3265/Nefrologia.pre2013.Apr.11979 . Prevalence of protein-energy wasting syndrome and its association with mortality in haemodialysis patients in a centre in Spain. Gracia-Iguacel C1, González-Parra E, Pérez-Gómez MV, Mahíllo I, Egido J, Ortiz A, Carrero JJ.
  2. Aparicio, M et al. Nephrol Dial Transplant, 1999;14:1679-86
**Studies show that providing nutrition therapy to CKD patients can improve the nutrition status of treated patients and the quality of life.
Nutrition status
  1. Nephrol Dial Transplant. 2016 Oct;31(10):1712-20. doi: 10.1093/ndt/gfw297 . Epub 2016 Aug 10. The effects of resistance exercise and oral nutritional supplementation during hemodialysis on indicators of nutritional status and quality of life. Martin-Alemañy G1, Valdez-Ortiz R1, Olvera-Soto G1, Gomez-Guerrero I1, Aguire-Esquivel G1, Cantu-Quintanilla G2, Lopez-Alvarenga JC1, Miranda-Alatriste P3, Espinosa-Cuevas A4.
  2.  Aparicio, M et al. Nephrol Dial Transplant ,1999;14:1679-86 Quality of Life
  1. J Ren Nutr. 2009 Mar;19(2):145-52. doi: 10.1053/j.jrn.2008.08.004 . Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients. Scott MK1, Shah NA, Vilay AM, Thomas J 3rd, Kraus MA, Mueller BA.
  2. Saudi J Kidney Dis Transpl 2016;27(2):250-255 Influence of Nutritional Education on Hemodialysis Patients’ Knowledge and Quality of Life Hossein Ebrahimi1, Mahdi Sadeghi2, Farzaneh Amanpour3, Ali Dadgari2
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Education & Training - this is the Core of the Association. Development of Educational materials, organize educational events like the annual International Conference and several Seminars along Europe. The aim of the Association is to provide tools and knowledge to Healthcare professionals as well as our Patients.

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