A decade of renal dietetic staffing and malnutrition prevalence in dialysis patients: An observational study in a large dialysis population.

Abstract

Aims: This study explores the maintenance of dietetic full time equivalent staffing alongside malnutrition rate in a metropolitan renal dialysis service in Victoria, Australia. Objectives were to: (1) describe changes in dietitian staff-to-patient ratios over time; (2) evaluate dietetic service delivery against best practice guidelines and (3) report malnutrition prevalence over a 10-year period.

Methods: Data were collated from nine retrospective point prevalence audits conducted between 2009 and 2024 across satellite, home haemodialysis and peritoneal dialysis modalities. Nutritional status was primarily assessed using the Subjective Global Assessment, with the Mini Nutritional Assessment and Global Leadership Initiative on Malnutrition criteria introduced in 2024. Malnutrition prevalence was analysed across gender, age and dialysis vintage. Staffing levels were mapped against patient growth, with a target of 1 full time equivalent dietitian per 143 patients (1:143). A decade of renal dietetic staffing and malnutrition prevalence in dialysis patients: An observational study in a large dialysis population RESULTS: Between 2014 and 2024, dietitian staffing levels increased proportionally with patient numbers, maintaining dietitian staff-to-patient ratios between 1:126 and 1:157. Nutritional assessments completed in the home haemodialysis population rose from 25% to 96%. Malnutrition prevalence declined from 25% to 18% in the haemodialysis and from 22% to 11% in the home haemodialysis populations. These improvements were sustained over time. Malnutrition prevalence was higher in older adults, females and individuals on dialysis for less than 1 year.

Conclusion: This audit observed that maintaining dietetics staffing in line with recommendations aligned with sustained reductions in malnutrition prevalence. These findings support the integral role of renal dietitians in multidisciplinary renal care.