Developing and Validating a Renal Nutrition Screening Tool to Effectively Identify Undernutrition Risk Among Renal Inpatients

Abstract

Objective: To develop and validate a nutrition screening tool that is effective to recognize renal inpatients at risk of undernutrition.

Design: A prospective, criterion validation.

Subjects: Adults admitted to a hospital ward with acute kidney injury, chronic kidney disease, and dialysis regardless of gender or ethnicity (n = 122) were recruited.

Intervention: The renal nutrition screening tool (R-NST) was developed from the Malnutrition Screening Tool and renal specific risk variables such as biochemical measures to identify renal inpatients who are at undernutrition risk.

Main outcome measure: The undernutrition risk of each participant was independently assessed using the R-NST and the 7-point Subjective Global Assessment (SGA). The R-NST was autonomously used by nursing staff to determine its feasibility as a routine screening method at ward level.

Results: The SGA and R-NST tools classified 53.3% and 68.0% of participants as malnourished or at undernutrition risk, respectively. The R-NST was determined to be valid to detect undernutrition risk (sensitivity = 97.3%, specificity = 74.4%, positive predictive value = 88.0%, and negative predictive value = 93.6%) compared with the SGA. The R-NST also showed ability to recognize timely dietetic intervention required due to renal conditions. The compliance rate in the R-NST screening by the nursing staff was low (22.6%).

Conclusion: The R-NST is a good screening tool for identifying renal inpatients at undernutrition risk. Further research is warranted to explore innovative yet effective strategies to establish undernutrition screening as standard renal ward practice.