Fuel Your Body grant winner focuses on nutritional needs of those with end stage kidney disease

One of the successful Fuel Your Body grant winners is based at the University of Western Australia and is using the funds to run an innovative project which is aimed at improving the nutrition and strength and balance of a group of individuals with end stage kidney disease.

These patients require dialysis or a transplant to stay alive, says project coordinator Aron Chakera, who is the Head, Translational Renal Research Group, based at UWA and the Harry Perkins Institute of Medical Research.

Chronic kidney disease affects one in six Australian adults and the incidence is rising Mr Chakera says.

Older adults over the age of 65 are now the fastest growing population on dialysis and currently make up 50% of the dialysis population.

These patients face an increased falls risk of between 13 and 50%(1), with one in seven patients suffering a fracture as a result of a fall, which in turn doubles the mortality risk of this cohort.(2,3) The research shows that older patients on dialysis are more vulnerable to falls due to a combination of risk factors including a sedentary lifestyle, muscle wasting and weakness, renal bone disease and malnutrition.

Malnutrition has been reported in up to 75% of patients on dialysis and this has been linked to frailty and an increased falls risk.(5-7) This project supported by the Stay On Your Feet®  Fuel Your Body grant aims to reduce the risk of falls in a high risk population through evidence based interventions that are aimed at improving their nutrition through the provision of dietary information and providing physiotherapist-led home based exercises to improve their strength and balance.

The project began in February this year and is due to come to an end at the end of this month and has seen an average of four participants for each of the individual sessions and incorporates three nutrition and physiotherapy education and support sessions.

The sessions look at specific topics aimed at maximising nutrition including providing some simple snack and meal ideas and providing simple nutritional assessments as well as providing individualised dietary advice and guidelines.

So far Mr Chakera said the feedback from the sessions had been positive, although numbers were a little lower than he had initially hoped.

“The group has been receptive to the dietary advice given to them however it also revealed a number of misconceptions from patients about what they should be doing and what some of their medications are for, so it also provided an opportunity to provide further education and advice,” he said.

He said the group were showing early signs of being able to self-manage once the program ends and they were continuing to revise the program and materials so that hopefully it would be able to provide direction and guidelines once the patient contact phase was over.

This advice will be linked to a home based exercise program for patients provided by a physiotherapist. The participants will then be encouraged to perform these exercises at home, based on the Otago Exercise Program, which is a home based program that aims to reduce falls in older adults.

Mr Chakera said it was hoped the program would reinforce the importance of self-management and encourage participants to continue to exercise at home and to be linked with community based exercise groups and a physiotherapy service.

The program will incorporate follow up information on falls frequency together with their compliance with nutritional advice and exercises and will be assessed at 6, 9 and 12 months via phone.

Mr Chakera said he believed the project was innovative because it provides dietary and physiotherapy advice for a group at an extremely high risk of falls.

He said it also provides the best chance of achieving any meaningful and sustainable changes in patient outcomes with the tools developed during this program, with the aim of enabling it to be provided to other dialysis units across the state.

The project includes a number of individuals from culturally and linguistically diverse backgrounds, of Aboriginal and Torres Strait Islander descent and   people who are socially isolated.

Ultimately, this innovative project aims to incorporate the information developed during this program and develop it into nutrition and exercise information resources, translated into a number of languages, reflecting the diversity of dialysis patients and will be available at the main dialysis units at Perth’s major hospitals.

Click here for more information about Stay On Your Feet® grants

Farragher J, Rajan T, Chiu E, Ulutas O, Tomlinson G, Cook WL, et al. Equivalent Fall

Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis. Peritoneal Dialysis

International. 2016;1:36(1):67-70.

Kohlmeier M, Saupe J, Schaefer K, Asmus G. Bone Fracture History and Prospective

Bone Fracture Risk of Hemodialysis Patients are Related to Apolipoprotein E Genotype. Calcified Tissue International.1998;62(3):278-81.

Mittalhenkle A, Gillen DL, Stehman-Breen CO. Increased risk of mortality associated

with hip fracture in the dialysis population. American Journal of Kidney Diseases. 2004;44(4):672-9.

Chan M, Kelly J, Batterham M, Tapsell L. Malnutrition (subjective global assessment)

Scores and Serum Albumin Levels not Body Mass Index Values, at Initiation of Dialysis are

Independent Predictors of Mortality: A 10 Year Clinical Cohort Study. Journal of Renal Nutrition. 2012;22(6):547-557.

Kalanter-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-inflam

Stay On Your Feet to launch new Fuel Your Body campaign on February 1, 2017

Older adults are at risk of malnutrition as a result of the body’s natural ageing process as well as a range of socioeconomic factors that can result in a poor diet and insufficient nutrition.

The new Fuel Your Body campaign, which is due to be launched by WA’s leading falls prevention program, Stay On Your Feet® early in 2017, will look at ways of addressing these concerns and ensuring that Western Australians over the age of 60 are informed about what a balanced diet looks like as they age.

The campaign will be launched on Wednesday February 1, 2017 at the National Lifestyle Village Lake Joondalup by the Hon Paul Miles MLA, Minister for Seniors, Local Government and Community Services and the local member for Wanneroo, as well as City of Wanneroo Mayor Tracey Roberts and Shadow Minister for Seniors Margaret Quirk as well as a host of special guest chefs, nutritionists and health professionals.

The Stay On Your Feet® program aims to reduce the incidence of falls in older adults in the community, which is the leading cause of hospitalisation of adults over the age of 65 in Australia and costs the WA Health System on average more than $100,000,000 each year.

Injury Prevention Manager Rachel Meade said that the new campaign was designed to give older adults living independently in the community some basic information around food, alcohol and water consumption that were simple to follow, cost effective and age appropriate.

She said malnutrition in older adults was a problem in the community that can lead to impaired muscle function and potential decreased bone density and increases falls-related morbidity and mortality rates.
“This can be as a result of physiological changes in the body, chronic diseases, the side effects of medication and a loss of appetite as we get older.

“However there are other factors to consider like deterioration in quality of life, or a lack of motivation to cook healthy meals for those who may be living alone after the death of a partner for example,” Ms Meade explained.

“This can have a whole lot of repercussions, from the mental to the physical state, which can greatly increase the risk of falls, hospitalisations and the ability of individuals to continue to live independently in the community.”

The Fuel Your Body campaign also highlights the importance of drinking water to avoid complications from dehydration and drinking less alcohol to keep your brain and body healthy.

The three-month campaign launches on February 1 and runs until April 30, 2017 and targets older adults over 60 living independently in the community.

For more information about the Fuel Your Body campaign or for tips on how you can stay active and alert to reduce your risk of falls contact Stay On Your Feet® on 1300 30 35 40 or visit www.stayonyourfeet.com.au.