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.
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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
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