Questionnaire survey on nutritional supplement therapy and exercise training at hemodialysis facilities in Japan

Background: Nutritional therapy and exercise training (ET) are important interventions for hemodialysis patients. We investigated the status of nutritional therapy and ET provided at hemodialysis facilities across Japan. Method: This was a cross-sectional study. The facilities investigated were 3993 facility member institutions of the Japanese Society for Dialysis Therapy in August 2015. Data was collected on the facility type, number of staff (doctors, nurses, and medic al engineers), presence of staff (clinical dietitians, pharmacists, and physical therapists), proportion of elderly patients (age ≥ 65 years), patients with albumin ≤ 3.5 g/dL, and types of oral nutritional supplements (ONS), intradialytic parenteral nutrition (IDPN), and ET in the facility. We summarized data on facilities and patient characteristics and calculated the proportion of the nutrition that were ONS, IDPN, and exercise interventions provided. We used multiple logistic analyses to examine the facility characteristics associated with the provision of nutritional support and ET. Results: We obtained responses from 1048 facilities (response rate 26.2%) and 88,492 patients (27.6%). Patients aged ≥ 65 years accounted for 63.4% of all investigated patients. Patients with Alb ≤ 3.5 g/dL accounted for 37.6% of all investigated patients. Meals during hemodialysis sessions were provided at 601 facilities (64%), ONS were used at 382 facilities (40%), and IDPN was administered at 471 facilities (46%). Exercise during hemodialysis sessions was provided at 190 facilities (20%). These trends did not change after adjustment of response rates by affiliations of facility type and region. At the patient level, only a limited number of patients were provided with ONS, IDPN, and ET, 2.1, 2.7, and 3.0%, respectively. ONS and IDPN were less likely to be offered in hospitals than in clinics without beds (odds ratio (OR) 0.21; 95% confidence interval (CI) 0.09-0.45) (OR 0.37; 95% CI 0.17-0.82). ET was also less likely to be offered in hospitals (OR 0.20; 95% CI 0.08-0.49). Conclusions: Nutritional support therapy is provided in a considerable number of hemodialysis facilities, ET is increasing but offered by fewer facilities compared to other countries, while a limited number of patients were provided with ET.