In April 2002, the medical insurance allowances for certain practices were revised, and repayment of the cost of dialysis meals to outpatients undergoing dialysis was abolished. One month later, a proposal was made for the early retirement of nutritionists and administrative nutritionists in 30.8% of all clinics.
One year after the revision to these medical insurance allowances, dialysis meals were still being provided to 66.6% of the dialysis patients: 73.7% of those undergoing dialysis during in the morning, 81.8% of those undergoing dialysis during the night, 73.9% of those living alone, and 76.7% of those with a dialysis history of 10 years or more. The most frequent reason for the continuing dialysis meals was “The time of the meal overlaps with the dialysis time.” The required patient payment was 600-650yen, and 13.7% of patients discontinued dialysis meals due to this “high” required payment.
One hundred and seven dialysis patients were classified into those continuing with dialysis meals (71 patients) and those who had discontinued (36 patients), and their nutritional state was compared. Those who had discontinued meals showed a lower Karnofsky activity scale and a higher blood cholesterol level than those who had continued meals. The BMI, hematocrit level, and serum albumin level did not significantly differ between the two groups. One year after the revision to meal provision, those who had discontinued meals showed a significant increase in body weight gain during the period of dialysis compared with that before the revision (
p<0.05) and they also drank significantly more water than those who continued with meals (
p<0.05).
Of those patients who continued with the dialysis meals, 85.9% considered that the meal content provided useful information on dietary control for preparing their daily meals. The meals provided during dialysis may play an important role in nutritional education and nutritional management.
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