ORIGINAL RESEARCH Effectiveness of a Nutrition Education Program for the Prevention and Treatment of Malnutrition in End-Stage Renal Disease Juan Jos  e Hern  andez Morante, PhD,* Almudena S  anchez-Villazala, RN,† Ruben Ca~ navate Cutillas, BcB,* and Mari Carmen Conesa Fuentes, PhD* Objective: In end-stage renal disease (ESRD) patients, malnutrition is mainly addressed from a pharmacological but not educational point of view. Therefore, the objective of this study was to implement a nutritional education program (NEP) and to evaluate and compare its effectiveness in the treatment and prevention of malnutrition with oral supplementation (OS)—the standard treatment in these patients. Design: This study was a longitudinal, 4-month prospective study. Settings: The study was conducted from January to May 2012 in the Hemodialysis Fresenius Medical Care Clinic of Murcia. Subjects: One hundred twenty patients with ESRD undergoing hemodialysis were randomly assigned to a NEP or to OS. Intervention: Patients assigned to the NEP group followed an educational program for 4 months that aimed to improve general nu- tritional knowledge and included culinary recommendations and an elaboration of balanced menus. The OS group received a nutritional supplement during the hemodialysis procedure. Main Outcome Measure: The main outcome measure was certain biochemical markers of nutritional and metabolic status. Nutrition knowledge was also evaluated. Results: After 4 months of intervention, nutritional knowledge was increased in all patients (P , .050) after the NEP, which was reflected in a decrease in the prevalence of malnutrition, especially in this group. Creatinine clearance, total protein serum values, and other biochemical parameters improved significantly in both groups (P , .050 in all cases), although other parameters such as C-reactive protein were impaired only in the NEP group. Conclusion: The NEP was at least as effective as OS for preventing and even treating malnutrition in patients with chronic renal failure on hemodialysis, improving their nutritional status, which may result in a long-term decrease in the mortality and morbidity of these patients. Ó 2014 by the National Kidney Foundation, Inc. All rights reserved. Introduction E ND-STAGE RENAL DISEASE (ESRD) patients are characterized by high nutritional risk impairment, with an estimated malnutrition prevalence of 40%. 1 Some of the most common origins of malnutrition, such as an in- crease of nutrient loss and an increase of the requirements, are present in ESRD patients. 2 In addition, these patients present some special situations that may also lead to the de- velopment of malnutrition, such as increased inflammatory and catabolic cytokine production, chronic blood loss, and decreased intake secondary to a uremic syndrome, among others. 3 Whatever the origin or etiology, the main cause of malnu- trition is due to the patient’s eating habits. 4 Thus, a balance between clinical intervention (pharmacological or surgical) and a nutritional approach would be the most suitable ther- apy to ensure a proper nutritional status. In this regard, as it has been recommended, 4 to increase the patient’s nutritional education is fundamental to improving the success of the he- modialysis process. 5 Taking into account these consider- ations and that some patients cannot properly tolerate oral supplementation (OS), it is necessary to seek alternatives to adequately nourish patients with this pathology. There is unfortunately a considerable geographic vari- ability in practice patterns and patient outcomes. 6 Con- cretely, in our environment, ESRD patients usually obtain nutrition information in a single session with a phy- sician, which leads to many doubts; therefore, they end up seeking further information in printed nutrition handouts, brochures, or guidelines. Thus, many ESRD patients wish to have a specific nutritional consultation, as previously shown by Sutton and colleagues. 7 * Faculty of Nursing, Catholic University ‘‘San Antonio’’ of Murcia, Murcia, Spain. † Hemodialysis Clinic, Fresenius Medical Care, Caravaca (Murcia), Spain. Financial Disclosure: This work was partially supported by a PMAFI-PI-04/ 11 grant from the Catholic University of Murcia. A.S.-V. is a member of the pri- vate Fresenius Medical Care Clinic. The other authors have no conflict of interest to declare. Address correspondence to Juan Jos  e Hern andez Morante, PhD, Faculty of Nursing, Catholic University of Murcia, Campus de Guadalupe, s/n. 30107, Murcia, Spain. E-mail: jjhernandez@ucam.edu Ó 2014 by the National Kidney Foundation, Inc. All rights reserved. 1051-2276/$36.00 http://dx.doi.org/10.1053/j.jrn.2013.07.004 42 Journal of Renal Nutrition, Vol 24, No 1 (January), 2014: pp 42-49