Effect of personalized nutritional counseling in maintenance hemodialysis patients

Abstract

Monitoring nutritional parameters is an integral part of hemodialysis (HD) patient treatment program. The purpose of this study was to evaluate the impact of the personalized nutritional counseling (PNC) on calcium-phosphorus metabolism, potassium, albumin, protein intake, interdialytic weight gain (IDWG), body composition parameters and fluid overload in HD patients. This was a multicenter longitudinal intervention study with 6 months of follow-up and 731 patients on maintenance HD from 34 dialysis units in Portugal were enrolled. Biochemical and body composition parameters were measured at baseline, 1, 3 and 6 months after the PNC. Patient's mean age was 64.9 (95% confidence interval [CI]: 63.8-66.0) years and mean HD time was 59.8 (95% CI: 55.3-64.3) months. Regarding data comparison collected before PNC vs. 6 months after, we obtained, respectively, the following results: patients with normalized protein catabolic rate (nPCR) ≥ 1 g/kg/day = 66.5% vs. 73.5% (P = 0.002); potassium > 5.5 mEq/L = 52% vs. 35.8% (P < 0.001); phosphorus between 3.5 and 5.5 mg/dL = 43.2% vs. 52.5% (P < 0.001); calcium/phosphorus (Ca/P) ratio ≤ 50 mg/dL = 73.2 % vs. 81.4% (P < 0.001); albumin ≥ 4.0 g/dL = 54.8% vs. 55% (P = 0.808); presence of relative overhydration = 22.4% vs. 25% (P = 0.283); IDWG > 4.5% = 22.3% vs. 18.2% (P = 0.068). PNC resulted in a significant decrease in the prevalence of hyperkalemia, hypophosphatemia and also showed amelioration in Ca/P ratio, nPCR and an increase in P of hyphosphatemic patients. Our study suggests that dietetic intervention contributes to the improvement of important nutritional parameters in patients receiving hemodialysis treatment.

Impact of Dietetic Intervention on Skin Autofluorescence and Nutritional Status in Persons Receiving Dialysis: A Proof of Principle Study

“…Nevertheless, in our study, we observed that an intensive and individualized dietetic intervention was associated with achievement of recommended dietary energy and protein intake 19,27 and with an improvement in serum albumin, SGA score and fat intake. A number of interventional studies conducted in persons receiving dialysis support our findings that with personalized nutritional counselling alone [28][29][30] and/or dietetic advice plus specific oral nutritional supplements [31][32][33][34][35][36][37] it is possible to achieve improvements in nutritional markers including serum albumin, serum prealbumin and total cholesterol, energy and protein intake, BMI, TSF and MAC. These findings highlight the importance of individualized nutritional advice and support as the cornerstone of the treatment of malnutrition in the dialysis population 19 .…”

Zinc Deficiency, Plasma Fatty Acid Profile and Desaturase Activities in Hemodialysis Patients: Is Supplementation Necessary?

“…Recently published studies demonstrated that the administration of oral zinc acetate could increase a risk for copper deficiency in hypoalbuminemic hemodialysis patients (83). A personal nutrition therapeutic approach is necessary for patients with CKD and hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe the appropriate interventions (84)(85)(86).…”

The state of nutrition care in outpatient hemodialysis settings in Malaysia: a nationwide survey

“…It has been conclusively shown that dietitians’ care improves nutrition and clinical outcomes of HD patients [ 27 – 29 ]. In addition, dietitians have other important roles in HD centers such as knowledge sharing with co-health care professionals, quality assessment and performance improvement, research, and protocol/algorithm development and monitoring, which may indirectly translate into improved patients’ nutrition outcomes [ 5 ].…”