Nutrition and dietary intake and their association with mortality and hospitalisation in adults with chronic kidney disease treated with haemodialysis: protocol for DIET-HD, a prospective multinational cohort study

Abstract

IntroductionAdults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the “DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study,” a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries.Methods and analysisDIET-HD will recruit approximately 10 000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA2LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation.Ethics and disseminationThe study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic trials of nutrition or dietary interventions in the setting of advanced kidney disease.

Differences in Knowledge, Stress, Sensation Seeking, and Locus of Control Linked to Dietary Adherence in Hemodialysis Patients

“…This means that patients have to limit their intake of foods and fluids in order to maintain safe levels (Palmer et al, 2015). …”

Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease

“…Well-designed trials investigating micronutrient status in this population of patients are urgently needed. The ongoing DIET-HD study raises expectations for better understanding the micronutrient needs of CKD patients, and for establishing strategies to improve health outcomes with the use of dietary interventions in advanced kidney disease [49]. This is critical if micronutrient interventions are to be not only effective, but also targeted to those with the greatest need.…”

Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift

“…Dieticians in dialysis facilities are pressured by the tension between decreasing phosphorus and increasing albumin, the balance for which is very difficult to manage especially since it is a false paradigm; albumin level is a very poor marker for dietary protein intake. Low IDWG values, prescribed to meet quality benchmarks, may inadvertently contribute to malnutrition . Uremia, nonadherence to dialysis, and overly restrictive diets are associated with malnutrition and inflammation, both of which are strongly associated with hospitalizations in patients with ESRD.…”

“…Low IDWG values, prescribed to meet quality benchmarks, may inadvertently contribute to malnutrition. 140 Uremia, nonadherence to dialysis, and overly restrictive diets are associated with malnutrition and inflammation, both of which are strongly associated with hospitalizations in patients with ESRD. Thus, system-and facility-level risks for hospitalizations include a payment structure that supports short, inflexible shifts with high patient to staff ratios, and education efforts based on incentive-driven metrics that focus too much on patient behaviors that are not closely associated with outcomes.…”