Nutritional education for management of osteodystrophy: Impact on serum phosphorus, quality of life, and malnutrition

Abstract

Introduction Osteodystrophy management includes dietary phosphorus restriction, which may limit protein intake, exacerbate malnutrition-inflammation syndrome and mortality among hemodialysis patients. Methods A multicenter randomized controlled trial was conducted in Lebanon, to test the hypothesis that intensive nutrition education focused on phosphorus-to-protein balance will improve patient outcomes. Six hemodialysis units were randomly assigned to the trained hospital dietitian (THD) protocol (210 patients). Six others (184 patients) were divided equally according to the patients' dialysis shifts and assigned to Dedicated Dietitian (DD) and Control protocols. Patients in the THD group received nutrition education from hospital dietitians who were trained by the study team on renal dietetics, but had limited time for hemodialysis patients. Patients in the DD group received individualized nutritional education on dietary phosphorus and protein management for 6 months (2-hour/patient/month) from study renal dietitians. Patients in the control group continued receiving routine care from hospital dietitians who had limited time for these patients and were blinded to the study. Serum phosphorus (mmol/L), malnutrition-inflammation score (MIS), health-related quality of life (HRQOL) index and length of hospital stay (LOS) were assessed at T0 (baseline), T1 (postintervention) and T2 (post6 month follow up). Findings Only the DD protocol significantly improved serum phosphorus (T0:1.78 ± 0.5, T1:1.63 ± 0.46, T2:1.69 ± 0.53), 3 domains of the HRQOL and maintained MIS at T1, but this protective effect resolved at T2. The LOS significantly dropped for all groups. Discussion The presence of competent renal dietitians fully dedicated to hemodialysis units was superior over the other protocols in temporarily improving patient outcomes.

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

“…This is in line with previous literature, where malnutrition was common among HD patients globally [40] and regionally [41]. In the previous literature, exercise appeared to improve protein energy wasting [42] and thus malnutrition.…”

Effect of stage‐based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial

“…The results of this analysis are in line with the findings of the NEMO trial . Following the intervention, a significant drop in phosphataemia was noted among patients in the three groups.…”

Educational Technologies Focused on the Chronic Renal Patients Aiming to the Self-Care Promotion / Tecnologias Educacionais Direcionadas para Pacientes Renais Crônicos na Promoção do Autocuidado

“…The improvement in serum phosphorus levels and patient knowledge scores on dietary management were only significant in group A. 13 It is important to remember that, despite the merit of educational technologies in renal patient education, it should not replace the health professional's follow-up. The professional, on the other hand, must participate in its production and validation in order to build adequate materials, which can function as a strategy in this process.…”

“…11 The educational interventions were, primarily, directed to patients undergoing hemodialysis. 6,[12][13][14][15][16][17][18][19][20][21] However, despite the importance of using educational technologies aimed at this public, the conservative treatment of renal disease, peritoneal dialysis, and transplantation also require complex demands for self-care, requiring attention by the nurse. Patient training for Peritoneal Dialysis (PD), for instance, requires a coordinated team and a multidisciplinary approach in order to promote health education that favors the maintenance of self-care in order to promote quality of life and prevent complications, such as peritonitis, which is considered one of the main causes of morbidity and treatment abandonment.…”

“…29 The educational game appeared as a teaching strategy in two studies. 13,23 In one group, the participants were divided into three groups, in which group A received the intervention with dietary self-management advice and use of an interactive game, in group B there was the only use of the game and group C did not receive an intervention. The results of the research showed a significant improvement in the serum calcium phosphate levels in both groups A and B.…”