Effect of nutritional education on serum potassium level in patients receiving haemodialysis

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Mehmet Çavdar https://orcid.org/0000-0003-3254-0952
Habibe Şahin https://orcid.org/0000-0003-2911-6907


haemodialysis, hyperpotassemia, nutrition education



Background: The most effective and practical way to prevent hyperpotassemia, which is an important problem in patients receiving haemodialysis, is to limit potassium intake with diet. One of the most effective methods to be applied for this purpose is nutrition education.

Objective: This study was aimed at investigating the effect of nutrition education given to patients receiving haemodialysis with hyperpotassemia on serum potassium levels.

Design: The study was conducted as a prospective intervention study.

Participants: A total of sixty-eight participants over the age of 18, who received at least three haemodialysis sessions per week for more than six months, and whose serum potassium level was above 5.5 mEq/L were recruited in the study.

Intervention: The participants in the intervention group (n=34) were given nutrition education and a handbook including information about potassium in haemodialysis treatment. No nutrition education was given to the participants in the control group (n=34).

Results: The comparison of the pre- and post- nutrition education serum potassium levels and the mean potassium knowledge score of the participants in the intervention group demonstrated that while their serum potassium levels decreased significantly, their potassium knowledge score increased (p <0.05). In the control group, no difference was determined between the participants’ pre- and-post study serum potassium levels and potassium knowledge scores (p> 0.05).

Conclusions: It was observed that the nutrition education given to patients receiving haemodialysis was effective in lowering the serum potassium levels of the participants


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1. Kovesdy C.P., Appel L.J., Grams M.E. et al. Potassium homeostasis in health and disease: A scientific workshop cosponsored by The National Kidney Foundation and The American Society of Hypertension. J Am Soc of Hypertens 2017; 11(12): 783-800. https://doi.org/10.1016/j.jash.2017.09.011.
2. Ahmed J., Weisberg L.S. Hyperkalemia in dialysis patients. Semin Dial 2001; 14(5): 348-356. https://doi.org/10.1046/j.1525-139X.2001.00087.x.
3. Pani A., Floris M., Rosner M.H., Ronco C. Hyperkalemia in hemodialysis patients. Semin Dial 2014; 27(6): 571-576. https://doi.org/10.1111/sdi.12272.
4. Lu X.H., Su C.Y., Sun L.H., Chen W., Wang T. Implementing continuous quality improvement process in potassium management in peritoneal dialysis patients. J Ren Nutr 2009; 19(6): 469-474. https://doi.org/10.1053/j.jrn.2009.04.003.
5. St-Jules D.E., Goldfarb D.S., Sevick M.A. Nutrient Non-equivalence: Does restricting high-potassium plant foods help to prevent hyperkalemia in hemodialysis patients? J Ren Nutr 2016; 26(5): 282-287. https://doi.org/10.1053/j.jrn.2016.02.005.
6. Cupisti A., Ferretti V., D’Alessandro C. et al. Nutritional knowledge in hemodialysis patients and nurses: focus on phosphorus. J Ren Nutr 2012; 22(6): 541-546. https://doi.org/10.1053/j.jrn.2011.11.003.
7. Durose C.L., Holdsworth M., Watson V., Przygrodzka F. Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. J Am Diet Assoc 2004; 104(1): 35-41. https://doi.org/10.1016/j.jada.2003.10.016.
8. Kent P.S., McCarthy M.P., Burrowes J.D. et al. Academy of Nutrition and Dietetics and National Kidney Foundation: revised 2014 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nephrology nutrition. J Acad Nutr Diet 2014; 114(9): 1448-1457. https://doi.org/10.1016/j.jand.2014.05.006.
9. Sanghavi S., Whiting S., Uribarri J. Potassium balance in dialysis patients. Semin Dial 2013; 26(5): 597-603. https://doi.org/10.1111/sdi.12123.
10. Dağdeviren A., Savaşer S. Education to reduce potassium levels in adolescent, haemodialysis patients. EDTNA-ERCA J 2003; 29(4): 195-197. https://doi.org/10.1111/j.1755-6686.2003.tb00312.x.
11. National Kidney Foundation. (2021). Potassium and your CKD diet. https://www.kidney.org/sites/default/files/02-10-0410_EBB_Potassium.pdf. Accessed January 24, 2021.
12. Ritz E., Hahn K., Ketteler M., Kuhlmann M.K, Mann J. Phosphate additives in food - a health risk. Dtsch Arztebl Int 2012; 109(4); 49-55. https://doi.org/10.3238/arztebl.2012.0049.
13. Yeun J.Y., Ornt D.B., Depner T.A. Hemodialysis. In Brenner & Rector’s The Kidney (eds Skorecki K., Chertow G.M., Marsden P.A., Taal M.W., Yu A.S.L.), (10th ed.) 2016; pp. 2058-2110. Philadelphia: Elsevier.
14. Kalantar-Zadeh K., Kopple J.D. Nutritional management of patients undergoing maintenance hemodialysis. In Kopple and Massry’s Nutritional Management of Renal Disease (eds Kopple J.D. & Massry S.G.), (2nd ed.) 2004; pp. 433-458. Philadelphia: Lippincott Williams & Wilkins.
15. Baines L.S., Jindal R.M. Noncompliance in patients receiving hemodialysis: An in-depth review. Nephron 2000; 85(1): 1-7. https://doi.org/10.1159/000045622.
16. Stewart J., Schvaneveldt N.B., Christensen N.K., Lauritzen G.C., Stein D.M. The effect of computerised dietary analysis nutrition education on nutritional knowledge, nutritional status, dietary compliance, and quality of life of hemodialysis patients. J Ren Nutr 1993; 3(4): 177-178. https://doi.org/10.1016/S1051-2276(12)80092-6.
17. Shepherd R. Resistance to changes in diet. Proc Nutr Soc 2002; 61(2): 267-272. https://doi.org/10.1079/PNS2002147.
18. Lindsay R.M., Bergström J. Membrane biocompatibility and nutrition in maintenance hemodialysis patient. Nephrol Dial Transplant 1994; 9: 150-155.
19. Putcha N., Allon M. Management of hyperkalemia in dialysis patients. Semin Dial 2007; 20(5): 431-439. https://doi.org/10.1111/j.1525-139X.2007.00312.x.
20. Cupisti A., Kovesdy C.P., D’Alessandro C., Kalantar-Zadeh K. Dietary approach to recurrent or chronic hyperkalaemia in patients with decreased kidney function. Nutrients 2018; 10(3): 261. https://doi.org/10.3390/nu10030261.
21. Fried L., Kovesdy C.P., Palmer B.F. New options for the management of chronic hyperkalemia. Kidney Int Suppl 2017; 7(3): 164-170. https://doi.org/10.1016/j.kisu.2017.09.001.
22. Kugler C., Maeding I., Russell C.L. Non-adherence in patients on chronic hemodialysis: An international comparison study. J Nephrol 2011; 24(3): 366-375. https://doi.org/10.5301/JN.2010.5823.
23. Idier L., Untas A., Koleck M., Chauveau P., Rascle N. Assessment and effects of therapeutic patient education for patients in hemodialysis: A systematic review. Int J Nurs Stud 2011; 48(12): 1570-1586. https://doi.org/10.1016/j.ijnurstu.2011.08.006.
24. Labriola L., Jadoul M. Sailing between scylla and charybdis: The high serum K-low dialysate K quandary. Semin Dial 2014; 27(5): 463-471. https://doi.org/10.1111/sdi.12252.
25. Baraz S., Mohammadi I., Boroumand B. A comparative study on the effect of two methods of self-care education (direct and indirect) on quality of life and physical problems of hemodialysis patients. Arak Med Univ J 2006; 9(1): 7-22.
26. Kalantar-Zadeh K. Patient education for phosphorus management in chronic kidney disease. Patient Prefer Adherence 2013; 7: 379-390. https://doi.org/10.2147/PPA.S43486.
27. Johnson J.P., Mighten A. A comparison of teaching strategies: Lecture notes combined with structured group discussion versus lecture only. J Nurs Educ 2005; 44(7): 319-322. https://doi.org/10.3928/01484834-20050701-06.
28. Baraz S., Parvardeh S., Mohammadi E., Broumand B. Dietary and fluid compliance: An educational intervention for patients having haemodialysis. J Adv Nurs 2010; 66(1): 60-68. https://doi.org/10.1111/j.1365-2648.2009.05142.x.
29. Ebrahimi H., Sadeghi M., Amanpour F., Dagdari A. Influence of nutritional education on hemodialysis patients’ knowledge and quality of life. Saudi J Kidney Dis Transpl 2016; 27(2): 250-255. https://doi.org/10.4103/1319-2442.178253.
30. Tsai W.C., Yang J.Y., Luan C.C. et al. Additional benefit of dietitian involvement in dialysis staffs-led diet education on uncontrolled hyperphosphatemia in hemodialysis patients. Clin Exp Nephrol 2016; 20(5): 815-821. https://doi.org/10.1007/s10157-015-1212-1.
31. Ford J.C., Pope J.F., Hunt A.E., Gerald B. The effect of diet education on the laboratory values and knowledge of hemodialysis patients with hyperphosphatemia. J Ren Nutr 2004; 14(1): 36-44. https://doi.org/10.1053/j.jrn.2003.09.008.
32. Naseri-Salahshour V., Sajadi M., Nikbakht-Nasrabadi A., Davodabady F., Fournier A. The effect of nutritional education program on quality of life and serum electrolytes in hemodialysis patients: A single-blind randomized controlled trial. Patient Educ Couns 2020; 103(9): 1774-1779. https://doi.org/10.1016/j.pec.2020.03.021.
33. Garagarza C.A., Valente A.T., Oliveira T.S., Caetano C.G. Effect of personalized nutritional counseling in maintenance hemodialysis patients. Hemodial Int 2015; 19(3): 412-418. https://doi.org/10.1111/hdi.12260.
34. Aghakhani N., Hoseini S.L., Kamali K., Vahabzadeh D. Effects of appropriate nutrition training in small groups on laboratory parameters in hemodialysis patients from Iran. Maedica 2017; 12(4): 276-280.
35. Karavetian M., de Vries N., Rizk R., Elzein H. Dietary educational interventions for management of hyperphosphatemia in hemodialysis patients: a systematic review and meta-analysis. Nutr Rev 2014; 72(7): 471-482. https://doi.org/10.1111/nure.12115.
36. Karamanidou C., Weinman J., Horne R. Improving haemodialysis patients’ understanding of phosphate-binding medication: a pilot study of a psycho-educational intervention designed to change patients’ perceptions of the problem and treatment. Br J Health Psychol 2008; 13(2): 205-214. https://doi.org/10.1348/135910708X288792.
37. Jo I.Y., Kim W.J., Park H.C., Choi H.Y., Lee J.E., Lee S.M. Effect of personalized nutritional counseling on the nutritional status of hemodialysis patients. Clin Nutr Res 2017; 6(4): 285-295. https://doi.org/10.7762/cnr.2017.6.4.285.
38. Jahanpeyma P., Makhdoomi K., Sajadi S.A. The effect of nutrition education program on biochemical parameters among patients with chronic kidney disease undergoing hemodialysis. J Crit Care Nurs 2017; 10(3): e12453.
39. Noori N., Kalantar-Zadeh K., Kovesdy C.P. et al. Dietary potassium intake and mortality in long-term hemodialysis patients. Am J of Kidney Dis 2010; 56(2): 338-347. https://doi.org/10.1053/j.ajkd.2010.03.022.
40. PubMed. “Hyperpotassemia and nutrition education”. https://pubmed.ncbi.nlm.nih.gov/?term=hyperpotassemia+and+nutrition+education. Accessed January 24, 2021