Effect of a dietary education intervention on biochemical markers in hemodialysis patients with chronic kidney disease: a study in Udupi and Mangalore regions of Karnataka, India
Nutrition Education for haemodialysis patients
Keywords:Nutrition Education Program, Biochemical parameters, Patient Education, End-stage renal disease, Hemodialysis. Adherence to fluid limitations, Udupi region.
Abstract. Background and aim: Nutritional health is one of the most critical aspects of overall health for chronic kidney disease (CKD) sufferers, particularly those on hemodialysis. In CKD, advanced kidney disease and renal replacement treatment cause protein-energy wasting, leading to various metabolic and nutritional abnormalities. Despite the importance of diet for hemodialysis patients, investigations have revealed that many individuals need more knowledge about optimal nutrition. As a result, inadequate nutrition reduces life quality and increases hemodialysis complications and mortality in these patients. This study aimed to evaluate the impact of a dietary education intervention on biochemical markers in hemodialysis patients with CKD in the Udupi and Mangalore regions of Karnataka, India. Materials and Methods: This is a multicentric and randomised control trial was conducted among 250 hemodialysis patients with CKD at KMC Hospital, Manipal, Dr TMA Pai Hospital Udupi, and Father Muller Medical College Hospital (FMMCH) Mangalore from April 5, 2022, to April 5, 2023. The participants were randomly assigned to either the intervention or control groups. The intervention group received a comprehensive dietary education program, including personalised dietary plans, nutritional counselling, and monitoring, while the control group received standard care without any specific nutritional intervention. The statistical analysis was carried out using the EZR software. Results: The results demonstrated a significant improvement in biochemical markers among participants in the intervention group compared to the control group. Specifically, there was a notable reduction in sodium (p < 0.001), haemoglobin (p < 0.001), and potassium (p = 0.009) levels in the intervention group. Conclusions: The findings of this study highlight the positive impact of a dietary education intervention on improving biochemical markers in hemodialysis patients with CKD.
Keywords: nutrition education program, biochemical parameters, patient education, end-stage renal disease, hemodialysis. Adherence to fluid limitations, udupi region
Nagem DR, Al-Qurashi EA, Alghamdi MA, Ali MA, Alshareef MM, Alsaedi FT, et al. Effect of a nutrition education program on the health status of hemodialysis patients in Makkah area. Int.J.Adv.Res 2016;4 (12) 2277-2283. doi:10.21474/IJAR01/2647.
Vijaya KL, Aruna M, Narayana Rao SVL, Mohan PR. Dietary Counseling by Renal Dietician Improves the Nutritional Status of Hemodialysis Patients. Indian J Nephrol 2019;29(3):179-185. doi: 10.4103/ijn.IJN_272_16.
Rini TPV, Kamath J, Mateti UV. Impact of patient education on interdialytic weight gain and blood pressure in patients undergoing hemodialysis. Indian J of Pharmaceutical Education and Research 2017;51(4S): S653-S60. doi: 10.5530/ijper.51.4s.95.
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 levels in hemodialysis patients: a single-blind randomized controlled trial. Patient Educ Couns 2020;103(9):1774-1779. doi: 10.1016/j.pec.2020.03.021.
Locatelli F, Fouque D, Heimburger O, et al. Nutritional status in dialysis patients: a European consensus. Nephrol Dial Transplant 2002 ;17(4):563-72. doi: 10.1093/ndt/17.4.563.
Bogacka A, Sobczak-Czynsz A, Kucharska E, Madaj M, Stucka K. Analysis of nutrition and nutritional status of haemodialysis patients. Rocz Panstw Zakl Hig 2018;69(2):165-174.
Jahanpeyma P, Makhdoomi K, Sajadi SA. The effect of nutrition education program on biochemical parameters among patients with chronic kidney disease undergoing hemodialysis. Crit Care Nurs J 2017;10 (3): 1-5. doi: 10.5812/ccn.12453.
Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis 2020;76(3 Suppl 1): S1-S107. doi: 10.1053/j.ajkd.2020.05.006.
Perez-Torres A, Gonzalez Garcia ME, Ossorio-Gonzalez M, et al. The effect of nutritional interventions on long-term patient survival in advanced chronic kidney disease. Nutrients 2021; 14;13(2):621. 1-12. doi: 10.3390/nu13020621.
Ghorbani A, Hayati F, Karandish M, Sabzali S. The prevalence of malnutrition in hemodialysis patients. J Renal Inj Prev 2020; 9(2): e15.DOI:10.34172/jrip.2020.15. doi: 10.34172/jrip.2020.15.
Hajira B, Manzoor M, Samiullah M, Chawla RK. Effect of dietary counselling on the nutritional status of end-stage renal disease patients. J Pak Med Assoc 2017;67(9):1327-1330.
Beto JA, Schury KA, Bansal VK. Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: a narrative review and commentary. Int J Nephrol Renovasc Dis 2016;9:21-33. doi: 10.2147/IJNRD.S76831.
Hernandez Morante JJ, Sanchez-Villazala A, Cutillas RC, Fuentes MC. Effectiveness of a nutrition education program for the prevention and treatment of malnutrition in end-stage renal disease J Ren Nutr. 2014;24(1):42-9. doi: 10.1053/j.jrn.2013.07.004.
Sharaf AY. The impact of educational interventions on hemodialysis patients’ adherence to fluid and sodium restrictions. IOSR J Nurs Health Sci 2016;5(3):50–60.
Baraz S, Zarea K, Dashtbozorgi B. Comparing the effect of two educational programs on the quality of life of hemodialysis patients in Iran. Iran Red Crescent Med J 2014;16(8): 1-7. doi: 10.5812/ircmj.19368.
Hashemi S, Tayebi A, Rahimi A, Einolahi B. Examining the effect of continuous care model on adherence to dietary regimen among patients receiving hemodialysis. J Crit Care Nurs 2015;7(4):215–20.
Manns BJ, Taub K, Vanderstraeten C, Jones H, Mills C, Visser M, McLaughlin K. The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: a randomized trial. Kidney Int 2005; 68(4):1777-83. doi: 10.1111/j.1523-1755.2005.00594.
Mason J, Khunti K, Stone M, Farooqi A, Carr S. Educational interventions in kidney disease care: a systematic review of randomized trials. Am J Kidney Dis 2008; 51(6):933-51. doi: 10.1053/j.ajkd.2008.01.024.
Ageborg M, Allenius BL, Cederfjall C. Quality of life, self-care ability, and sense of coherence in hemodialysis patients: a comparative study. Hemodial Int 2005; 9 Suppl 1: S8-14. doi: 10.1111/j.1542-4758.2005.01164. x.
Lingerfelt KL, Thornton K. An educational project for patients on hemodialysis to promote self-management behaviors of end-stage renal disease education. Nephrol Nurs J 2011;38(6):483-8.
Gowda S, Desai PB, Kulkarni SS, Hull VV, Math AA, Vernekar SN. Markers of renal function tests. N Am J Med Sci 2010;2(4):170-3.
Zimmerman DL, Nesrallah GE, Chan CT, et al. Dialysate calcium concentration and mineral metabolism in long and long-frequent hemodialysis: a systematic review and meta-analysis for a Canadian Society of Nephrology clinical practice guideline. Am J Kidney Dis 2013; 62(1):97-111. doi: 10.1053/j.ajkd.2013.02.357.
Cupisti A, Gallieni M, Rizzo MA, Caria S, Meola M, Bolasco P. Phosphate control in dialysis. IntJ Nephrol Renovasc Dis 2013; 6:193–205. doi: 10.2147/IJNRD.S35632.
Karaboyas A, Zee J, Brunelli SM, et al. Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2017; 69(2):266-277. doi: 10.1053/j.ajkd.2016.09.015.
Santos SF, Peixoto AJ. Sodium balance in maintenance hemodialysis. Semin Dial 2010; 23(6):549-55. doi: 10.1111/j.1525-139X.2010.00794. x.
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):541-6. doi: 10.1053/j.jrn.2011.11.003.
Ford JC, Pope JF, Hunt AE, 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. doi: 10.1053/j.jrn.2003.09.008.
Molfino A, Chiappini MG, Laviano A, et al. Effect of intensive nutritional counseling and support on clinical outcomes of hemodialysis patients. Nutrition 2012;28(10):1012-1015. doi: 10.1016/j.nut.2012.01.008.
Morey B, Walker R, Davenport A. More dietetic time, better outcome? A randomized prospective study investigating the effect of more dietetic time on phosphate control in end-stage kidney failure haemodialysis patients. Nephron Clin Pract 2008;109(3):c173-80. doi: 10.1159/000145462.
Akpele L, Bailey JL. Nutrition counselling impacts serum albumin levels J Ren Nutr 2004;14(3):143-148. doi: 10.1053/j.jrn.2004.04.003.
Hill NR, Fatoba ST, Oke JL, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One 2016;11(7):e0158765. doi: 10.1371/journal.pone.0158765.
Seck SM. Issues of renal replacement therapy in elders living low-income African countries. Nephrourol Mon 2012;4(4):648-9. doi: 10.5812/numonthly.7077.
Kargar Jahromi M, Javadpour S, Taheri L, Poorgholami F. Effect of nurse-led telephone follow ups (tele-nursing) on depression, anxiety and stress in hemodialysis patients. Glob J Health Sci 2015;8(3):168-73. doi: 10.5539/gjhs.v8n3p168.
Reza HM, Shuvo SD, Ahmad T. Assessing the prevalence of malnutrition in chronic kidney disease patients undergoing hemodialysis in Kushtia District, Bangladesh. Nutr. Food Sci. 2018;48(1):150-164. doi: 10.1108/nfs-05-2017-0103.
Bramania P, Ruggajo P, Bramania R, Mahmoud M, Furia F. Nutritional Status of Patients on Maintenance Hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania: A Cross-Sectional Study. J Nutr Metab 2021; Article ID 6672185:1-7. doi: 10.1155/2021/6672185.
Al-Rewashdeh YA, Al-Dmoor MH. Anthropometry and dietary assessment of males and females students at Mutah University. J Appl Sci 2010;10(9):759-65. doi: 10.3923/jas.2010.759.765
Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis 2008;52(1):128-36. doi: 10.1053/j.ajkd.2008.02.300.
Tsai MT, Liu HC, Huang TP. The impact of malnutritional status on survival in elderly hemodialysis patients. J Chin Med Assoc 2016;79(6):309-13. doi: 10.1016/j.jcma.2016.01.015.
Vasa H, Pendli A, Premalatha KS. A study on nutritional intake in the maintenance of hemodialysis patients. Int. J. Health. Sci 2019; 4 (2):128-132.
Cavdar M, Sahin H. Effect of nutritional education on serum potassium level in patients receiving hemodialysis. Prog.Nutr 2021;23(3): 1-9. doi: 10.23751/pn.v23i3.11302.
Mansour MA, Youssef HA, Salameh TN, Yaseen RW. Impact of education program on protein balance among hemodialysis patient. World J. Medical Sci 2014;11 (1):69 -77. doi: 10.5829/idosi.wjms.2014.11.1.83320.
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