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Karupaiah T, Mat Daud ZA, Khosla P, Khor BH, Sahathevan S, Kaur D, Tallman DA, Rashid HU, Rahman T, Saxena A, Gulati S, Sengupta P, Susetyowati S. Identifying Challenges and Potential Solutions for Sustainable Kidney Nutrition Care Delivery in Selected Asian Countries. J Ren Nutr 2023; 33:S73-S79. [PMID: 37597574 DOI: 10.1053/j.jrn.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries. OBJECTIVE This paper narrates ground experiences gained through the Palm Tocotrienols in Chronic Hemodialysis (PaTCH) project on kidney nutrition care scenarios and some Asian low-to-middle-income countries namely Bangladesh, India, and Malaysia. METHOD Core PaTCH investigators from 3 universities (USA and Malaysia) were supported by their postgraduate students (n = 17) with capacity skills in kidney nutrition care methodology and processes. This core team, in turn, built capacity for partnering hospitals as countries differed in their ability to deliver dietitian-related activities for dialysis patients. RESULTS We performed a structural component analyses of PaTCH affiliated and nonaffiliated (Myanmar and Indonesia) countries to identify challenges to kidney nutrition care. Deficits in patient-centered care, empowerment processes and moderating factors to nutrition care optimization characterized country comparisons. Underscoring these factors were some countries lacked trained dietitians whilst for others generalist dietitians or nonclinical nutritionists were providing patient care. Resolution of some challenges in low-to-middle-income countries through coalition networking to facilitate interprofessional collaboration and task sharing is described. CONCLUSIONS We perceive interprofessional collaboration is the way forward to fill gaps in essential dietitian services and regional-based institutional coalitions will facilitate culture-sensitive capacity in building skills. For the long-term an advanced renal nutrition course such as the Global Renal Internet Course for Dietitians is vital to facilitate sustainable kidney nutrition care.
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Affiliation(s)
- Tilakavati Karupaiah
- Food Security and Nutrition Impact Lab, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia.
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Sharmela Sahathevan
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Kampar, Malaysia
| | - Deepinder Kaur
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan
| | - Dina A Tallman
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan
| | - Harun-Ur Rashid
- Kidney Foundation Hospital and Research Institute Bangladesh, Dhaka, Bangladesh
| | - Tanjina Rahman
- Institute of Food Science and Nutrition, University of Dhaka, Dhaka, Bangladesh
| | - Anita Saxena
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Teong LF, Khor BH, Radion Purba K, Gafor AHA, Goh BL, Bee BC, Yahya R, Bavanandan S, Ng HM, Sahathevan S, Narayanan SS, Daud ZAM, Khosla P, Karupaiah T. A Mobile App for Triangulating Strategies in Phosphate Education Targeting Patients with Chronic Kidney Disease in Malaysia: Development, Validation, and Patient Acceptance. Healthcare (Basel) 2022; 10:535. [PMID: 35327013 PMCID: PMC8950478 DOI: 10.3390/healthcare10030535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Hyperphosphatemia afflicts end-stage chronic kidney disease (CKD) patients, contributing to comorbidities and mortality. Management strategies are dialysis, phosphate binder, and limiting dietary phosphate intake, but treatment barriers are poor patient compliance and low health literacy arising from low self-efficacy and lack of educational resources. This study describes developing and validating a phosphate mobile application (PMA). The PMA development based on the seven-stage Precaution Adoption Process Model prioritized titrating dietary phosphate intake with phosphate binder dose supported by educational videography. Experts (n = 13) first evaluated the PMA for knowledge-based accuracy, mobile heuristics, and clinical value. Adult HD patients validated the improved PMA using the seven-point mHealth App Usability Questionnaire (MAUQ). Patient feedback (n = 139) indicated agreement for ease of use (69.2%), interface and satisfaction (69.0%), and usefulness (70.1%), while 72.7% said they would recommend this PMA. The expectation confirmation for 25 PMA features ranged from 92.1% (lifestyle) up to 100.0% (language option); and the utilization rate of each feature varied from 21.6% (goal setting and feature-based log) to 91.4% (information on dietary phosphate and phosphate binder). The Conclusions: MyKidneyDiet-Phosphate Tracker PMA was acceptable to adult Malaysian HD patients as part of clinical phosphate management in low-resource settings.
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Affiliation(s)
- Lee-Fang Teong
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia; (L.-F.T.); (S.S.N.)
- Department of Dietetics and Food Service, Selayang Hospital, Batu Caves 68100, Malaysia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia;
| | - Kristo Radion Purba
- School of Computer Science, University of Southampton Malaysia, Iskandar Puteri 79100, Malaysia;
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur 56000, Malaysia;
| | - Bak-Leong Goh
- Clinical Research Center, Serdang Hospital, Kajang 43000, Malaysia;
| | - Boon-Cheak Bee
- Department of Nephrology, Selayang Hospital, Lebuh Raya Selayang-Kepong, Batu Caves 68100, Malaysia;
| | - Rosnawati Yahya
- Department of Nephrology, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur 53000, Malaysia; (R.Y.); (S.B.)
| | - Sunita Bavanandan
- Department of Nephrology, Kuala Lumpur Hospital, Jalan Pahang, Kuala Lumpur 53000, Malaysia; (R.Y.); (S.B.)
| | - Hi-Ming Ng
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
- Department of Dietetics & Nutrition Services, Sunway Medical Center, Petaling Jaya 47500, Malaysia
| | - Sharmela Sahathevan
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia;
| | - Sreelakshmi Sankara Narayanan
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia; (L.-F.T.); (S.S.N.)
| | - Zulfitri Azuan Mat Daud
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia;
| | - Pramod Khosla
- Department of Nutrition & Food Sciences, College of Liberal Arts & Sciences, Wayne State University, Detroit, MI 48202, USA;
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia; (L.-F.T.); (S.S.N.)
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Sualeheen A, Khor BH, Balasubramaniam GV, Sahathevan S, Chinna K, Mat Daud ZA, Khosla P, Abdul Gafor AH, Karupaiah T. Benchmarking Diet Quality to Assess Nutritional Risk in Hemodialysis Patients: Applying Adequacy and Moderation Metrics of the Hemodialysis-Healthy Eating Index. J Ren Nutr 2022; 32:726-738. [PMID: 35182714 DOI: 10.1053/j.jrn.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study modified Healthy Eating Index (HEI) based on hemodialysis (HD) specific guidelines and investigated associations between the diet quality (DQ) and nutritional risk in HD patients. METHODS The HD-HEI tool adapted the XXX Dietary Guidelines 2010 framework according to HD-specific nutrition guidelines. This HD-HEI was applied to 3-day dietary records of 382 HD patients. Relationships between HD-HEI scores and nutritional parameters were tested by partial correlations. Binary logistic regression models adjusted with confounders were used to determine adjusted odds ratio (adjOR) with 95% confidence interval (CI) for nutritional risk based on HD-HEI scores categorization. RESULTS The total HD-HEI score (51.3 ± 10.2) for this study population was affected by ethnicity (Ptrend<0.001) and sex (P=0.003). No patient achieved "good" DQ (score: 81-100), while DQ of 54.5% patients were classified as "needs improvement" (score: 51-80) and remaining as "poor" (score: 0-51). Total HD-HEI scores were positively associated with dietary energy intake (DEI) and dietary protein intakes (DPI), dry weight and handgrip strength, but inversely associated with Dietary Monotony Index (DMI) (all P<0.05). Individually, scores for refined grain, total protein, and animal protein were positively associated with DEI (all P< 0.05), whilst total, animal, fish and vegetable proteins indicated positive associations with DPI (all P< 0.05). Moderating metrics for convenience meals, saturated fats, sodium, and fluid negatively correlated towards DEI with similar trends for DPI excepting convenience meals and fluids. "Poor" DQ was associated with DMI ≥ 29.2 (adjOR: 18.83, 95% CI: 9.36-37.86, P<0.001), Malnutrition Inflammation Score (MIS) ≥ 5 (adjOR: 1.78, 95% CI: 1.01-3.15, P=0.045), and Protein Energy Wasting (PEW) (adjOR: 1.96, 95% CI: 1.14-3.34, P=0.031), but became nullified with covariate adjustments. "Poor" DQ was also associated with low lean tissue mass (< 32.6 kg) in men (adjOR: 2.38, 95% CI: 1.01-5.58, P=0.046) but not women. CONCLUSIONS "Poor" DQ was associated with poor nutritional status in XXX HD patients, who should be targeted for nutritional counselling.
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Affiliation(s)
- Ayesha Sualeheen
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, 88400, Kota Kinabalu, Malaysia
| | | | - Sharmela Sahathevan
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor 47500, Malaysia
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, 56000, Kuala Lumpur, Malaysia
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health & Medical Science, Taylor's University Lakeside Campus, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
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