Understanding Barriers to Implementing and Managing Therapeutic Diets for People Living with Chronic Kidney Disease in Remote Indigenous Communities

Examining the Relationship between Dietary Intake, Socioeconomic Status, and Systolic Blood Pressure of Adults on Hemodialysis in Quito, Ecuador

Background

In Ecuador, the number of adults on hemodialysis (HD) continues to rise. Currently, the effect dietary habits and socioeconomic status (SES) have on blood pressure is not known for those on HD.

Objectives

The objectives of this study focused on adults on HD in Quito, Ecuador to 1) assess the relationship between dietary intake and SES; 2) compare dietary intake to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines; and 3) explore the relationship between dietary intake and systolic blood pressure.

Methods

This cross-sectional study was conducted at the dialysis center within Eugenio Espejo Specialties Hospital in Quito, Ecuador between May and June 2022 among 50 adults on HD. Three 24-h recalls were used to determine average dietary intake and the 25-item Instituto Nacional de Estadística y Censos-Stratification of SES was used to determine SES. Electrolytes and 2 blood pressure readings were collected. Qualitative narrative data analysis was performed to identify themes using NVivo v12. T-tests of independence, simple, and multiple linear regressions using age and sex as confounders were conducted using R and a P < 0.05 was deemed as statistically significant.

Results

On an average, 76% of participants consumed <25 kcal/kg body weight energy and 64% consumed <1 g protein/kg body weight. Participants consumed less energy and protein compared with the KDOQI guidelines (P < 0.05). Positive relationships were observed with potassium and blood pressure (β = 0.020, P < 0.05) and SES with energy, protein, and phosphorus (P < 0.05). Themes that were identified as contributing to dietary intake were limited knowledge, lack of consistency with dietary information, and limited appetite.

Conclusions

Findings from this study indicate that the focus should be on improving energy and protein intake for this population.

Impact of SARS-CoV-2 Pandemic on food Security in Patients With chronic Kidney Disease

OBJECTIVE

The present study aims to determine the degree of Food Insecurity (FI) in adult patients with CKD during the COVID-19 pandemic, as well as the association between FI and food consumption.

METHODS

A cross-sectional study was conducted on patients with chronic kidney disease (CKD), with and without substitutive treatment, and older than 18 years of age. Food security was measured using the Mexican Food Security Scale (MFSS). Sociodemographic data and a food frequency questionnaire were obtained. Multinomial logistic regression was performed using the 4 categories of food security (food security as reference); principal component analysis was also performed to assess the relationship between food consumption patterns and sociodemographic characteristics.

RESULTS

The prevalence of FI in patients with CKD was 71.6%, the most prevalent degree of FI was moderate. As FI increased, a greater amount of beans, eggs, sweets/desserts, soft drinks, and artificial juices (P < .001) was consumed. The risk factors of FI were diabetes, hypertension, unpaid occupation, living in the country's capital, having children at home, or a decrease in income due to the pandemic. Four main components were identified that were associated with the different degrees of FI.

CONCLUSION

The present study allowed us to conclude that more than 70% of CKD patients in the study cohort had some type of FI, which makes it difficult to adhere to treatment and may increase the risk of advanced CKD. A less healthy food pattern is associated with greater FI.