Diet quality in patients with end-stage kidney disease undergoing dialysis

Taking care of myself in a different and broken world: self-care practices of adolescents on dialysis

PURPOSE

Being on dialysis is a traumatic situation particularly during adolescence. Therefore, adolescents must have self-care support according to their special needs. The goal of this study was to describe the adolescents´ self-care practices when they are on dialysis. This paper reports only the adolescents´ selfcare practices based on the health care team guidelines but adjusted to their beliefs and habits.

METHODS

The methodology of the study was interpretive phenomenology. In-depth interviews were conducted with 15 adolescents; Smith´s IPA procedure was used for data analysis.

RESULTS

Being on dialysis meant to the adolescents living in a different and broken world. Self-care practices included: 1) coexisting with the dialysis slavery or being attached to a machine day or night, 2) struggling with the maddening thirst experience, 3) Deciding what, when and how much food to eat, 4) taking care of an alien that helps to survive, 5) taking the medicines when feeling in need of them.

CONCLUSION

The adolescents tried to care for themselves adjusting their care activities to the health team´s recommendations. However, they also adjusted those practices to their beliefs and habits, which allows them to live with dialysis in a less traumatic way.

Causal associations between polyunsaturated fatty acids and kidney function: A bidirectional Mendelian randomization study

BACKGROUND

PUFAs were suggested to be beneficial for kidney function in observational studies. However, whether these associations are causal remains unclear.

OBJECTIVES

This study explores the causality between PUFAs and chronic kidney disease (CKD) or estimated glomerular filtration rate (eGFR) using bidirectional 2-sample Mendelian randomization (MR).

METHODS

Single nucleotide polymorphisms associated with PUFAs and kidney function were obtained from the largest and most recent genome-wide association studies with sample sizes of 13,544, 13,506, 13,499, 13,527, and 13,549 for omega-3 fatty acids, omega-6 fatty acids, DHA, LA, and other PUFAs than 18:2 (otPUFA), and 480,698 and 1,201,909 for CKD and eGFR, respectively. MR inverse-variance weighted (IVW) and pleiotropy residual sum and outlier test (MR-PRESSO) were used for data analysis, supplemented with a weighted median estimator, MR-Egger regression, and multivariable MR, giving β or OR and their 95% CIs.

RESULTS

There was suggestive evidence that higher omega-6 fatty acids were associated with increased eGFR using MR-PRESSO [β: 0.005 log(mL/min/1.73 m²) per SD increase in omega-6 fatty acids; 95% CI: 0.002, 0.008; P = 0.008]. Higher LA level was also associated with higher eGFR [β: 0.005 log(mL/min/1.73 m²) per SD increase in LA; 95% CI: 0.003, 0.007; P = 0.0007] using MR-PRESSO. Neither association of the other PUFAs, i.e., omega-3 fatty acids, DHA, and otPUFA, with CKD or eGFR nor the association of CKD and eGFR with PUFAs was found. Similar results were found in sensitivity analyses.

CONCLUSIONS

Our results suggest that higher omega-6 fatty acids and LA may increase eGFR levels. Although the estimated effects were relatively small, the results provide public health and research relevance, indicating the need for further longitudinal cohorts or randomized controlled trials on omega-6 fatty acids in improving kidney function.

Gastrointestinal symptom burden and dietary intake in patients with chronic kidney disease

BACKGROUND

Gastrointestinal (GI) symptoms can present a significant burden to patients with chronic kidney disease (CKD) but the reported prevalence is inconsistent.

OBJECTIVE

To examine the GI burden and dietary intake in patients with CKD with or without dialysis.

METHODS

This was a cross-sectional study of 216 adults, recruited from outpatient and dialysis clinics, with CKD stage 4 or 5 not receiving dialysis (CKD-ND), or receiving haemodialysis (HD) or peritoneal dialysis (PD). Three questionnaires were administered: the Bristol Stool Form Scale (BSFS); a modified Gastrointestinal Symptom Rating Scale and a short Food Frequency Questionnaire. Outcomes were stool frequency and consistency, GI symptoms and dietary intake.

RESULTS

Data were collected from 216 patients (mean age, 63 years [95% CI: 61, 65]; 63% males; CKD-ND: n = 134; HD: n = 67; PD: n = 15). Mean stool frequency for all groups was one bowel action per day (p = .45) and consistency was normal (BSFS type 4, p = .95). Overall GI symptom burden was low but several symptoms occurred at least "most of the time" including "tiredness/lethargy" (54% of participants), "reduced appetite" (29%), "early satiety" (25%) and "change in taste" (15%). Low intakes of fresh fruit, vegetables, whole-grains and legumes were found. No associations were observed between diet and GI symptoms.

CONCLUSION

The overall GI symptom burden was low, but >15% of participants reported several symptoms as occurring most to all of the time. Low intakes of fresh fruit, vegetables, whole-grains and legumes were observed in all CKD patients.

Analyzing clinical characteristics of patients with different cumulative hemodialysis durations: a cross-sectional study

Background

The objective of this study was to examine the clinical characteristics of patients with different cumulative hemodialysis (HD) durations, so as to improve their survival rate.

Methods

In this cross-sectional study, we extracted background information and relevant clinical data from 145 patients who were undergoing maintenance HD three times a week at the Affiliated Hospital of Nantong University between January 1998 and January 2019. The study subjects were divided into four groups according to the duration of their HD: <5 years, 5–10 years, 10–15 years, and >15 years of HD. We collected the medical history and relevant clinical parameters for each subject, and measured the urea reduction ratio (URR), hemoglobin (Hb), serum calcium, phosphorus, parathyroid hormone (iPTH), and serum albumin (ALB) levels for each group.

Results

The average patient age was 52.06 ±  11.93 years old. The average patient age in the 10–15 years and >15 years groups was significantly lower than in the <5 years and 5–10 years groups (P = 0.002, P < 0.001, P = 0.012, and P = 0.0025, respectively). The most common cause of end-stage renal disease (ESRD) was chronic glomerulonephritis. We found no significant differences in URR, Hb, serum calcium, serum phosphorus, iPTH, and ALB levels.

Conclusion

A prolonged HD duration was related to a younger mean age at the start of HD treatment. The leading cause of ESRD was chronic glomerulonephritis. We predominantly found diabetic nephropathy in the group with a duration of <5 years cumulative HD. Most of the indexes related to hemodialysis almost satisfied the recommended values in these patients.

Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

Healthy Eating Index of Living Donor Renal Transplantation Recipients During the First Year Posttransplant

BACKGROUND

The aim of this study was to examine the relationship between diet quality and weight gain in kidney transplant recipients from pretransplant baseline through posttransplant at 3 months and 1 year.

METHODS

Data from a prospective, observational cohort study of kidney transplant patients (n = 26) were analyzed. Participants were adult (aged 18-65 years), living donor kidney transplant recipients who were participating in a prospective body composition study. Body weight, body mass index, dietary intake, and Healthy Eating Index scores were used to assess changes in weight, nutrient intake, and diet quality.

FINDINGS

At the time of kidney transplantation, 42% (n = 11) were obese and 27% (n = 7) were overweight. Weight significantly increased from transplantation to 12 months (mean [SD]: 83 [18] kg and 90 [18] kg, respectively; mean change 8.4%, P = .002). At 12 months posttransplant, dietary fat intake significantly increased (P = .033). Body weight was strongly correlated with total dietary fat intake (r = 0.56, P = .003). The Healthy Eating Index total scores at baseline and 1-year posttransplant were not significantly different (45.75 [14.99] and 42.59 [12.70]). Likewise, component scores did not change from pretransplant to posttransplant.

DISCUSSION

Diet quality of transplant recipients was poor both before and after transplantation. Using the Healthy Eating Index confirmed that improvements in food intake are needed. Further research is warranted to identify dietary recommendations for the prevention of excessive weight gain and the potential adverse health complications following kidney transplantation.

Nutritional Status and Dietary Management According to Hemodialysis Duration

As the incidence of chronic diseases such as diabetes and hypertension increases, complications such as decreased renal function are also increasing in many patients. Nutritional management in hemodialysis patients is a very important factor for prognosis and quality of life. The purpose of this study was to investigate the differences in nutritional status and dietary management according to hemodialysis duration. A total of 145 patients were divided into 4 groups according to hemodialysis duration: less 1 year (D1), 1–5 years (D2), and above 5 years (D3). The rates of protein-energy wasting were 31.1% in D1 group, 49.5% in D2 group, and 47.6% in D3 group. However, there was no significant difference between the 3 groups. Nutrient intake analysis showed that protein, iron, and vitamin C were significantly lower in the D3 group than in the D1 group. Protein intake in all 3 groups was insufficient compared to the recommended dietary amount for dialysis patients. The most difficult aspect in dietary management was cooking with low sodium. In the D3 group, which had the longest duration of dialysis, the practice of diet therapy and self-perceived need for nutrition education was lowest. Observations of nutritional status are necessary to maintain the health status of dialysis patients. In addition, education plans should be prepared to mediate the nutrient intakes and identify the patient's difficulties and provide practical help.

Blood Fatty Acid Status and Clinical Outcomes in Dialysis Patients: A Systematic Review

Blood fatty acids (FAs) are derived from endogenous and dietary routes. Metabolic abnormalities from kidney dysfunction, as well as cross-cultural dietary habits, may alter the FA profile of dialysis patients (DP), leading to detrimental clinical outcomes. Therefore, we aimed to (i) summarize FA status of DP from different countries, (ii) compare blood FA composition between healthy controls and DP, and (iii) evaluate FA profile and clinical endpoints in DP. Fifty-three articles from 1980 onwards, reporting FA profile in hemodialysis and peritoneal DP, were identified from PubMed, Embase, and the Cochrane library. Studies on pediatric, predialysis chronic kidney disease, acute kidney injury, and transplant patients were excluded. Moderate to high levels of n-3 polyunsaturated fatty acids (PUFA) were reported in Japan, Korea, Denmark, and Sweden. Compared to healthy adults, DP had lower proportions of n-3 and n-6 PUFA, but higher proportion of monounsaturated fatty acids. Two studies reported inverse associations between n-3 PUFAs and risks of sudden cardiac death, while one reported eicosapentaenoic acid + docosahexaenoic acid)/arachidonic acid ratio was inversely associated with cardiovascular events. The relationship between all-cause mortality and blood FA composition in DP remained inconclusive. The current evidence highlights a critical role for essential FA in nutritional management of DP.

An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease

BACKGROUND

Dietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD.

METHODS

The Web of Science and Scopus databases were searched using the search terms 'adherence' and 'end stage kidney disease'. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence.

RESULTS

Most of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence.

CONCLUSION

Dietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.