Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study

Nutrient intake in adult haemodialysis patients and influence of dialysis treatment day and patient age

AIM

This study aimed to evaluate the variation in food intake during dialysis and non-dialysis days and to assess the nutritional status of elderly haemodialysis patients.

METHODS

An observational multicentre cross-sectional study was conducted. A total of 311 patients aged ≥18 years were recruited. Multiple 24-h recalls were collected, appetite levels were assessed through self-reporting, and biochemical and anthropometric data were obtained. Data were collected via a face-to-face interview during haemodialysis sessions at four major dialysis centres.

RESULTS

The findings of this study revealed higher consumption of sodium (2570.25 ± 74.15 vs. 2106.25 ± 77.39, p-value < 0.001) and potassium (1456.59 ± 47.42 vs. 1137.41 ± 35.40, p-value < 0.001) on dialysis days compared to non-dialysis days. Superior appetite levels were significantly associated with higher protein and energy intake and better serum albumin levels on days with versus without dialysis. Patients who reported a better understanding of the importance of their dietary recommendations had lower consumption of sodium, phosphorus, and potassium. Further, patients aged ≥60 years had significantly lower albumin levels and consumed considerably lower levels of protein and sodium but had higher body mass index and waist circumference compared to young patients.

CONCLUSIONS

Dialysis treatment schedules could affect nutrient intake and compliance rates with renal guidelines; thus, nutritional education must be performed individually to eliminate barriers to adherence. Elderly haemodialysis patients might be prone to a high risk of nutritional deficiencies and require special continuous and in-depth dietary provisions.

Nutritional Intake and Diet Quality in Hemodialysis Patients: Scope for Improvement

OBJECTIVE

Hemodialysis (HD) patients face challenges in upholding dietary compliance. This study aimed to compare dietary intake against disease-specific guidelines. Secondary, to assess the overall diet quality and to explore the association between dietary potassium intake and serum potassium concentrations.

METHODS

In this cross-sectional multicenter study, nutrient intake of Dutch adult HD patients was assessed using food frequency questionnaires and diet quality with the Dutch Healthy Diet 15-index. Intake and diet quality were compared to disease-specific dietary recommendations or Dutch Dietary Guidelines. Insufficient intake was defined as <90% of the requirement, sufficient as 90-100%, and excessive as >110%. The association between serum potassium concentration and dietary potassium intake was modeled with linear regression analysis.

RESULTS

The study population consisted of 248 participants (60% male) from 21 dialysis centers. Energy intake (1789 [872] kcal/day) was insufficient for 45% of the participants, while protein intake (1 [0.5] g/kg/d) was insufficient for 50%. Despite 67% of participants managing to align their energy intake below 110% of the recommended level, a high prevalence of overweight (61%) was observed in this cohort. Saturated fat intake was excessive for 87% of participants, while only 15% met the recommended fiber intake. Overall diet quality was low (74 [20] maximum score of 150). No association was observed between serum potassium and dietary potassium intake after adjusting for relevant confounders (r = 0.163, P = .261).

CONCLUSIONS

A considerable proportion of Dutch HD patients were unable to meet disease-specific dietary guidelines. Diet quality was shown to be poor.

GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment

Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.

Effects of Nutritional Protocol Changes on Hemodialysis Adequacy and Patient Health During the COVID-19 Pandemic

BACKGROUND During the COVID-19 pandemic, strict feeding restrictions were implemented in many dialysis centers to minimize transmission between patients. This study aims to evaluate the effects of these feeding restrictions on dry weight, intradialytic hypotension (IDH), and dialysis adequacy in hemodialysis patients. MATERIAL AND METHODS In this retrospective single-center study involving 76 hemodialysis patients, data from 2 consecutive 6-month periods were analyzed: the first before the COVID-19 pandemic when intradialytic nutrition was supported, and the second during the pandemic when intradialytic nutrition was restricted. Data from the patients' monthly visits during both periods were evaluated, averages were recorded, and a comparison was made between the 2 periods. RESULTS The frequency of IDH was significantly higher during the feeding period compared with the no-feeding period (1.4±1.2/month vs 0.81±0.86/month, P=0.01). Conversely, the urea reduction ratio was greater in the no-feeding period [72.5% (69-76) vs 71% (68-75), P=0.01], as were the single-pool Kt/V values (1.59±0.23 vs 1.52±0.26, P=0.004) and ultrafiltration rates (mL/h/kg) (11.4±3.0 vs 10.4±3.2, P=0.01). However, the dry weight of the patients was similar in the 2 periods (65.4±13.7 kg vs 65.7±14.2 kg, P=0.62). CONCLUSIONS During the COVID-19 pandemic, mandatory feeding restrictions for hemodialysis patients, aimed at reducing transmission, were linked to a decrease in IDH frequency and improved dialysis adequacy. However, no significant reduction in patients' dry weights was observed.

Questionnaire survey of the frequency of dietary intake during hemodialysis and the impact of COVID-19 in Japan

BACKGROUND

There have been no coherent reports on the effects of dietary intake during hemodialysis in Japan. Furthermore, few studies have reported the impact of the COVID-19 pandemic on them. This study aimed to investigate dietary intake during hemodialysis and its impact on the spread of COVID-19.

METHODS

This consecutive cross-sectional study included a survey of all hemodialysis facilities in the Niigata Prefecture. The survey form was sent via e-mail or fax.

RESULTS

Fifty four facilities (98%) responded to the 2018 survey. Twenty-eight facilities (52%) provided meals, with 18% of all patients undergoing dialysis and 41% of patients undergoing nocturnal dialysis consuming meals during hemodialysis. In the 2020 survey, the number of facilities decreased to 17 (33%), and the number of all patients undergoing dialysis and nocturnal dialysis consuming meals decreased to 13% and 32%, respectively. In the 2022 survey, the number of facilities decreased to 14 (27%), and the number of all patients undergoing dialysis and nocturnal dialysis decreased to 9% and 19%, respectively.

CONCLUSION

The COVID-19 pandemic has caused a decrease in both facilities serving meals and patients' food consumption during hemodialysis. To prevent the loss of meal opportunities, establishing safe methods for food intake and alternatives in hemodialysis facilities is necessary.