Acta Scientific Nutritional Health (ASNH)(ISSN: 2582-1423)

Research Article Volume 7 Issue 8

Effect of Individualized Dietary Counseling Improve Hyperphosphatemia among Hemodialysis Patients

Suhair Abdalla Khalil Abdallah*

College of Applied Medical Sciences, Department of Clinical Nutrition, King Saud University for Health Sciences Jeddah, Saudi Arabia

*Corresponding Author: Suhair Abdalla Khalil Abdallah, College of Applied Medical Sciences, Department of Clinical Nutrition, King Saud University for Health Sciences Jeddah, Saudi Arabia.

Received: June 14, 2023; Published: July 08, 2023

Abstract

Rationale: Hyperphosphatemia is a significant health problem in end-stage renal disease (ESRD) patients on hemodialysis (HD). It can lead to cardiovascular, bone, and other disorders, as well as secondary hyperparathyroidism, and is also associated with an increased prevalence of mortality in HD patients. The aim of the present study was to evaluate the effect of nutrition counseling and dietetic intervention on hyperphosphatemia management.

Methods: The study was organized at big dialysis centers in Khartoum for six months. ESRD patients (n = 145) on regular HD (three times weekly for the duration of three hours each session), dialyzed for at least 3 months, were included in the study. They were divided into a test group (n = 83) and a control group (n = 62). All participants (in both the test and control groups) were similar in everything, including their dialysis time and durations. In the same age group, all were adults above 18 years old, following the same medications with specific doses as prescribed and followed by their physician (erythropoietin intravenous injection, iron, active vitamin D, phosphorus binders, B-complex vitamins, folic acid, and vitamin E). and only differ in their dietary regimens. The test group received nutritional counseling and consumed individualized diets (restricted in phosphate intake) for a period of 6 months. The study was organized at big dialysis centers in Khartoum for six months. ESRD patients (n = 145) on regular HD (three times weekly for the duration of three hours each session), dialyzed for at least 3 months, were included in the study. They were divided into a test group (n = 83) and a control group (n = 62). All participants (in both the test and control groups) were similar in everything, including their dialysis times and durations. In the same age group, all were adults above 18 years old, following the same medications with specific doses as prescribed and followed by their physician (erythropoietin intravenous injection, iron, active vitamin D, phosphorus binders, B-complex vitamins, folic acid, and vitamin E). and only differ in their dietary regimens. The test group received nutritional counseling and consumed individualized diets (restricted in phosphate intake) for a period of 6 months. The control group consumed the usual diet. Serum phosphorus levels were measured at baseline and 2, 4, and 6 months after the start of the study.

Results: Serum phosphorus levels decreased significantly from 5.6 mg/dL to at baseline 4.8, 4.2 and 3.8 mg/dL 2, 4, and 6 months after the onset of the study in the test group. In the control group, the decrease was mild and insignificant (5.0, 5.0, 4.7, and 4.3 mg/dL at baseline, 2, 4, and 6 months). Significant differences between groups were apparent in months 4 and 6 (p < 0.05).

Conclusions: The study demonstrated that effective nutritional counseling was effective in controlling and improving serum phosphorus levels among HD patients. Therefore, nutritional counseling by qualified dietitians should be mandatory in renal units as part of the medical therapy management to reduce the incidence of hyperphosphatemia in HD.

Keywords: Serum Phosphorus; Hemodialysis; Hyperphosphatemia; Dietary Counseling

References

  1. “KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease”. American Journal of Kidney Diseases 42 (2003): S7-S169.v
  2. Covic A., et al. “Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality, and cardiovascular events in chronic kidney disease”. Nephrology Dialysis Transplantation 24 (2009): 1506-1523.
  3. Leaf DE and Wolf M. “A physiologic-based approach to the evaluation of a patient with hyperphosphatemia”. American Journal of Kidney Diseases 2 (2013): 330-336.
  4. Covic A., et al. “Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality, cardiovascular mortality and cardiovascular events in chronic kidney disease”. Nephrology Dialysis Transplantation 5 (2009): 1506-1523.
  5. Kalantar-Zadeh K., et al. “Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients”. Kidney International 4 (2006): 771-780.
  6. Shaw-Stuart NJ and Stuart A. “The effect of an educational patient compliance program on serum phosphate levels in patients receiving hemodialysis”. Journal of Renal Nutrition 10 (2000): 80-84.
  1. NATIONAL KIDNEY FOUNDATION. “K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease”. American Journal of Kidney Diseases 42 (2003): S1-S201.
  2. T Alp Ikizler., et al. “KDOQI clinical practice guideline for nutrition in CKD: 2020 update”. AJKD 76.3-1 (2020): S78.
  1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group: KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)”. Kidney International 113 (2009): S1-130.
  2. Byham-Gray L., et al. “A clinical guide to nutrition care in kidney disease”. 2nd American Dietetic Association. Academy of Nutrition and Dietetics (2013).
  3. Burtis CA and Ashwood ER. “Tietz Textbook of clinical chemistry and Molecular Diagnostics, 4th St Louis, MO;Elsevier Inc (2001).
  4. Kang S., et al. “Nutritional status predicts 10-year mortality in patients with end-stage renal disease on hemodialysis”. Nutrients4 (2017): 399.
  5. Biruete A., et al. “Modified nutritional recommendations to improve dietary patterns and outcomes in hemodialysis patients”. Journal of Renal Nutrition 1 (2017): 62-70.
  6. Block GA., et al. “Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: A national study”. American Journal of Kidney Diseases 31 (1998): 607-617.
  7. Kang S., et al. “Nutritional status predicts 10-year mortality in patients with end-stage renal disease on hemodialysis”. Nutrients4 (2017): 399.
  8. Isakova T., et al. “Effects of dietary phosphate restriction and phosphate binders on FGF23 levels in CKD”. Clinical Journal of the American Society of Nephrology 6 (2013): 1009-1018.
  9. Nelms M., et al. “Nutrition Therapy and Pathophysiology, 3rd Edition (2016).
  10. Shinaberger CS., et al. “Nutritional status, dietary intake, and body composition. Is controlling phosphorus by decreasing dietary protein intake beneficial or harmful in persons with chronic kidney disease?” American Journal of Clinical Nutrition 6 (2008): 1511-1518.
  11. Kopple JD. “National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure”. American Journal of Kidney Diseases 2 (2001): S66-S70.
  12. Sanlier N and Demircioğlu Y. “Correlation of Dietary Intakes and Biochemical Determinates of Nutrition in Hemodialysis Patients”. Renal Failure 29 (2007): 213-218.
  13. Yusuf AA., et al. “Serum potassium levels and mortality in hemodialysis patients: a retrospective cohort study”. American Journal of Nephrology 44 (2016): 179-186.
  1. Abdel-Hafiz AM. “Adequacy of Hemodialysis among End Stage Renal Disease Patients at Al-Watani Hospital”. Master thesis in Public Health Science. An-Najah National University Faculty of Graduate Studies. Nablus, Palestine (2006).
  1. Zammrawi FY., et al. “The severity and causes of malnutrition among hemodialysis patients in Sudan”. Journal of Renal Nutrition3 (2008).
  1. Abu-Al Makarem ZS. “Nutritional status assessment of the hemodialysis patients in Riyadh-Al-Kharj Hospital”. 2004. Master thesis in clinical nutrition in the department of community health sciences at the college of applied medical sciences, King Saud University, Kingdom of Saudi Arabia (2004).
  1. Sanlier N and Demircioğlu Y. “Correlation of Dietary Intakes and Biochemical Determinates of Nutrition in Hemodialysis Patients”. Renal Failure 29 (2007): 213-218.

Citation

Citation: Suhair Abdalla Khalil Abdallah., et al. “Effect of Individualized Dietary Counseling Improve Hyperphosphatemia among Hemodialysis Patients".Acta Scientific Nutritional Health 7.8 (2023): 40-45.

Copyright

Copyright: © 2023 Suhair Abdalla Khalil Abdallah., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.316

Indexed In





News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is April 30th, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue".
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US