The effects of adapted renal dietary guidelines on adherence in hemodialysis patients

Date
2021-03
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Background: Renal dysfunction and chronic kidney disease (CKD) is known to affect as much as 10% of the population worldwide.1 The annual mortality rate of hemodialysis patients is as high as 20%, with poor nutritional status being one of the biggest influencers of poor outcomes.2 There is currently an increased awareness of the importance of optimal nutrition and early intervention to address malnutrition.3 Despite the known advantages of nutritional intervention for dialysis patients, the CKD diet remains one of the most complex therapies to teach, understand and moreover, adhere to. Better adherence may be achieved by adapting and simplifying the dialysis patient’s dietary prescription.4 This study assessed whether simplifying the current renal dietary guidelines would have a positive effect in terms of patient adherence to the dietary guidelines and improve nutritional status. Methods: A Quasi-experimental study including 75 hemodialysis patients from 4 dialysis units in Pretoria, South Africa. Adult hemodialysis patients undergoing dialysis 3 times per week between the ages of 18–70 years were included. Each participant’s nutritional status was determined using anthropometrical measurements (body mass index (BMI)), waist circumference, triceps skinfold, mid-upper arm circumference (arm muscle area (AMA)) and biochemical parameters. Dietary intake was determined using a food frequency questionnaire (FFQ). Statistical tests were performed to analyse the stated objectives. Results: Seventy-five participants were enrolled^ 42 participants in the intervention group and 33 in the control group. The mean age of the population was 55 years (± 10.90). Fifty-five of the participants (73%) have been on dialysis for longer than 2 years. In terms of gender, 52 (69.33%) of the study population were male and 23 (30.67%) female. The majority of participants were well educated with a high household income. The most prevalent chronic illness reported was hypertension in 66 (88%) of the participants. The average BMI of the population at baseline was 26.6kg/(m²) (± 5.40) with 42 (56%) participants being overweight or obese. The majority of participants, 52 (69.33%), presented with an average AMA. The average protein intake of the group was within the recommendation at 1g/kg/day. The population showed a high intake of saturated fats and refined sugar. The average fiber intake was 20.68g/day (±10.86), which is lower than the recommendation of 25g/day. An improvement in adherence to the renal dietary guidelines was seen in all aspects in both the intervention and the control group. After the intervention, the total adherence for the population improved by 15%, although adherence remained poor in terms of fruit, vegetables and fiber intake. When comparing the improvement in adherence to the renal dietary guidelines between groups, no statistically significant difference was found between the traditional vs simplified guidelines (p = 0.341). Conclusion: Both the control and the intervention group received in-depth dietary education which might explain an equal improvement in terms of adherence. Given the high prevalence of overweight and obesity in end-stage renal disease, the management thereof should form an integral part of the nutritional intervention. Further intervention should focus on weight loss and increasing fruit, vegetable and fiber intake.
AFRIKAANSE OPSOMMING: Agtergrond: Renale disfunksie en kroniese nierversaking affekteer 10% van die populasie wereldwyd. Die jaarlikse sterftesyfer onder hemodialise pasiente is 20%, met voedingstatus as een van die grootste rolspelers in terme van ongewenste uitkomste. Daar is tans ’n toename in bewustheid rakende die invloed van optimale voedingstatus en vroee intervensie om wanvoeding aan te spreek. Ten spyte van die voordele geassosieer met voedingsintervensie vir dialisepasiente, bly die dieet vir kroniese nierversaking moeilik om te verstaan, oor te dra en by te hou. Vereenvoudiging en aanpassing van die dialisepasient se dieetvoorskrifte mag dalk lei tot beter nakoming. Hierdie studie is gedoen om vas te stel of die vereenvoudiging van die renaledieetriglyne ’n positiewe effek sal he op sowel die nakoming van die dieetriglyne as die voedingstatus van pasiente. Metode: Die kwasi-eksperimentele studie het altesaam 75 pasiente van 4 dialise eenhede in Pretoria, Gauteng Provinsie, Suid-Afrika ingesluit. Volwassenes tussen die ouderdom van 18–70 jaar wat 3 maal per week dialise ondergaan is ingesluit. Elke pasient se voedingstatus is met behulp van sowel antropometriese metings (liggaamsmassa-index (LMI), middelomtrek, triseps-velvou en bo-arm omtrek (armspieromtrek)) as biochemiese parameters bepaal. Dieetinname is bepaal deur die gebruik van ’n voedsel frekwensie vraelys (VFV). Statistiese toetse is gedoen om bepaalde uitkomste te toets. Resultate: Vyf-en-sewentig pasiente het deelgeneem aan die studie^ 42 as deel van die intervensiegroep en 33 in die kontrolegroep. Die gemiddelde ouderdom was 55 jaar (± 10.90). Vyf-en-vyftig (73%) van die pasiente ondergaan al vir langer as 2 jaar dialise. Die deelnemers was oorwegend manlik, 52 (69.33%), en 23 (30.67%) was vroulik. Meeste van die deelnemers was geleerd met ’n hoe maandelikse huishoudelike inkomste. Die gemiddelde LMI van die studiepopulasie was 26.6kg/(m²) (± 5.40) en 42 (56%) pasiente is geklassifiseer as oorgewig of vetsugtig. Die armspieromtrek van 52 (69.33%) deelnemers was gemiddeld. Die gemiddelde proteieninname van die groep was voldoende teen 1g/kg/dag. Die populasie se inname van versadigde vette en suiker was egter hoog. Veselinname was onvoldoende teen 20.68g/dag (±10.86). ’n Verbetering is gesien in terme van die nakoming van die dieetriglyne by beide groepe. Die totale nakoming vir die populasie as ’n geheel het verbeter met 15%, alhoewel inname van groente, vrugte en vessel steeds swak was. Daar was geen statisties beduidende verskil tussen die 2 groepe in terme van ’n verbetering in die nakoming van die dieetriglyne nie (p = 0.341). Gevolgtrekking: Sowel die kontrole- as die intervensiegroep het diepgaande dieetvoorligting ontvang. Dit mag dalk die rede wees waarom die groepe soortgelyke verbeteringe getoon het in terme van nakoming. Gegewe die hoe prevalensie van vetsug in eindfase-nierversaking moet gewigsbeheer aangespreek word tydens dieetvoorligting. So ook die inname van vrugte, groente en vesel.
Description
Thesis (MNutr)--Stellenbosch University, 2021.
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