The Association of Dietary Education with Short-Term Phosphate Control and Nutrition in Chronic Hemodialysis Patients: A Single-Center, Retrospective Cohort Study

En-Shuo Chang ； Chieh-Li Yen ； George Kuo

《Acta Nephrologica》 35卷2期 (2021/06) Pp. 91-104

https://doi.org/10.6221/AN.202106_35(2).0005

摘要

BACKGROUND: Persistent hyperphosphatemia is common and contributes to long-term adverse cardiovascular events in hemodialysis patients. Among the causes of hyperphosphatemia, non-adherence to dietary phosphate restriction is an important patient-related factor. This study retrospectively analyzed the result of a phosphate-specific dietary education program that aimed to improve hyperphosphatemia. METHODS: We retrospectively collected data from patients who participated in a multidisciplinary, phosphate-specific dietary education and patients who did not enroll in the program as control during June to August, 2019. Hemodialysis patients were enrolled into the education program if they have averaged phosphate levels higher than 6 mg/dL in the past 6 months. The education provides knowledge of phosphate binder equivalents, daily menus, and dietician's counseling. The serial lab data from baseline to the end of program was collected. The trend of changes was analyzed with a linear mixed model. RESULTS: Total 52 patients finished the dietary education, and in the same period, 71 patients with similar baseline phosphate were included as the control group. The patients were averaged 57 years old with a mean dialysis vintage of 8 years. Compared with baseline, the phosphate in the education group reduced after the first month of dietary education (P = 0.026). Compared to the control group, the albumin and calcium of the education group increased at the end of dietary education (P = 0.027 and 0.008, respectively). The proportion of patients with phosphate below 6 mg/dL increased from 23.1% at baseline to 38.5% at the end of education. The median parathyroid hormone (PTH) reduced and the knowledge, attitude, and practice score increased significantly after education. CONCLUSION: The study showed that a multidisciplinary, phosphate-specific dietary education was associated with short-term phosphate control, improvement of nutrition, and PTH level.

關鍵字

dietary education ； hemodialysis ； hyperparathyroidism ； hyperphosphatemia ； nutrition status