SAT-109 ELABORATION OF A TEXTURE-MODIFIED FOOD DIDACTIC TOOL FOR PATIENTS WITH END-STAGE KIDNEY DISEASE UNDERGOING HEMODIALYSIS IN GUANAJUATO, MEXICO, WHO HAVE MISSING TEETH

Abstract

The role of an adequate food intake on the preservation of an optimal nutritional status in patients with chronic kidney disease (CKD) undergoing dialysis, has been well described and there is significant evidence sustaining that a poor nutritional status can be related to several diseases, such as protein energy wasting syndrome, sarcopenia, it has a strong association with increased risk of hospitalization, worse clinical outcomes and even mortality. In order to ensure an adequate nutritional status and considering oral feeding as the classic pathway, we found imperative the necessity to offer options to patients who have masticatory issues due to dental loss. CKD patients undergoing dialysis usually have multiple comorbidities like diabetes, hypertension, mineral and bone disorder, inflammation, malnutrition, protein energy wasting, uremia, etc., which combined with aging and poor hygiene could promote oral cavity problems as periodontitis, cavities, gum disease and dental loss. Dental loss affects nutritional status of CKD patients in dialysis by interfering with the right intake of nutritious food. While it is true that some patients usually modify the texture of their meals in order to make chewing easier, sometimes the resulting dishes contain higher amounts of liquids than those they should consume (e.g. soups and jelly), which makes controlling of daily liquid intake harder. Thus, we aimed to elaborate a texture-modified food didactic tool for patients with CKD under hemodialysis who have missing teeth. From previous evidence in clinical practice guidelines, systematic reviews and original papers about nutritional requirements, based on food-texture modifications useful for patients with dental issues or deglutition problems and given that some recommendations can be extrapolated for patients with masticatory problems, we elaborated a didactic tool for CKD under hemodialysis patients, with dental loss. Subsequently, pertinent adjustments for patients undergoing dialysis were made: adequate use of liquids, restriction on high sources of sodium, phosphorus and potassium, and the incorporation of protein supplements and specialized polymeric formulas. We elaborated a didactic tool, digital and printed version, where the food-texture modifications for CKD under hemodialysis patients are described: double cooking, dicing, mincing, shredding, grating, pureeing and shaking. An extra section was included, where we designed easy to chew preparations that incorporate protein supplements and specialized polymeric formulas. For each technique, we described the making process, lists of ingredients and foods that can be used, taking into account low sources of sodium, phosphorus and potassium, as well as products we recommend avoiding. We also developed suggestions based on the loss of dental pieces according to their masticatory function: incisives, canines, premolars, molars or a combination of them. As far as we know, this texture-modified food didactic tool is the first step to help chronic hemodialysis patients with missing teeth, to improve their intake using low sources of phosphorus, potassium and sodium and without using more liquids than those required, giving them supplemented easy to chew meals. The recommendations herein could be used for other dialysis therapies users and by healthcare providers.