THE IMPORTANCE OF NUTRITIONAL COUNSELING FOR HYPERPHOSPHATEMIA IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract

Aim: To assess the impact of dietetic intervention on the nutritional status and calcium–phosphorus metabolism in maintenance hemodialysis (MHD) patients. Material and methods: Six-month longitudinal intervention study of 162 MHD patients selected from one dialysis unit in Romania. They were divided into 4 groups according to serum albumin (SA) level and the comorbid condition of chronic liver disease (CLD). Clinical and biochemical parameters were measured at baseline and 6 months after PNC (personalized nutritional counseling). Nutritional status was assessed by mSGA (modified Subjective Global Assessment) and dietary calorie and protein intake by diet history with the help of 72 h recall method. Nutritional counselling and personalized diets were recommended by the dietician bimonthly for a period of 6 months only to groups I and III (groups with hypoalbuminemia). Results: Comparison of data collected prior PNC (T0) and 6 months after (T6) showed: phosphorus (P) level decreased significantly in all 4 groups: group I- T0 vs. T6 p=0.005, group II: T0 vs. T6 p= 0.002; group III: T0 vs. T6 p=0.001, and group IV T0 vs. T6 p=0.042; serum Ca followed a similar trend; serum parathyroid hormone (PTH) remained stationary; SA level was significantly improved in both nutrition counseling groups (group I: T0 vs. T6 p= 0.001, group III: T0 vs. T6 p=0.001, respectively). Conclusions: Our study suggests that dietetic intervention focused on phosphate and albumin control in MHD patients with hyperphosphatemia and hypoalbuminemia contributes to an improvement in important nutritional parameters and to a positive calcium-phosphorus balance.